Daily Column

April 9, 2008 By

DEAR DR. GOTT:
I am an 82-year-old woman. I have a very puzzling problem.
Since June 2007, I have had a small amount of drainage from my right breast. I saw a breast surgeon who took a sample and ordered a blood analysis. I was told unless there was blood in the fluid, there was only about a ten percent chance that the drainage was caused by cancer.

I have a strong family history of cancer so the specialist suggested I have a biopsy. He said it would be a painful process. He also gave me the option of wait-and-see.

I have not done anything yet but wonder if I should. The surgeon told me he thought the drainage was from a milk duct abnormality. What is your opinion?

DEAR READER:
Any breast drainage is a red flag warning of possible cancer. Your breast surgeon is, in my view, somewhat correct that a biopsy is an appropriate step, however I suggest you first explore non-invasive techniques, such as mammogram and breast ultrasound. In this way, the surgeon would be able to visualize the mammary glands (milk ducts) as well as the rest of the breast. These procedures should show any abnormalities.

I would just like to mention that I am unsure how your breast surgeon would know where to do a biopsy unless he has already done imaging studies. This would be like throwing a dart at a target but only knowing what wall the target is on. Chances are, if something is present, it would be missed.

Because you have a strong family history of cancer, the drainage is persistent and you have delayed for nearly a year, I urge you to have the imaging studies. Further testing and possible treatment can then be based on those findings. Don’t delay any longer. Breast cancer can be cured if caught in the early stages. There is always a likely chance that the drainage is benign but without evaluation, there is no way to tell.

To give you related information, I am sending you a copy of my Health Report “Breast Cancer and Disorders”. Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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Daily Column

April 7, 2008 By

DEAR DR. GOTT:
I’m 73 years old and have been told by two doctors (after having two lung X-rays one month apart) that I have a small spot on my lung. The last doctor said it is probably scar tissue. I have never smoked, had pneumonia or any other disease or illness that might have caused this. The doctors just attribute it to age. The latest advice was to wait six months and have another X-ray to see if the spot has enlarged.

Can you shed any light on this? Do you think it’s advisable to wait six months or should I go to a pulmonary doctor?

DEAR READER:
I advise you not to wait. Were I in your shoes, I would opt to discover what the “spot” is now, not later.

You need to have proof that the “small spot” is benign and not an early lung cancer. In my opinion, you should be referred to a pulmonary specialist who may choose to obtain a CT scan or MRI possibly followed by a biopsy of the lesion. Depending on the outcome of the tests, the specialist can then advise whether treatment is necessary, and if so, can provide you with appropriate options.

While I may be over-reacting, I would hate to miss diagnosing an early lung malignancy that could be cured if addressed early in the course of the disease. Let me know how this turns out.

To give you related information, I am sending you copies of my Health Reports “Pulmonary Disease” and “Medical Specialists”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

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Treatment refusal ill advised until all facts are in

February 11, 2008 By

DEAR DR. GOTT: I’m a 78-year-old female on the frail side due to osteoporosis and mitral valve prolapse. I recently had a routine chest X-ray and was advised to have a pet scan because of a spot on my left lung. I had the scan and was diagnosed with a pulmonary nodule. I was informed that it could be an inflammatory process but a malignancy could not be ruled out. There is no evidence it has spread to my chest, abdomen or pelvis. I’m not considering a biopsy because I won’t have chemo.

DEAR READER: I strongly urge you to have further testing, including a biopsy. This will at least inform you and your doctors if the nodule is benign and harmless (such as scar tissue) or malignant.

Whether or not to have chemotherapy is your choice. However, I don’t believe it is a decision you can make without knowing if you have cancer or not. Go ahead with the biopsy and depending on the results, you may wish to speak to an oncologist (cancer specialist). He or she can tell you about possible treatment options. This is not to say you must have treatment, but it will at least allow you to make an informed decision.

If the biopsy shows the nodule is harmless, you probably won’t need more than regular check-ups with a pulmonologist who will monitor the lesion and check it if has increased in size or developed any abnormal characteristics.

Let me know how things turn out.

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