DEAR DR. ROACH: I just read another sad story about a woman who had breast cancer, fought it and seemed to win, but after five years, it came back and took her life. The same sequence of events happened to my wife two years ago. She fought the second round of cancer for a year and a half, but it was just about everywhere. What is this connection between the initial breast cancer occurrence and it coming back five or six years later even more widespread throughout the body? Is screening stepped up during that period? — Anon.
ANSWER: I am very sorry to hear about your wife.
With most cancers, no evidence of disease five years out from diagnosis usually means a cure, that the person will not have a recurrence of that particular cancer, although people who've had one cancer are at a higher risk of developing a second, unrelated cancer. Breast cancer is one of the exceptions. Late recurrences (after five years) are possible, even very late recurrences. I have seen 20 years afterward, and there are reports of even longer.
Although the reasons why breast cancer seems to hide for many years are not known precisely, we do know some risk factors for recurrence: Larger tumors are more likely to recur. Those with positive lymph nodes are at high risk, and women with estrogen receptor positive, progesterone receptor positive and HER2 negative tumors are more likely to experience recurrence.
Screening is absolutely appropriate in women who have had breast cancer. There is not a consensus about the type and frequency of screening, but many experts choose yearly mammography. Breast MRI has been considered, but it has not been proven to be better in women with a history of breast cancer.
A healthy lifestyle, including regular exercise, a diet with plenty of fresh fruits and vegetables, abstinence from smoking and minimal alcohol intake, has been shown to reduce cancer risk in women with a history of breast cancer.
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DEAR DR. ROACH: I have had stage 4 kidney disease for several years now. My doctors have said there is not much else they can do for me. I have been told by an alternative health care practitioner that asparagus and watermelon eaten approximately three times per week could have a beneficial effect. Any comments or suggestions you have would be appreciated. — R.A.
ANSWER: Chronic kidney disease is not a single entity. Any condition that can cause long-term damage to the kidney will cause reduced kidney function, measured by the glomerular filtration rate. It is graded on a scale of 1 to 5, based on how well the kidneys can filter blood. A normal GFR is above 90: CKD 1 is kidney disease with a normal GFR, while CKD 2 is a GFR of 60-89; CKD 3 is 30-59; CKD 4 is 15-29; and CKD 5 is below 15. At this point, people are usually contemplating dialysis.
Occasionally, kidney experts can find a reversible cause of poor kidney function, such as poor blood flow to the kidneys. Most of the time, the damage is largely irreversible.
I dearly wish that asparagus and watermelon could reverse kidney damage. It cannot. The main goal in someone with chronic kidney disease is to take steps to slow the decline. A plant-based diet does that, and some people, especially those with protein in the urine, may benefit from an ACE inhibitor to slow kidney damage.
A nephrologist is the expert in CKD and should be consulted early in the course of the disease. You can read much more on the National Institutes of Health's excellent site: https://tinyurl.com/y6gekvqo.