DEAR DR. ROACH: I have an increased genetic risk for breast cancer and take an annual mammogram and sonogram. I had a baby last year and am now breastfeeding. What is the best way to do screening while breastfeeding? — Anon.
ANSWER: Breast cancer during pregnancy and lactation is unusual, but unfortunately does rarely happen. There does seem to be a temporary increase in the likelihood of breast cancer around the time of pregnancy and for three to four years afterward. For women with a palpable mass, they should undergo screening, and providers should assess any suspicious masses, recognizing that the vast majority will not be suspicious.
For someone in your situation, both mammograms and sonograms have been used for screening. (Women who are pregnant should have lead shielding to protect the fetus during a mammogram.) The hormonal changes make interpretation of the mammogram more difficult, and screening during pregnancy and breastfeeding is more likely to result in a biopsy, which is very likely to be benign.
MRI scans have also been used during lactation, although the effect of the MRI contrast agent, gadolinium, on the fetus is unknown, so its use is not recommended during pregnancy.
Unfortunately, there isn’t one perfect answer for all women. A sonogram is a reasonable starting place, with a mammogram in case of any suspicious abnormalities on the sonogram.
Finally, breastfeeding reduces the risk of future breast cancer and has many benefits for your baby. It’s a great choice for many women.
DEAR DR. ROACH: My question is about over-the-counter medications that help prevent memory loss. One medication lists the active ingredient that helps prevent memory loss as apoaequorin, and the other lists phosphatidylserine.
I would like to know which is better to take or if either one is of any benefit. — S.W.
ANSWER: There are no peer-reviewed studies showing a benefit of apoaequorin (found in Prevagen) in treating or preventing memory loss. The manufacturer has claimed it has effectiveness, but it is very likely that the key ingredient in this supplement breaks down in the gut before being absorbed. So, I do not recommend it.
There have been several studies on phosphatidylserine, which may help repair the membranes of nerve cells. Some studies have shown improvements in people with dementia or those with concerns about memory problems, but others have shown no benefit. I don’t recommend this supplement, at least until further studies potentially show benefit.
The best evidence for preventing memory problems remain a healthy diet, such as a Mediterranean-style diet mostly based on plants, but with omega 3 fatty acids (plant-based or from fatty fish); regular moderate exercise; and avoiding alcohol, especially to excess. There are probably benefits that come with regular sleep and regular mental exercise, such as word, number and visual puzzles and games.
Because blood vessels to the brain can be damaged by excess blood pressure or blood sugar, treating high blood pressure and diabetes is appropriate if a person has been diagnosed with those conditions. Treatment of high cholesterol with a statin may have a benefit in preventing dementia, but this is also unproven.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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