Dear Dr. Roach: I am 68 years old, and I hesitate to continue with mammograms. I have a couple of friends who were treated with very harsh chemo and radiation for tiny stage 1 tumours. I wonder if, at this age, the severe treatment is more risky than just keeping an eye on the tumour: Maybe it would grow so slowly that you could outlive it. On the other hand, I wouldn鈥檛 want to allow something to grow that could be dealt with early. What do you think?
Anon.
I think you have precisely identified the dilemma. There does come a point in a woman鈥檚 life when screening tests, like mammograms, are more likely to cause harm than benefit. This comes at the point that a woman鈥檚 life expectancy is short enough that she gets the early harms of the screening, including the treatment for a tumour that might be found, but does not live long enough to enjoy the extra life she might get as a result of treating the tumour early.
There isn鈥檛 an exact age that I can say is the right time for every woman, but 68 is a bit too young for most. The best evidence is that there is more benefit than harm for women up to age 74 (again, recognizing that mammograms are not appropriate for every 74-year-old), and some healthy women may still get a net benefit into their mid-80s. It also depends on a woman鈥檚 other medical conditions and her own opinion, so it鈥檚 definitely a choice for a woman and her doctor to make. Between 75 and 85 usually is the right time to have that discussion, but earlier is fine, especially in women who have other chronic health conditions.
Dear Dr. Roach: In 2013, I suffered terribly with sciatica. The pain was more than excruciating 鈥� it felt like a knife was stuck in my leg. I also had numbness in my toes. I had a CAT scan, which showed spinal stenosis, and I was scheduled for a laminectomy and spinal fusion. The surgery was a complete success. However, I thought that the numbness would go away after the surgery, but it hasn鈥檛. Even now, I still feel some tingling and sharp pains in my toes or foot, and more than three years later I still have the numbness in my toes, foot and leg, up to my knee. Is it likely this is permanent nerve damage?
J.B.
Spinal stenosis is a common condition, where the spinal cord or nerve roots of the cord are compressed by bony structures related to arthritis of the spine. The major symptoms are pain and numbness. Weakness is the most worrisome symptom, and progressive weakness is a surgical emergency.
After successful surgery, the symptoms are relieved, but in my mind, surgery is not completely successful unless all of the symptoms are gone. Your surgeon may have done as good a job as humanly possible; however, nerves do not always recover 100 per cent of their function. If nerve recovery is going to happen, it usually does so by the end of the first year.
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 [email protected].
