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.
DEAR DR. ROACH: A few days ago at the Red Cross, my hemoglobin level was 12.4 according to a drop of blood from one hand, and 11.2 according to a drop of blood from the other hand. That’s such a big difference. Is there something wrong with me, or something wrong with the machine? — P.D.
ANSWER: Measuring hemoglobin levels is done by blood banks, such as the Red Cross, to see whether it is safe to donate blood. The Red Cross requires a hemoglobin level of 12.5 g/dL for women and 13.0 g/dL for men. That is close to the bottom of the normal range in most laboratories, so you are at or just below the cutoff for anemia.
Hemoglobin levels do bounce around a fair bit from test to test, and a change of a point is not unusual. It doesn’t mean a bad machine or a bad technician nor anything wrong with you. A classic article from 1946 noted a variation within a day of 1.3 g/dL, consistent with my own decades of observation. This is important to note, and we should be cautious about interpreting just a single lab value.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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