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Mammograms After Age 75 Are Voluntary

Dear Dr. Roach: I am an 84-year-old woman in good health. I have been faithfully going to the gynecologist and having a mammogram every year. Do I really need to keep seeing the gynecologist — I haven’t had any problems in 30 years — or can I just continue to get my annual mammogram? — S.B.H.

Answer: I wouldn’t recommend stopping visits to your primary care doctor, who may be your gynecologist. It’s very important to have your regular visits, even if in good health, to check in, check your blood pressure and have an exam. When to stop performing screening tests is a controversial subject. If your gynecologist is still doing Pap smears, those can stop. Women who have had multiple normal regular exams and who have no history of precancerous abnormalities or cancer can stop Pap smears after age 65.

When to stop mammograms isn’t clear, but both the Canadian Task Force and the U.S. Preventive Service Task Force make no recommendations above age 75. I recommend still doing them for a healthy woman until she gets a condition where it makes no sense to do them anymore (like a terminal illness), or she is over age 75 and doesn’t want to do them anymore.

Dear Dr. Roach: In a May column, a person commented about developing cancer after the death of a husband, child or someone close, and your response was about caring for that person and stress. However, after finding out that a young married couple from my high school both died from cancer in their 40s, and through the years (I am 72) seeing many other married couples, including my parents, die from it, I have been wondering if it is possible that cancer could be a virus like HIV and be contagious through bodily fluids. Is this a possibility, and is there any proof one way or the other? I hope this isn’t a stupid question. I have never written to a column before, but it is something that has been on my mind for 30 years. Your thoughts would be much appreciated. — D.J.

Answer: I often have seen married couples die within a short period of time from each other, sometimes from the same cause and sometimes from different causes. But to answer whether cancer can be spread as a virus, clearly, yes, it can be. Cervical cancer is caused by changes to the body via human papillomavirus (HPV), and we expect that the vaccine for HPV will dramatically reduce cervical cancer and death. Kaposi’s sarcoma is similarly caused by HHV-8.

Although there are other examples, most cancers are not caused by contagious viruses, as far as we know. You have to remember that “cancer” isn’t one disease — it’s a bunch of diseases.

Dear Dr. Roach: Almost on a daily basis, I have small black spots in my phlegm. My doctor has told me that it is blood. I am concerned that it could be something more serious. I am a veteran of the first Gulf War, and I was exposed to oil fires and burn pits. Is it common for blood to be in phlegm, or should I seek further treatment? — C.T.

Answer: Blood in the mucus (phlegm) is NOT common, it is ALWAYS a concern, and you should definitely seek further treatment from a pulmonologist (lung specialist). You almost certainly will need a CT scan. Don’t wait.

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 write to P.O. Box 536475, Orlando, FL 32853-6475.