Dr. Roach: Conflicts on aspirin use
Dear Dr. Roach: When I was 60, my doctor told me to take a baby aspirin daily to prevent heart attack and stroke. So I did. When I was 70, a new doctor said the risk wasn't worth the benefit, so I stopped. I heard and read a lot more about the benefits of aspirin. But a senior friend of mine had a horrific nosebleed that was thought to be from the aspirin.
Should we take aspirin?
Dear A.H.: When you see multiple opinions on a topic in medicine, it usually means there is conflicting evidence, and that certainly is the case with aspirin. The differences take place at the highest levels: the United States Food and Drug Administration recommends, in general, against using aspirin to prevent heart attack and stroke in people who have not already had a heart attack or stroke. However, the US Preventive Services Task Force recommends aspirin in general for men age 45-79 and women age 55-79. The USPSTF makes no recommendation about men or women over age 79. Both groups agree your doctor should be helping you decide on whether to take aspirin.
Aspirin risks causing bleeding, which can be more serious than a nosebleed. A bleed in the stomach or intestines can be life-threatening, and there is a very small risk of bleeding in the brain.
As a doctor, I prescribe aspirin for those at higher risk based on many factors, and don't prescribe aspirin to people at high risk of a gastrointestinal bleed. This is a judgment call about which physicians may differ.
Dear Dr. Roach: I recently heard on a medical TV program that tuna fish contains a large amount of mercury, so intake should be limited. I like solid white albacore tuna. I eat one 4-ounce can per week. How much is safe to eat?
Dear P.W.K.: Albacore has relatively high amounts of mercury, and the recommendation by the Environmental Protection Agency is to limit consumption to three 6-ounce portions per month for women, and three 8-ounce servings for men. You are well within the safe limit. Canned light tuna has less mercury, as does canned salmon.
Dear Dr. Roach: I have a follow-up question regarding your answer about testosterone replacement. You say it should not be used in someone who has had prostate cancer. Does that apply even if this person had the entire prostate removed?
Dear P.R.: Testosterone stimulates most prostate cancer to grow. In the case of someone who has had the entire gland removed, many urologists and oncologists worry that any cancer cells that may have spread before surgery but that are currently not growing might be stimulated to do so.
Email questions to ToYourGoodHealth@med.cornell.edu.