Dr. Roach: Surgery is a valid option for male breast cancer in a 90-year-old
Dear Dr. Roach: My 90-year-old father has been diagnosed with breast cancer. His doctor is recommending mastectomy, after which time they will determine a course of treatment. My father is fairly healthy for his age, although he does have high blood pressure, diabetes and spinal stenosis, for which he takes oral medications. He has a history of transient ischemic attack at age 75. I am concerned that the risks of surgery at this age may be greater than that posed by the cancer. There is not much information available on male breast cancer, and any information you could provide would be appreciated.
Dear G.S.: I am sorry about your father. Breast cancer in men is less common than in women, but usually diagnosed later, as male breast cancer is not readily suspected by patients or many physicians.
Yours is a question I have seen frequently in medical practice. The risk of cancer increases with age, and it is not uncommon to see a person who, like your dad, has been doing pretty well until a cancer is diagnosed at a late age. Some people choose to ignore it, but in your father’s case I would still be likely to agree with his doctor’s recommendation of surgery.
Although any surgery at age 90 should be taken seriously, mastectomy is not particularly dangerous. The surgery not only will provide critical information about your father’s diagnostic options, it will also tell a lot about his prognosis. Perhaps most importantly of all, the surgery can reduce potential pain and suffering in many cases. Untreated breast cancer, in both men and women, can have terrible physical effects. These are much better prevented than treated.
Even with his medical issues, surgery is relatively low risk, and the benefits in understanding treatment options and their expected benefits, as well as reducing risk of complications from local tumor growth, makes this a strong recommendation. Of course, it’s your father’s decision, but I agree with his doctor’s recommendation.
Dear Dr. Roach: I have diabetes, and I was looking at different types of traditional herbal teas to cut down on caffeine and to try to help my diabetes. I always double-check to make sure none of the ingredients interacts with my medications. I read the tea that I am considering is an inactivator of cytochrome P450 3A4. I am taking metformin, Arthrotec, Paxil, Eltroxin and Ventolin. Must I worry?
Dear N.E.: The cytochrome P450 system is a major way the body has of detoxifying medications. Some medicines and a few foods (notably grapefruit juice) can affect the P450 system, especially the important enzyme CYP3A4. Depending on the medicine, increasing the activity of 3A4 can make a medication more toxic or less effective. However, the effect on the enzyme by foods is relatively small, and significant drug-food interactions are uncommon.
Your tea, like grapefruit juice, inhibits the activity of 3A4. I have access to a program that can look up drug-drug and drug-food interactions, and I found that one of the teas (Abies balsamea, also called balsam fir) will increase the effective dose of Paxil by about 40%. That is a large-enough effect that I recommend you talk to your doctor about it. They may wish to lower your dose or recommend against this particular tea.
Your pharmacist likely has access to the same or similar program that I have, and checking for interactions is a very good idea. This is particularly true for medications with large numbers of interactions (like warfarin and some HIV medications) or those where a small change in dose could lead to problems (like seizure medicines).
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