While prophylactic double mastectomy will reduce the likelihood of developing breast cancer in the future by 90 percent, it does not reduce the risk to zero. That's because breast tissue is widely distributed on the chest wall and there may still be remaining breast tissue under the axilla, above the collarbone, or on the upper part of the abdominal wall.
Also, tumors can grow back in scar tissue.
While the procedure can lead to depression and anxiety over an altered body image, the rate of preventive mastectomy on the opposite breast following a diagnosis of breast cancer in women ages 18-39 has increased from 5.3 percent in 2000 to 15.4 percent in 2006 (and steadily climbing). Alternatives to such surgery include aggressive surveillance with yearly mammograms plus breast MRIs beginning at age 30; use of antiestrogen drugs such as Evista and Tamoxifen; avoidance of estrogen-containing birth-control and postmenopausal drugs; weight control; and limiting alcohol to a maximum of one drink a day.
Thanksgiving tiredness tied to calorie intake
Q: Why do some people get sleepy after eating turkey? Is it because of the tryptophan in the meat?
A: Tryptophan, a building block of protein, can indeed make you sleepy.
It works as a mild, natural sedative by causing a brief and transient release of the brain neurotransmitter serotonin - the same mood-improving compound that antidepressants such as Zoloft and Prozac help the body manufacture. So theoretically speaking, consuming a large amount of turkey can make one sleepy because of the tryptophan in the meat. The only caveat is that for it to work, the tryptophan-containing turkey must be consumed on an empty stomach. Other foods eaten along with the turkey will block tryptophan absorption.
That means the sleepiness we all experience after a large Thanksgiving meal is caused by something other than tryptophan. The "something" is the body digesting thousands of calories - especially all those carbs from stuffing, sweet potatoes, and desserts spiking blood sugars. We eat an average of 3,000 calories and more than 200 grams of fat at Thanksgiving. The body is working in overdrive trying to digest a day and a half of calories consumed in a period of just a few hours. That's what makes us tired.
Mitchell Hecht specializes in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076.
