Dear Dr. Roach: I am an 85-year-old woman in very good health. I have had a mammogram done every year for the past 45 years, each scan being excellent, with no problems. I have stipulated in my living will that I do not want chemotherapy or radiation treatments should any kind of cancer develop. Do I really need to continue with the procedure of annual mammogram testing?
S.S.
The most important point is that it is your body and your choice. You can choose not to have mammograms or any other procedure done. But it sounds like you are asking for my medical judgment in your case.
There are very limited data on mammogram screening for women age 80 or older. One study found that women who were screened had no difference in breast-cancer rate, stage or mortality compared with women who were not screened. Some expert groups recommend doing mammograms only in women whose life expectancy is 10 years or more. The average life expectancy for an 85-year-old woman is about six years, but very healthy 85-year-old women might have 10 years or more in life expectancy. Overall, though, expert recommendations certainly do not strongly support mammography in a woman your age.
It seems you have strong feelings about treating cancer. It is true that early cancer, such as that found on mammography, can be treated sometimes with surgery alone. If you would not consider surgery, then I would recommend against a screening mammogram. There is very little benefit — and perhaps some harm — in making the diagnosis of a breast cancer you would be unwilling to treat.
Dear Dr. Roach: I am a 78-year-old man who wants to keep exercising for health reasons, but it is getting a lot harder due to my burping. When I start jogging or mowing the lawn, I start burping. It’s almost as if there is gas trapped in my stomach just waiting to be expelled. It doesn’t hurt and becomes less frequent after I “get over the hump” by running a bit and burping several times. The burping occurs exclusively when I am in a vertical position: I can work for hours in my garden on my hands and knees without burping. My doctor thinks it’s my diet, as I do eat popcorn, peanuts and an apple every night.
E.M.
People who burp a lot tend to be those who swallow air as they eat. The medical term “aerophagia” has Greek roots and is not uncommon. Burping — which has its own medical name, “eructation” — and abdominal discomfort or distention are the common symptoms, and it is associated in some people with gastroesophageal reflux.
You are correct that the swallowed air literally is sitting in your stomach waiting to be expelled. It can come out only when you are upright because the lower esophageal sphincter, through which stomach air would be expelled, is at the top of the stomach. Air rises to the top.
Avoiding gum chewing, smoking and carbonated beverages will help, if you do any of those things. Slower, more relaxed eating also might help, and a speech therapist with special training in diaphragmatic breathing techniques might be helpful. Still, I can reassure you that what you are experiencing is just an accentuation of normal physiology.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu
