Judy Foreman

Nationally Sindicated Fitness, Health, and Medicine Columnist

What is inflammatory breast cancer and is it worse than regular breast cancer?

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While treatment for inflammatory breast cancer has improved in recent years, it still carries a worse prognosis than many other forms of breast cancer. According to the American Cancer Society, the 5-year survival rate for inflammatory breast cancer is 40 percent, compared with 87 percent for all breast cancers.

In typical breast cancers, the tumor forms a lump that a person can feel or see on a mammogram. In the inflammatory kind, which makes up 1 to 2 percent of the roughly 180,000 new breast cancer cases per year, the cancer “is often not a mass,” says Dr. Eric Winer, chief of the Division of Women’s Cancers at Dana-Farber Cancer Institute. “Instead, the breast is often warm, red, swollen and tender.” The cancer is often misdiagnosed as an infection treatable by antibiotics.

The cancer moves so quickly “that the breast can become noticeably larger in just a few weeks,” says Dr. Barbara Smith, director of the breast program at Massachusetts General Hospital. What makes the cancer so dangerous, she says, is that it grows in the lymphatic vessels, “the highways out of the breast to the rest of the body.” Immediate treatment is essential.

Women with inflammatory cancer get chemotherapy first to get rid of cancer cells that have spread to the rest of the body, then surgery and radiation.

A potent drug called Herceptin can also be used.

Two years ago, the M.D. Anderson Cancer Center in Texas became the first clinic in the world to open a specialized program for inflammatory breast cancer. Other centers, including Dana-Farber, are developing such programs.

Because care is specialized, doctors advise women to seek treatment at major medical centers.

Clarification: The Health Answers column in the 2/9/09 Boston Globe’s Health/Science section should have noted that, while the drug Herceptin is sometimes used to treat inflammatory breast cancer, it has not been approved for this use by the US Food and Drug Administration. The FDA has approved the drug for treatment of some other breast cancers

Does eating broccoli help prevent cancer?

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Despite 30 years of searching, scientists have not been able to nail down a clear link between human cancer prevention and consumption of broccoli, or any of the vegetables in the same family, says Dr. Walter Willett, chairman of the Department of Nutrition at Harvard School of Public Health.

But in the test tube, tantalizing clues keep emerging. In December, University of California, Berkeley toxicologist Leonard Bjeldanes and molecular biologist Gary Firestone reported in the Proceedings of the National Academy of Sciences how one component of broccoli, a compound called indole-3-carbinol (I3C), can slow cell proliferation, a hallmark of cancer.

In mice, the Berkeley researchers say, I3C was found to stop the growth of breast and prostate cancer cells, and the substance is now in clinical trials in humans. But Willett cautions, “We really can’t connect these new findings from subcellular mechanisms to any effects of broccoli consumption in humans.”

And even if I3C, which is available as a dietary supplement, does slow cancer growth, it’s unclear how a person would take it. Stomach enzymes transform it into other chemicals, says Bjeldanes; research suggests injections might be more effective.

Karen Collins, nutrition adviser to the American Institute for Cancer Research, cautioned that “cancer patients should not start taking supplemental versions of I3C without full discussion with their doctors because we don’t yet have clinical data about all effects possible.”

Even if broccoli and similar cruciferous vegetables aren’t a magic bullet for cancer prevention, says Willett, they “are excellent sources of many essential nutrients and good to include in our diets.”

For what it’s worth, Bjeldanes is convinced enough of the value of broccoli-type vegetables that he makes sure to eat one serving a day of them.

What do prayer books written in hospital chapels reveal about us?

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In what is believed to be the first systematic review of hospital prayer books, Brandeis University sociologist Wendy Cadge and a colleague analyzed the heartfelt offerings of people whose loved ones are ill. The analysis of 683 prayers – written by 536 people at Johns Hopkins University Hospital between 1999 and 2005 – showed that writers were searching for strength, not miracles.

The prayers primarily offer thanks to God, and ask for courage and the ability to cope, not for specific medical outcomes.

The finding contrasts with earlier research showing that two-thirds of Americans believe that God can cure illnesses that science deems incurable, said Cadge.

The people who recorded their prayers appear to view God not as an authoritarian, gruff figure who could tell them what to do, but as an accessible, wise friend.

One child wrote, “Dear God, Please let this be P’s last thing he has to go through. And let the journey down his long road of recovery start today.” An adult wrote, “Dear Jesus, please heal G. Heal his little heart so he will be able to come home soon.” (For privacy reasons, the names of the loved ones were reported as initials.)

Anger rarely showed up in people’s prayers, though frustration did creep in occasionally, as in the prayer that asked: “Keep an eye on the pediatric neurologist resident or fellow that fouled up. Make sure he don’t hurt anyone.”

Analyzing people’s prayers “gives us a glimpse of how people conceive God,” says Cadge. The prayers, she feels, “are snippets of an ongoing conversation” with God.

George Fitchett, an epidemiologist and hospital chaplain at Rush University Medical Center, who studies how people use prayers in medical settings, agrees with Cadge’s finding that people “have a sense of God as someone who is listening, caring.” Basically, he says, people seem to pray to God not for miracles but “to help them cope.”

Should men get the biopsy for prostate cancer that requires general anesthesia?

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Probably not – at least not as a first step in cancer diagnosis.

In a typical office biopsy, a man is given local anesthesia and the doctor uses needles, inserted through the rectum, to take 12 samples of prostate tissue. Because the needles may miss some areas, the test may falsely say a man does not have cancer when he does.

In the new “saturation transperineal” biopsy, needles are used to take 40 samples. Doctors insert the needles through the perineum, the skin between the bottom of the scrotum and the front of the rectum. General anesthesia is used.

In a study to be published soon, Dr. Brian Moran, medical director of the Chicago Prostate Center, used perineal biopsies on 747 men, all of whom had rising PSA scores, a sign of potential cancer, yet consistently negative rectal biopsies.

Moran said he found cancer in 39 percent of the men, suggesting that this method is better at finding hidden cancer. But only 40 percent of these newly detected cancers were serious, that is, carried a “Gleason score” of 7 or higher.

And there is the conundrum. The saturation perineal method may increase the cancer detection rate, “but are we necessarily detecting significant cancers? That is the great issue,” said Dr. Kevin Loughlin, a senior urologist at Brigham and Women’s .

If most of the cancers found by the new technique are not life threatening, is it worth putting men through the ordeal of more aggressive detection?

Probably not, say some doctors, advising instead that the new method should be saved for men in that gray zone of rising PSA scores and negative findings on rectal biopsies.

How can you be sure that microwaved frozen chicken is safe to eat?

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Use a meat thermometer and make sure the internal temperature of the chicken is at least 165 degrees Fahrenheit, according to a recent warning from the Food Safety and Inspection Service of the US Department of Agriculture. This means really cooking the chicken, in a regular oven or microwave, not merely thawing it.

Some consumers have fallen ill with salmonella, a type of bacteria that causes diarrhea, after they did not follow the cooking directions on packages of frozen chicken, said a USDA spokesman, Roger Sockman. Many frozen chicken products, such as chicken Kiev and chicken cordon bleu, may appear to be precooked, but are actually only prebreaded or prebrowned. Thus, microwaving only to the point of thawing will not kill salmonella, which causes an estimated 1.4 million cases of food borne illnesses and more than 500 deaths every year, according to government figures.

The USDA became aware of the problem after more than two dozen people in Minnesota fell ill after improperly microwaving such chicken products, even though product packaging made clear that the chicken was uncooked and did not contain microwaving instructions.

Said Roger Fielding, a professor of nutrition at Tufts University: “Always cut it open and make sure it is white, not pink or translucent. You really have to be careful.”

Is vodka better for you than other alcoholic beverages?

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No, although it is less likely to give you headaches and hangovers.

Alcoholic beverages are divided into three categories: beers, wines, and spirits. Beer and wine are made by fermentation of plant material that contains sugar or starch, while spirits (vodka, gin, scotch, etc.) are made by fermentation followed by distillation, that is, boiling, followed by condensation. Beer is typically 4 percent to 6 percent alcohol by volume; wine, 9 percent to 16 percent; and spirits, at least 20 percent. (Spirits that are 20 percent alcohol are said to be 40 “proof.”)

The reason for headaches and hangovers are toxic chemicals formed during fermentation called congeners, says Samir Zakhari, director of the Division of Metabolism and Health Effects at the National Institute on Alcohol Abuse and Alcoholism.

Because vodka has fewer congeners than most other alcoholic drinks, it is less likely to cause hangovers.

That said, the alcohol in vodka is metabolized the same way as alcohol in any other drink.

When a person drinks alcohol, the alcohol gets processed in the liver by two enzymes.

The first, alcohol dehydrogenase, breaks alcohol down to acetaldehyde, a nasty substance that in most people is rapidly broken down by a second enzyme, aldehyde dehydrogenase.

The result is acetic acid, or vinegar.

Some ethnic groups, including some Asians, have common genetic mutations that make the second enzyme ineffective, leaving the drinker to suffer the unpleasant effects of acetaldehyde such as nausea and rapid heartbeat.

Even though vodka has fewer congeners than other forms of alcohol, warns Dr. Emanuel Rubin, a professor of pathology at Thomas Jefferson University, that doesn’t mean you can drink all you want and never get hung over. Nor does it mean that vodka drinkers avoid becoming alcoholics.

“The major effect by far is the amount of alcohol you drink,” not what kind, he says.

Do people urinate more during the cold months?

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This is not exactly the most-studied question in medicine, but yes, patients often do report a greater sense of urinary urgency in the winter, doctors say.

“In the olden days, we would have pooh-poohed this question. Now, we’re paying attention and trying to see what causes it,” says Dr. Pablo Gomery, a urologist at Massachusetts General Hospital. Cold air seems to trigger an increased sense of urgency, he says, though this does not necessarily translate into incontinence.

A 2005 study by researchers at Whittington Hospital in London, did assess both urgency and incontinence in nearly 2,000 men and women.

They found that certain conditions, particularly fatigue and worry, were associated with the highest risk of urgency and incontinence.

Running water and cold weather were next most likely to do so, followed by waking, rising and “latchkey” situations, in which one suddenly feels the need to use the bathroom when putting the key in the front door.

Animal studies suggest that cold weather “can induce bladder muscle overactivity,” says Dr. Michael O’Leary, a senior urologic surgeon at Brigham and Women’s Hospital.

And the hallmark of an overactive bladder – as those TV ads make clear – is a sense of urgency. This is in contrast to the other main type of incontinence, “stress incontinence,” which is triggered by an increase in intra-abdominal pressure such as from coughing, sneezing, or jumping.

People may also make more urine in the winter as in the summer because in warm weather, the body gets rid of more fluid by sweating.

As we age, is the pattern of hearing loss different for men and women?

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No. The hearing loss that comes with age affects men and women the same way.

“There is no sex difference in the pattern of hearing loss, although there are different patterns of age-related hearing loss,” says Dr. Steven Rauch, an ear specialist at the Massachusetts Eye and Ear Infirmary.

Usually, age brings with it “a high frequency hearing loss, and that’s true whether you are male or female,” says Dr. David Vernick, an ear, nose, and throat specialist in private practice in Chestnut Hill.

Curiously, there does not appear to be any age-related loss of low frequency sounds. It is also not clear why high frequency sounds are the ones to go. “The current thinking is that higher frequency sounds have a higher metabolic demand, so the ‘hair cells’ in the ear that process sound wear out first,” says Rauch.

As a practical matter, this means certain speech sounds – especially the consonants like “s,” “f,” and “th,” which have a hissing quality and are high frequency – become harder to hear as a person ages. Vowel sounds are low frequency, hence, more easily heard by an older person.

How do you know if you are developing hearing loss? The signs, according to the National Institute on Deafness and Other Communication Disorders, include having problems hearing over the telephone; trouble following a conversation if multiple people are talking; turning up the TV so loud that people complain; and finding yourself frequently asking people to repeat themselves.

By age 65, roughly one third of the population needs a hearing aid and by 75, half the population does, though many people who need aids don’t use them. But don’t just go to a store and buy one. Get your hearing tested by an audiologist, not a hearing aid salesperson. And remember, according to Massachusetts law, you can try it for a month, then get your money back if you decide it doesn’t really help or you don’t want to use it.

Or you may decide to just put up with a little hearing loss. “Unless it is a social problem,” says Vernick, “most people do not care what their level of hearing is.”

But if it does get more severe, hearing loss can lead to isolation and even pose safety risk, so it’s worth getting checked out. After all, hearing loss is one of the most treatable conditions of aging.

Should I take an aspirin before a plane flight to avoid getting blood clots?

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No, according to new guidelines issued in June by the American College of Chest Physicians, though if you already take aspirin for general cardiovascular health, you should continue to do so while you travel.

In everyday life, aspirin helps prevent clots in arteries by keeping platelets, the major element in plaque, from building up in ones arteries.

But the type of clots triggered during long plane flights are different. They start in deep leg veins, says Dr. Michael Jaff, medical director of the vascular center at Massachusetts General Hospital.

Deep vein clots are composed predominantly of fibrin, which aspirin does not affect.

Taking aspirin in hope of preventing air-travel-induced clots may lull you into a false sense of security, which raises the chance that you will forget to do the things that can prevent deep vein clots.

It is important to stay well hydrated, says Dr. Samuel Goldhaber, director of the Venous Thromboembolism Research Group at Brigham and Women’s Hospital.

Avoiding alcohol during flights helps because alcohol is dehydrating, he says.

You can also wear below-knee compression stockings in the 20-30 millimeter strength. To get the best price, you may have to search online, according to Goldhaber. And be sure to flex your calf muscles often as you fly.

Leg pain may or may not be a sign of a clot. But clots that travel to the lungs – a pulmonary embolism – it can be fatal.

The odds of this are low – one in a million – for an otherwise healthy person. But if, in the hours or days after a flight, you experience sudden discomfort in the chest, especially with deep breaths, passing out, heart palpitations, or if you cough blood, get emergency medical help right away.

Why don’t you hear about people getting heart cancer?

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Heart cells, called myocytes, do obviously divide as we grow – “to make new cells during embryonic development, but after birth, as childhood development progresses, these cells have reduced abilities to divide,” said Lewis C. Cantley, a biophysical chemist who is director of the Cancer Center at Beth Israel Deaconess Medical Center. Certain cardiac tumors do occur in infants and in utero, and often resolve without any medical intervention as cellular signals that turn off cell division kick in.

But even in adults, heart cell division is not completely absent, said Dr. Steven Colan, associate director of cardiology at Children’s Hospital. Indeed, if heart muscle cells never divided, there would be no way for the heart to repair itself after a heart attack or other tissue damage. In other words, heart cells, like nerve cells in the brain, do divide, but less often than most other cells, he said.

The other distinguishing feature of heart cells is that, like nerve cells in the brain that fire incessantly, heart cells are metabolically active every minute of life. That constant activity, said Colan, means that these cell types rarely get a chance to “put themselves into a resting state and devote their resources to dividing.”

Precisely because of heart cells’ relatively low division rate, pharmaceutical companies are working on ways to stimulate heart cells to divide, in hopes that this would help the heart recover better after damage.