DEAR DR. DONOHUE: I hope you can settle a dispute between my husband and me. I have been advised by my doctor to have a screening colonoscopy. I am 54. My husband does not want me to follow the doctor’s recommendation. He found a Web site that claims people are fine with a sigmoidoscopy and an occult blood test. He believes doctors recommend the more extensive and expensive procedures to “line their pockets.” I appreciate your advice on this. – N.T.

ANSWER: Early detection of colon cancer practically ensures cure. That’s why such a big deal is made about screening tests for it.

The simplest and cheapest screening test is the fecal occult blood test. Here, “occult” means hidden, not witchcraft. It’s a standard test recommended on a yearly basis. It’s not 100 percent accurate, but its ease and low cost make it a worthwhile investment.

Sigmoidoscopy employs a telescope-like instrument that is inserted into the rectum and permits the doctor to have a bird’s-eye view of the last 1 to 2 feet of the colon – depending on the length of the scope. That’s only one-quarter to half the colon, but that’s where most cancers are found.

A colonoscope, on the other hand, is a scope that reaches the entire length of the colon. Naturally, it provides the most information.

Other screening tests include a special X-ray, a double-contrast barium enema and a new procedure done with a CT scan, called virtual colonoscopy. Its value is being investigated.

Reasonable people can disagree about the value and choice of screening procedures. The American Cancer Society has issued guidelines for people over 50. They include a yearly fecal occult blood test and: a sigmoidoscopy every five years; a colonoscopy every 10 years; or a double-contrast barium enema every 10 years. My personal choice lies with colonoscopy. The entire colon is examined, and biopsies of suspicious areas can be taken right then and there.

DEAR DR. DONOHUE: This year my husband, at age 53, died suddenly and without warning in the middle of the night. They told me it was a heart attack, but no autopsy was done. How do they know what happened? In the three days before his death, he had trouble swallowing his vitamins. I wonder now if that was a sign. I struggle with this every day. How could a young man die so suddenly? – A.B.

ANSWER: “They” don’t know what happened for sure, but they are offering an explanation that accounts for 70 percent of all natural sudden deaths – heart disease. Heart attacks are responsible for most of those deaths, and the actual cause is often a lethal heart rhythm brought on by the heart attack.

The only way to know the cause of death is through an autopsy, and even then some deaths remain unexplained.

A ruptured brain artery (a cerebral aneurysm) and a dissection of the aorta (a split in the wall of the body’s largest artery) are other causes of sudden death, but they are much less frequent causes than heart disease.

I cannot assure you that your husband’s difficulty swallowing a vitamin in the days before his death was a symptom of heart disease. It would be a most unusual symptom if it was, one that would not have been recognized by doctors as a warning of an impending heart attack.

Many times, heart disease produces no symptoms, and people who suffer without any signs of trouble are the ones who die unexpectedly and suddenly.

DEAR DR. DONOHUE: Is the age-related decrease in testosterone production of a healthy 60-year-old man the only factor prohibiting him from performing sexually like a 25-year-old? – B.R.

ANSWER: Definitely not. Testosterone increases libido, but its exact role in erectile function is unclear. Providing additional testosterone to a man whose natural supply is very low might help performance, but it is not usually helpful for a man whose testosterone is normal for his age. Unimpeded blood flow through clog-free arteries and functioning nerves have much more important roles in achieving and maintaining an erection than does testosterone.

DEAR DR. DONOHUE: How long does it take after changing to a low-fat diet for cholesterol levels to change?

My second question is, If you overwork a muscle, the next day it is sore. How does the heart muscle respond to overwork? – R.B.

ANSWER: It takes about four weeks to see a change in cholesterol after a person adopts a new diet.

I have never heard that the heart muscle gets sore from overwork. It has never happened to me. Work does bulk up the heart muscle and makes it beat with greater force.

The cholesterol story is told in the pamphlet of that name. Readers can obtain a copy by writing: Dr. Donohue — No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a sharp pain on the right side of my chest, next to the breastbone, when I take a deep breath or twist. It’s ruining my golf game. It’s not a large area, only about an inch or so, but it is a large pain. Any thoughts? – M.R.

ANSWER: Costochondritis, an inflammation of the cartilage holding the rib to the breastbone, is a thought. The cause of the inflammation is seldom tracked down.

Anti-inflammatory drugs can often lessen pain and quiet inflammation. Soaking a washcloth in hot – not boiling – water and putting it over the tender area is often helpful.

My usual closing remark applies here. If this pain doesn’t respond in a week or so, you are going to have to see the family doctor. If it turns out to be costochondritis, the doctor can inject cortisone for faster relief.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.