DEAR DR. DONOHUE: I had a lumpectomy for breast cancer. After the surgery, I got radiation treatments, and I took Nolvadex. The thought of it coming back frightens me. What are the chances that it will come back? – B.C.

ANSWER: The chance for breast cancer recurrence depends on the size of the original tumor, whether it has spread to lymph nodes or distant sites, the microscopic appearance of the cancer and certain biological characteristics of the cancer, such as having receptors for estrogen. On average, the chance for a second breast cancer is about three times the chance of having an original cancer. In other words, the chances are slightly greater than are the chances of a woman having a first breast cancer.

Treatments are now available that cut the threat of recurrence. You had two of them – radiation and Nolvadex. Not every woman with breast cancer needs both. The kind of tumor dictates the kind of preventive treatment.

A brand-new drug, Herceptin, is very effective in reducing the risk of cancer return. It’s used for women whose cancer has the HER2 protein on the surface of its cancer cells. That protein stimulates growth of the cancer. Herceptin acts like a stealth missile that homes in on HER2 cancer cells and destroys them. About one-quarter of breast cancers have the HER2 protein.

Three new drugs – Femara, Arimidex and Aromasin – block the conversion of androgens (male hormones) to estrogen. Women do make male hormones. Their conversion to estrogen – which nourishes cancer cells – can foster the return of breast cancer. Blocking the change of male hormone to the female hormone estrogen is a new way of lessening the chance for a return of cancer.

You have had two very effective means of lowering the chance of a cancer return.

The booklet on breast cancer goes more deeply into this subject. Readers can obtain a copy by writing: Dr. Donohue – No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Can a diabetic safely diet? My aunt would like to lose weight. She is not overweight. She uses insulin and tests her blood sugar four times a day. – J.A.

ANSWER: Overweight diabetic patients are encouraged to lose weight. While dieting, they have to adjust the dose of their medicine (insulin or oral pills) to accommodate their lower calorie and carbohydrate intake. They should discuss this with their doctor.

Why does your aunt want to lose weight if she’s not overweight?

DEAR DR. DONOHUE: When an adult uncle teases and tickles a nephew (my grandchild) until he cries, is this acceptable behavior or a friendly act? What is your opinion about this? – C.M.

ANSWER: In my opinion, the adult uncle is an idiot and should be stopped, in no uncertain terms, from abusing the child.

Is the uncle your son? Even if he isn’t, step in and tell him to knock this off. The boy’s parents should do the same.

DEAR DR. DONOHUE: What’s a coxsackie infection? My son had it. The doctor didn’t give him any medicines for it aside from something to soothe his stomach and stop his diarrhea. Where does it come from? – K.V.

ANSWER: Coxsackie is the name of a family of viruses that are found all over the world. It’s difficult to trace where an individual picked up the infection. The name comes from a town in New York where the virus was first discovered.

Coxsackie infections cause many different kinds of illnesses – sore throats, gastrointestinal disturbances like your son’s, and infections of the brain coverings, which causes severe headaches. People, including youngsters, get over most of these infections in a short time with no permanent disability. There are no specific medicines for coxsackie virus.

DEAR DR. DONOHUE: Since the age of 20 (I am now 36), my left testicle has been larger than my right. I was told that it was nothing more than a sack of veins and was harmless. The last doctor said that if there is no pain, it is best to leave it as is. Is this a common thing? What more can I do? Through the years, I have had it checked many times, including ultrasounds. – M.M.

ANSWER: A “sack of veins” in the testicle is a varicocele (VAR-uh-coe-seal), something much like varicose veins in the legs. The testicular veins’ valves are not working properly, so blood backs up in them and distends them.

It is a common thing. Close to 10 percent of males have a varicocele, and it’s usually on the left side.

Surgical treatment is indicated if the man’s fertility is affected or if the varicocele causes discomfort. Doctors treat adolescents who have a varicocele if it affects testicle growth. It seldom does. In all other cases, it’s safe to ignore one.

The sudden onset of a varicocele in an older man could indicate that a tumor is blocking the drainage of blood, and this sort of situation requires further investigation. Yours has been thoroughly investigated.

There is nothing you can do about it on your own.

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. Readers may also order health newsletters from www.rbmamall.com.