DEAR DR. ROACH: I am 90 and in reasonably good health. I recently had blood tests that showed a spike in my liver levels. An evaluation showed that I had hepatitis C. I have had a very hard time trying to get an appointment with an infectious disease specialist. The ER doctor said that I shouldn’t be traumatized over the diagnosis. — D.R.
ANSWER: Hepatitis C is an extremely common viral illness, with nearly 60 million people worldwide and about 3 million Americans affected. Hepatitis C can be transmitted by blood or blood products, improperly sterilized medical equipment, sexually, and from mother to child. The virus can also be transmitted by household items that contain blood, such as razors and toothbrushes. It’s possible that you have had this infection for many years.
Until recently, hepatitis C was a chronic infection for which there wasn’t good treatment, but there are now many good treatments that are usually (95% to 99%) effective at completely eradicating hepatitis C. The best regimen depends, to some extent, on the genotype of the hepatitis C, found by sophisticated blood testing. Both hepatologists and infectious disease specialists are experts in treating hepatitis C, so if you can’t find an ID specialist, you can also consult with a hepatologist.
In most people, a treatment of 8-12 weeks is effective at curing hepatitis C. Unlike the previous treatment regimens, these once-daily treatments are very well-tolerated for most people, with less than 1% of people unable to complete the regimen.
DEAR DR. ROACH: Back in 2005, I read that drinking alcohol increases a woman’s risk for developing breast cancer. Apparently, half a drink daily increases the risk by 59%, but taking folate can help reduce the risk of developing breast cancer. Could alcohol be part of why breast cancer is increasing? — M.S.
ANSWER: It is absolutely true that drinking even modest amounts of alcohol increases a woman’s risk of developing breast cancer, but a large study that evaluated all the published data showed an increase of about 5% for light drinkers; a 15% increase among women who drank three to six drinks per week; and an increasing risk for anything above this amount.
A different large prospective study showed that in women who took folate and drank alcohol, there wasn’t a significant increase in breast cancer risk, but for women who didn’t take folate, there was a 32% increase in the risk of breast cancer.
I wouldn’t say that folate completely reduces the increased risk of breast cancer due to alcohol, but it probably reduces much of it. Since this data has been published, many more products are fortified with folate, so taking a supplement may not be as important. However, folate is safe and inexpensive. (Though, in theory, it could make a vitamin B12 deficiency symptomatic.)
Alcohol consumption rates in the U.S. have been increasing since their recent low in 1995, but are still well below the 1975 rates in per-person consumption. Breast cancer rates have been increasing largely due to increased diagnoses, but cancer death rates have been falling steadily. It is possible, but not proven that alcohol consumption is partly responsible for the increased incidence.
Some alcohol companies put pink ribbons on their products, but this doesn’t mean they are safe. All alcohol consumption increases risk of breast cancer.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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