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DEAR DR. ROACH: My husband is about to start radiation treatment for stage one cancer on his vocal chord. Does radiation negatively affect the immune system the same way chemotherapy does? Should I be looking out for people who don’t vaccinate? – H.T.
ANSWER: Radiation can affect the immune system when it is given to large areas of the body, since the immune system cells are largely sensitive to radiation. Whole-body radiation rarely is used now, except in people planning for bone-marrow transplant. By contrast, localized radiation does not adversely affect the immune system to anywhere near the degree that chemotherapy can, since the bone marrow, where the immune system cells live, is diffuse throughout the large bones of the body.
As far as avoiding unvaccinated individuals, people who are unvaccinated and who are healthy do not pose a risk. It is in an outbreak of vaccine-preventable disease (there have been localized outbreaks of measles and mumps in the past year, and there are seasonal outbreaks of influenza) that unvaccinated people are much more likely to be infectious. So anyone with immune system disease (such as chemotherapy or whole-body radiation) should avoid people with potentially infectious illness. Caregivers of people with severe immune disease certainly should be immunized according to current guidelines. Even elderly people whose caregivers are immunized for flu get flu less often than those whose caregivers are not.
DEAR DR. ROACH: I know women who have had double mastectomies in order to reduce the risk of cancer. It seems extreme, but I guess it depends on the evaluation of risk. Are prophylactic hysterectomies done for similar reasons? It used to be routinely done when a woman had passed her reproductive years. I’m interested in your take on this. Will health insurance cover these types of surgeries, and if not, how expensive are they? – S.B.
ANSWER: Prophylactic mastectomies – that is, surgery to remove the breasts in order to avert a breast cancer diagnosis – are a reasonable choice for some women at very high risk of breast cancer, especially those with a family history of breast cancer who have an identifiable genetic predisposition, such as one of the BRCA gene mutations. This decision should be made carefully and in consultation with her doctors, usually an oncologist and a genetic counselor. I have very little experience with this in my own patients, fortunately, but I understand that in the case of women with very high genetic risk, it usually is covered by insurance, if it is the consensus of the treating physicians and the patient that she should proceed.
Hysterectomy – the removal of a uterus – is not done routinely today, the way it was decades ago. They are removed for disease, either benign or malignant. However, the removal of both ovaries and Fallopian tubes, called a bilateral oophorectomy and salpingectomy, is performed in some women at high risk for ovarian cancer. In fact, women with the BRCA mutations may consider both a prophylactic double mastectomy and a prophylactic bilateral oophorectomy and salpingectomy, since BRCA mutations increase risk of breast cancer and ovarian cancer (as well as other cancers).
The cost of surgery in the United States varies dramatically depending on where it is done, but in general it is very expensive.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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