Dr. Keith Roach

DEAR DR. ROACH: I am a 70-year-old woman. I have asked my doctor for genetic cancer screening and was told I didn’t need it unless I had symptoms. I had a hysterectomy, but I still have my ovaries. My maternal grandmother died of ovarian cancer. My mother had an ovarian cyst removed when she was in her 50s. I have aunts on both sides of my family that have died from both breast and ovarian cancers. Am I a candidate for this screening? How do I convince my doctor? — J.S.
ANSWER: Women who are at highest risk for ovarian cancer are those with a known family cancer syndrome, such as BRCA1/2 and Lynch syndrome. Any woman (or anyone with ovaries, whether they identify as female or not) with one of these conditions should get expert care on whether screening is appropriate.
Women at increased risk, not the highest risk, such as those with one or more first-degree relatives (mother, sister), should meet with an expert to consider ways to reduce risk of ovarian cancer, including oral contraceptives in premenopausal woman and surgery to remove the ovaries and fallopian tubes. Unfortunately, neither birth control pills nor surgery reduces the risk of ovarian cancer to zero.
Although screening with blood testing (such as the CA-125 test) and imaging studies (such as an ultrasound or MRI) have been studied, screening for ovarian cancer has never been shown to have a benefit in reducing the risk of dying from ovarian cancer in average-risk or increased-risk women. There are also potential harms from screening, as there are false-positive tests that sometimes require follow-up testing or even surgery to prove that the results are false-positive.
Many patients have written to me that they have had a screening test, which led to an intervention. Again, though, well-established studies haven’t shown a benefit.
Since you do have a family history, but fortunately not a first-degree relative with ovarian cancer, you are not at the highest risk, and screening is more likely to result in harm than benefit.
DEAR DR. ROACH: I was recently diagnosed with Nocardia cyriacigeorgica. There doesn’t seem to be a lot of information about it, and my pulmonologist has never treated it. Could you please explain it? — P.G.
ANSWER: Nocardia is not a common infection. It’s an unusual bacteria that doesn’t respect tissue boundaries and can spread to different parts of the body. It tends to recur or even progress despite appropriate antibiotic treatment, so it’s quite difficult to eradicate. There are more than 90 species, but I have never seen a case of Nocardia cyriacigeorgica.
The diagnosis is made by culture or molecular testing, such as a PCR test. Although Nocardia is often seen in people with a compromised immune system, about a third of the time, it occurs in people with no apparent immune system disease. Apart from the lungs, the skin is the most commonly affected site, but the infection can spread almost anywhere in the body.
Nocardia is most commonly treated with antibiotics for a long time. Six months, or even 12 months, is not uncommon. Trimethoprim-sulfamethoxazole (Bactrim) is the usual treatment, sometimes with linezolid. Nocardia cyriacigeorgica is typically resistant to all other oral antibiotics. An infectious disease specialist would be a smart consultation, especially since your pulmonologist isn’t familiar with it.
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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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