DEAR DR. ROACH: I am taking an angiotensin receptor blocker and a calcium channel blocker for my blood pressure, which work very well to control my hypertension. However, I have a history of breast cancer, and I have heard that calcium channel blockers are associated with new cases of breast cancer. My daughter also takes a CCB, and my question is whether either or both of us should ask our physicians to find another class of drug because of my history. — H.S.
ANSWER: An article was published looking at the risk for breast cancer in long-term (10 or more years) users of calcium channel blockers, and found a two-fold increase in risk. Previous studies did not show an increase in risk, but these did not include people who had taken calcium channel blockers for so long. If confirmed, that would make calcium channel blockers one of the most powerful risk factors for breast cancer.
An accompanying editorial recommended against changing from a calcium channel blocker, since this data is too preliminary, and recommended waiting for further studies. I agree. However, because there is a possible risk, in people with an increased risk of breast cancer — such as a personal history or strong family history -- it has been my experience that both patient and physician may feel a little less anxious if a replacement can be found that controls the blood pressure as well.
DEAR DR. ROACH: I’m a 64-year-old male, and I’ve never had a colonoscopy, the main reason being that all the clinics in my area require the patient to come to the appointment with a driver or escort. I live in a somewhat rural area, and volunteers are hard to come by. I can’t afford to pay someone to take off a day from work. I’ve attempted to see if the clinics and myself could reach some sort of compromise, and they won’t even talk to me about it. It seems to me that in the interest of saving lives something could be worked out. I’ve written the local papers, emailed and called the clinics, and even contacted a local TV station, and absolutely no one will address this. — J.S.
ANSWER: I’ll bet a compromise can be worked out. I have seen several ways. One is to have the colonoscopy very early in the morning and stay in the office until the end of the day. This can work, particularly if the doctor uses a short-acting sedative. Another is to have a friend or taxi come pick you up at the end of the day, so they don’t have to lose a day of work waiting for you. The last is to have the colonoscopy without sedation, which I have occasionally had a patient do, but both you and the gastroenterologist would need to be willing to do this. I completely agree that the test can be lifesaving, so working out a compromise is best. A visit to the physician who’ll be performing the procedure might enable you to work it out.
TO READERS: Questions about the common problem of uterine fibroids are answered in the booklet of that name. To obtain a copy, write: Dr. Roach — No. 1106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.