HEALTH: Patient with risk of breast cancer questions safety of yearly MRI

— S.A.

ANSWER: I’m afraid I don’t have a good answer for you. It is true that most authorities recommend an intensive breast cancer surveillance program for women at a high risk of breast cancer in the range of a 20% to 25% lifetime risk. (The average risk for developing breast cancer for a woman born today is estimated to be about 13%.)

The Tyrer-Cuzick model of estimating breast cancer risk tends to give higher estimates than the other commonly used models, such as the BRCAPRO. Other models may not put you over the threshold for intensive screening with MRIs, which is usually combined with mammogram.

The question about gadolinium (the chemical element used in the contrast dye for MRIs) is important because some people do store gadolinium in various tissues, including the brain, but the clinical significance of this is unknown. (People with kidney disease can develop a skin disease due to gadolinium, and so they are not recommended to have MRIs with gadolinium.)

Although gadolinium can stay in the body for months or years, there has been no evidence of harm from gadolinium in brain tissue, despite these agents having been used for many years. Some agents have less retention than others. The U.S. FDA has mandated patient guides for these contrast agents, which relay the above information.

Given that there is a probable benefit to intensive screening for breast cancer in your case, due to your high genetic risk, and no more than a theoretical risk from gadolinium, I believe that the benefits outweigh the risks, but I can’t say that with complete certainty.

DEAR DR. ROACH: A friend gave me a hemp product to try on the quite painful arthritis in my fingers, which affects my ability to enjoy golf. I was reluctant to try it, but for the last two weeks, I’ve used it topically on my fingers and have been pleasantly surprised by a significant reduction in pain and an improvement in flexibility.

One of your recent columns mentions Voltaren, which I have also used, but without as much relief. Can you comment on CBD as an alternative treatment for arthritis?

— P.H.A.

ANSWER: There are animal studies suggesting benefit from oral cannabidiol, a component of cannabis (hemp) that has no psychoactive component (it’s the THC in cannabis that gets people “high”). I found some small studies showing pain relief from topical CBD in people with neuropathy, but not for arthritis. Several people, like you, have written to me with reports of pain relief.

Topical CBD is probably very safe. Even oral CBD should be safe, but studies have found that many products labelled CBD have trace, or more than trace, amounts of THC, enough to make a urine test positive for cannabis.

Until there is some evidence of effectiveness, I can’t recommend it, but people can try it based on safety and anecdotal reports.