DEAR DR. DONOHUE: Last year I was rejected for life—insurance coverage due to an elevated CEA (carcinoembryonic antigen) test. The report stated that, regardless of the value, the test should not be interpreted as absolute evidence of the presence or absence of disease. I had several more tests done, all with no evidence of cancer. Now I can’t even obtain medical health coverage, and my coverage is running out in July.
So, what does the CEA level actually confirm and what could be the reason my level is out of the norm? How can I reduce it? — W.K.
ANSWER: Who ordered this test for you? It seems to me that person is responsible for getting you out of the situation you describe. CEA is not a trustworthy test for detection of colon cancer. It has too many pitfalls. It can be positive in healthy people and negative in people with cancer. It is useful, however, in following a cancer patient’s response to treatment.
You are a casualty of testing. With this positive test, insurance companies are requiring you to prove you don’t have cancer. Write to the insurance company’s medical director and ask what tests the company demands as proof that you don’t have cancer. If the insurer ordered the test, I believe it has some responsibility to extricate you from this dilemma. If your doctor ordered the test, then he or she should go to bat for you and submit the other tests you had done to show that you are not harboring cancer.
CEA blood levels do rise in colon, pancreatic, breast and lung cancers. They also rise in illnesses such as ulcerative colitis, Crohn’s disease, pancreatitis and hepatitis. Cigarette smoking can cause an elevation. No advisory panel recommends using this test as a screening test.
DEAR DR. DONOHUE: A dermatologist removed several sun crusts from my face and the lower part of my nose. I applied the medicines the doctor gave me and the crusts fell off and healed very well. Shortly thereafter I was told that the biopsy indicates cancer and that I need further surgery. Since the skin healed, I refused.
Two months later I got two more crusts, and the biopsy indicated cancer. The doctor wants to do more surgery. I would like a second opinion. How dangerous is it to delay? Could the biopsy be in error? — M.W.
ANSWER: You’re being foolish. A biopsy is the ultimate cancer test. A pathologist carefully examines the tissue with a microscope, and rarely are mistakes made. Your cancer is likely to be either a basal cell skin cancer or a squamous cell skin cancer.
Basal cell cancers start off as pearly white or pink bumps that evolve in crusted sores. They rarely spread to other parts of the body, but they can bore deeply down in the skin to structures below and can be severely disfiguring. My grandfather lost half his nose due to a basal cell cancer to which he applied a cream sold by a traveling salesman.
Squamous cell skin cancers can spread. They start as warty growths or scaly patches that often progress to an open sore.
You can also get the opinion of a second dermatologist. You don’t have to act in haste, but you do need to have these cancers completely removed.
DEAR DR. DONOHUE: An 88—year—old friend broke out in a rash on the left side of his forehead and his eye. It turned into dark scabs. Residents here believe it is related to having chickenpox as a youngster. Many of us have had chickenpox. What causes shingles to break out when we are older? — G.F.
ANSWER: The residents are correct. Shingles is the awakened chickenpox virus that lives on in nerve cells from the childhood (or adult) infection until death. It breaks out in older years, when there’s a transient lapse in a person’s immunity. More than 90 percent of American adults had chickenpox whether they remember having it or not. The shingles vaccine has been designed to prevent such breakouts.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853—6475. Readers may also order health newsletters from www.rbmamall.com.
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