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Dr. Roach: Pathologists can determine if cancer is due to outside exposure

Dr. Keith Roach
To Your Health

Dear Dr. Roach: I recently lost a brother to non-small cell carcinoma in his lungs. He was 82 years old. He was a heavy smoker in his younger years, but quit smoking 31 years ago. He worked many years in the construction trade as a union carpenter and also worked with roofing materials. He had been exposed to many toxic materials during those years.

My question is: Is it possible that he may have come into contact with materials such as asbestos, or any foreign material that may have caused lung cancer in his later years? Would the pathologists who studied his cancer find cells that would have indicated this?

— C.S.

Dear C.S.: I am very sorry about your brother. I can’t answer which risk factor — smoking or occupational exposure — was responsible for him getting lung cancer. They have additive effects, which makes understanding the relationship more complicated.

Dr. Keith Roach

Many people in different occupations are exposed to asbestos, but the occupations most likely to result in lung cancer include ship repair, building construction, and some types of electrical work. It is entirely possible that he was exposed to asbestos, especially when he was working as a young man when there were fewer or no regulations. I always ask about prior military service, since this is another possible exposure to asbestos.

Pathological evaluation of lung cancer tissue often finds asbestos fibers among those who have had occupational exposures, and some expert groups feel that this is a major criterion for determining whether the cancer was due to asbestos exposure. This should have been part of the pathology report that made your brother’s diagnosis of non-small cell lung cancer.

Dear Dr. Roach: I have read and heard recently that long-term use of the medication pantoprazole leads to a 33% increased risk of dementia. I am concerned because I have been using this medication for approximately eight years, and lately, I get really concerned every time I can’t recall a name or place.

What have you heard about this? And if this is true, is it a risk for everyone? Are there any over-the-counter medications that might work as a substitute?

— L.G.M.

Dear L.G.M.: It is true that some studies have shown an increase in dementia risk with people who take proton-pump-inhibitor drugs like pantoprazole or omeprazole. It is also true that other studies haven’t shown an increase in risk.

Some experts think the apparent increase in dementia risk may be explained by an issue called confounding. People with early dementia may be more likely to be prescribed these kinds of medications due to other reasons, like the known increased risk of heart disease whose treatment sometimes calls for proton-pump inhibitors to be prescribed.

Early work has suggested a plausible mechanism (a change in metabolism of the amyloid and tau proteins thought to be responsible for Alzheimer’s), so it is possible that there is a real interaction. A different type of study design is necessary to answer the question definitively.

In the meantime, because of the possible effects of dementia and the known harms of long-term proton-pump-inhibitor risk, these drugs should only be used long-term when they are really necessary, such as in people with Barrett’s esophagus or people who have severe erosive damage to the esophagus.

Many people with occasional heartburn due to gastroesophageal reflux do very well with OTC medications like Zantac or Pepcid, which are less likely to cause long-term harm.

Finally, having difficulty with recall is a common phenomenon that does not necessarily indicate dementia.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.