Health Mailbox

Q: Does sun lotion go bad? Each autumn, my wife discards our summer stock of lotions, some half full. At upward of $7 to $10 a tube, that seems like quite a waste. But she defends the practice with, "The stuff doesn't last." Is that true?

A: Sunscreen lotion does expire, but not as quickly as your wife thinks. The FDA requires sunscreen to be stable at its original strength for at least three years unless otherwise indicated by an expiration date. Lotions that carry specific expiration dates typically will last at least 18 months to two years after purchase.

Even so, dermatologists tend to be more conservative and suggest replacing old bottles every year just to be safe. It's important to buy lotions from reputable stores that restock regularly and don't leave ancient bottles sitting on the shelf. And look for sunscreens with Parsol 1789, also known as avobenzone, the active ingredient that blocks the broadest spectrum of harmful rays.

HEALTH JOURNAL Health Journal: Taking Viagra and Other New Treatments to Preserve Potency After Prostate Cancer You can e-mail Tara Parker-Pope at healthjournal@wsj.com.

But this isn't the end of the story. The fact that you have so much left over may be a sign that you aren't using enough in the first place. The rule of thumb is that it takes one to two ounces to cover an entire body. "If you're buying a six-ounce bottle you should go through that in less than a week," says Jon Starr, adjunct clinical assistant professor of dermatology at Stanford Medical School. "You should be using enough that you don't have the same bottle around year to year."

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Q: It seems every article about prostate-cancer detection and accompanying discussion of treatment options includes a negative adjective with the word "biopsy." In your article it was "unpleasant."

Why not just "biopsy?" I can attest the 15-minute procedure using small-diameter needles in soft tissue to obtain a dozen samples the size of angel hair pasta is not "unpleasant" or "uncomfortable." There are enough males already apprehensive about how to proceed when they need to make an informed decision.

A: Other readers have also chided me for describing a prostate biopsy as unpleasant. One man told me the procedure was much easier than he expected. "The level of discomfort was like being snapped by a rubber band six times," wrote R.B. of Granby, Colo. Given that I have no personal experience with the issue, I will certainly defer to these reader experts. Indeed, most doctors agree that a biopsy of the prostate itself isn't painful, but note that the stress and fear associated with the procedure is what makes it so unpleasant for many men.

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Q: I read your article about virtual colonoscopies. Can you tell me how to find centers that use the 3-D scans? Do you know if any of the other 3-D software programs from other companies are as good as the Viatronix?

A: In December, the New England Journal of Medicine reported that a three-dimensional virtual colonoscopy was just as effective for detecting polyps and cancer as regular colonoscopy. The technology that was used is available in about 50 centers around the country. For a list of centers, go to www.viatronix.com.

While the Viatronix software is the only one to have FDA approval for screening colonoscopy, the fact that a radiology practice uses the software doesn't automatically make it the best choice. It's important to note that many qualified radiologists use a combination of three-dimensional and two-dimensional scanning techniques for virtual colonoscopy. Personally, I believe the most important issue is the experience of the radiologist and whether he or she is performing scans in an academic research setting. In the NEJM study, some of the radiologists had seen more than 100 cases. And some highly experienced academic researchers are producing promising results with the most up-to-date two-dimensional technology.

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Q: Would you opt for the virtual procedure if you were faced with the choice?

A: Virtual colonoscopy isn't being developed to replace regular colonoscopy, or to give people a "choice" between the two procedures. Instead, the virtual scans are intended for people who need to be screened but are too apprehensive about the traditional procedure to consider it. The hope is that those patients will receive a virtual scan instead of doing nothing at all.

When the time comes, I will seek a regular colonoscopy with a skilled gastroenterologist. My reason is practical. If the doctor finds something, he or she can remove it during the procedure. If a polyp is detected in a virtual procedure, the patient has to get a regular colonoscopy anyway to have it removed.

© 2003 Wayne Hollopeter, M.D. All Rights Reserved
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