DEAR MAYO CLINIC: Our neighbors were selling their home and had it tested for radon. The test was positive. Why should we be concerned about radon, and should we have our home tested too?

ANSWER: The positive test for radon in your neighbors' home has given you a heads-up that your home should be tested as well.

Radon is an odorless, invisible radioactive gas. It's naturally released from rocks, soil and water — and it can get trapped inside your home, office or school. There's no known safe level of radon. Unfortunately, there are no symptoms associated with radon exposure, unlike with carbon monoxide poisoning.

Why radon is so dangerous

Breathing high levels of radon over time can lead to lung cancer since this gas is a Class A carcinogen. It's the No. 1 cause of lung cancer in nonsmokers and the second-leading cause of lung cancer overall. Nationwide, 21,000 people die from radon-caused lung cancer each year.

Smoking and secondhand smoke, combined with exposure to high radon levels, increase your risk of lung cancer. If you or your family are experiencing breathing issues, consult with a pulmonologist.

Radon can be found in any home — old or new — and typically enters through cracks in the foundation caused by natural settling and windows. Radon levels often are higher in lower levels and basements. Across the U.S., 1 in 15 homes have elevated radon levels, and levels are higher in the Midwest. For example, radon levels range from 4.7 picocuries per liter of air (pCi/L) in Indiana to 9.6 pCi/L in North Dakota. The nationwide average is 1.3 pCi/L.

Testing for radon

There's a simple solution to this close-to-home health hazard: testing. That's what the Environmental Protection Agency urges all homeowners to do, especially those in high-radon areas. Testing is the only way to determine the radon level in your home.

You can find radon testing kits at hardware or other home maintenance stores and online. They cost around $20 or less and are easy to use. It typically takes two to seven days for results. Although there's no safe level of radon, look for test results of 4.0 pCi/L or less. 

If your home tests higher than 4.0 pCi/L, then you'll need to have a professional fix the radon issue, which includes installing venting equipment. The equipment looks like a big tube that reaches below the foundation of your home and vents radon up and out of the house. 

The cost of a radon mitigation system varies according to the size and design of your home, as well as the system being installed. Costs average $1,000-$2,000. Check with your local city and county housing agencies to see if they have funds available for low-interest loans or grants for radon mitigation, and learn if you're eligible for these funds.

Once the mitigation system has been installed, your home should be tested again to make sure the fix is effective. Even if your home passes the first test, you should retest every two years.

Also, radon testing isn't required when selling a home. However, if you're a buyer, you should insist on it. If levels are high, you may be able to negotiate the costs of the mitigation with the seller.

Radon testing and mitigation are investments in your home — and in your health.

Elizabeth Morton, Physician Assistant, Pulmonology, Mayo Clinic Health System, Mankato, Minnesota

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DEAR MAYO CLINIC: Our daughter was recently diagnosed with cancer. She's interested in participating in a clinical trial but doesn't really know what that means or how to get involved. Can you help?

ANSWER: A cancer diagnosis can feel overwhelming and often comes with a long list of decisions to make. 

Many people are surprised to learn that clinical trials aren't just for people who have run out of standard treatment options, but are an important part of cancer care at every stage and most aspects of diagnosis and treatment. They help physicians study new and better ways to diagnose, treat and improve the quality of life for people. They also give patients access to promising treatments that they might not otherwise receive.

What happens in a cancer clinical trial?

During a clinical trial, participants may receive specific interventions or potentially the standard treatment. Researchers measure how safe and effective the interventions are and usually compare them to standard treatments. These may include:

• New cancer drugs or drug combinations.
• New medical procedures or devices.
• New surgical techniques.
• New ways to use existing treatments.
• Lifestyle or behavioral approaches.

One of the biggest misconceptions is that joining a trial means you might not receive treatment or be given a placebo. Most clinical trials compare a new treatment with the current standard of care.

Who's eligible for a trial?

Your daughter’s care team is the best starting point. Feel free to ask if she is a candidate for any trial. Physicians at Mayo Clinic routinely review whether patients qualify for available trials. If there's a study that's potentially right for your daughter, your team can connect her with research coordinators and help navigate eligibility, consent, scheduling and next steps.

How do people find and sign up for trials?

Patients can find out about trials in several ways:

• Direct referral from their care team (medical oncologist, surgical oncologist, radiation oncologist, radiologist to name a few).
• Search tools, such as the Mayo Clinic clinical trials website and ClinicalTrials.gov.
• Trial navigators or research coordinators who help determine eligibility and guide enrollment.
  

When a clinician identifies that a patient may be a good candidate for a study, they review the study purpose, what participation involves, potential risks and benefits, and available alternatives. Patients can take time to decide whether to participate and may bring family members or caregivers into these conversations.

Clinic Trials Beyond Walls: Expanding who can participate

Participating in a clinical trial typically has meant frequent trips to a major medical center, which is something that can be difficult for people balancing work, caregiving responsibilities, transportation needs or facing financial strain. 

Mayo Clinic's Cancer Trials Beyond Walls is an initiative that brings elements of cancer clinical trials closer to home, such as lab draws, remote patient monitoring and virtual visits. This brings the benefits of research directly to patients' doorsteps and makes trial participation more manageable for families.

Mayo Clinic's decentralized research initiative uses telehealth, remote monitoring, mobile phlebotomy and home-based services so patients can complete parts of a clinical trial without traveling. 

The care of these patients being managed at home, with the support of a dedicated clinical team, may include vital sign monitoring, symptom reporting, medication administration or follow-up assessments.

Why do clinical trials matter so much?

Every cancer therapy available today exists because patients such as your daughter volunteered to participate. Volunteering for trials is a crucial way to advance medical treatment.

Joining a trial may give your daughter access to cutting-edge care and contribute to future breakthroughs.

Judy Boughey, M.D., Surgical Oncology, Mayo Clinic in Rochester 

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DEAR MAYO CLINIC: Heart disease runs in my family, and I really want to avoid developing it myself if I can. What heart-health habits should I consider starting in the new year?

ANSWER: When it comes to heart health, prevention still delivers the greatest return. Taking steps now — no matter how small — provides far greater benefits than managing heart disease later. Fortunately, there are many practical, sustainable ways to lower your risk, even if heart disease is common in your family.

A good place to begin is with the simple, everyday choices that influence your long-term cardiovascular health. To build healthier habits, start gradually. Improving your diet one step at a time, moving your body throughout the day and avoiding long periods of sitting can make a measurable difference. Small changes add up, and consistency matters more than perfection.

Emotional well-being also plays a vital role in heart health. Activities that bring meaning or connection, such as walking with a friend or focusing on purpose in daily life, can lower stress and support healthier behaviors. Caring for your emotional health isn't separate from caring for your heart; both are deeply interconnected.

Taking medications as directed is another key factor in preventing heart attacks or stroke. If you have been prescribed treatment for high blood pressure, high cholesterol or other risk factors, following your clinician's guidance and monitoring your numbers ensures those risks stay under control.

Heart-healthy steps to consider

Here are eight additional steps that can strengthen your heart-health plan for the year ahead.

1. Avoid tobacco.
Smoking or using smokeless tobacco damages the heart and blood vessels, and it lowers the oxygen available to your body, forcing the heart to work harder. The benefits of quitting begin almost immediately, and the risk of heart disease decreases significantly within a year.

2. Get moving every day.
Aim for 30 minutes or more of physical activity most days of the week. Brisk walking, cycling, gardening, taking the stairs and even brief movement breaks throughout the day all contribute to better cardiovascular fitness. National guidelines recommend at least 150 minutes of moderate or intense activity weekly, but any amount of movement is better than none. If you've been inactive, increase your activity gradually.

3. Follow a heart-healthy eating plan.
Diet affects many major risk factors, including blood pressure, cholesterol and blood sugar. Heart-healthy patterns such as the Mediterranean diet and DASH eating plan emphasize fruits, vegetables, legumes, fish, lean protein, low-fat dairy products, whole grains, and healthy fats like olive oil and avocado. Limiting salt, added sugars, refined carbohydrates, alcohol, saturated fat and processed foods, including processed meat, further protects your heart.

4. Maintain a healthy weight.
Excess weight, especially around your belly, raises the risk of high blood pressure, high cholesterol, type 2 diabetes, sleep apnea and heart disease. Even modest weight loss of 3% to 5% can improve blood sugar, triglycerides and overall metabolic health.

5. Prioritize quality sleep.
Adults typically need at least seven hours of sleep each night. Poor sleep is linked to obesity, high blood pressure, diabetes and heart disease. Maintain a consistent sleep schedule and a restful environment. If you snore loudly, wake up gasping or feel excessively tired despite adequate sleep, talk to your clinician about screening for obstructive sleep apnea.

6. Manage stress in healthy ways.
Chronic stress can elevate blood pressure and affect lifestyle choices. Techniques such as mindfulness, yoga, relaxation exercises, mindful breathing, physical activity and seeking social support can lessen stress and improve overall well-being.

7. Stay up to date with screening tests.
High blood pressure, high cholesterol and high blood sugar often develop silently. Regular screenings allow early detection and treatment. Your clinician can recommend how often to check your numbers based on your age and risk profile.

8. Prevent infections.
Good dental care and staying up to date on vaccinations reduce risks associated with infections that can harm the heart or worsen existing conditions.

While you can't change your family history, you can adopt many habits that strengthen and protect your heart. Start with small, manageable steps, stay connected emotionally, take medications as prescribed, and partner with your care team to monitor your health. 

Prevention is a powerful investment and the new year offers a perfect opportunity to begin.

Francisco Lopez-Jimenez, M.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I’m confused about prebiotics and probiotics. Could you help me understand what they are and how they could benefit my health?

ANSWER: You're not alone in wondering about the health benefits of prebiotics and probiotics. Even the names can be confusing.

The human gastrointestinal tract houses roughly 100 trillion microorganisms (good bacteria). These microorganisms make up what's called the gut microbiome.

These good bacteria fight off bad bacteria to help keep our intestinal tract healthy. 

Probiotics: Promoting digestion, benefiting health

Let's start with probiotics. Probiotics are living organisms, also known as microbes. They're primarily bacteria and yeast whose main role is to aid digestion and improve overall health. Probiotics help strengthen the gut barrier, aid in the absorption of nutrients, and replace less beneficial or harmful microbes. 

Research shows that probiotics can treat and even prevent conditions such as gastrointestinal (GI) tract infections, irritable bowel syndrome (IBS), lactose intolerance, allergies, cystic fibrosis, urogenital infections, diarrhea, high cholesterol, eczema and certain cancers. 

Probiotics also may support dental health by treating and preventing tooth decay, periodontal disease and bad breath. 

In addition to aiding digestion, another essential role of probiotics is promoting a healthy immune system and preventing chronic diseases. 

Some examples of probiotics include fermented foods, such as certain yogurts, many cheeses, pickled vegetables, apple cider vinegar, fermented teas and sauerkraut. Probiotic supplements also are available in pill or powder form. 

Prebiotics: Feeding probiotics

Prebiotics are the food for probiotics. They help feed the probiotics through fermentation and metabolization, which are beneficial to the gut. These microorganisms contribute to a variety of processes, including cell energy, immune function, hormone regulation, anti-inflammatory responses and bowel management. 

Research indicates that high prebiotic consumption may enhance our immune system, help regulate blood sugar levels, reduce the risk of colorectal cancer and increase calcium absorption. When good bacteria (probiotics) are fed an abundance of healthful food (prebiotics), our bodies will be healthier.

Prebiotics are found in foods that contain:

• Dietary fibers, which the body doesn't fully digest.
• Resistant starches, which are a form of carbohydrate that isn't digested in the small intestine. Instead, it ferments in the large intestine. 

The most common prebiotics are inulin, oligosaccharides and pectin, which are found in fibrous foods. Foods containing prebiotics include most fruits and vegetables — especially green bananas, asparagus and onions — as well as garlic, nuts, seeds, oats, barley, potatoes, and legumes such as soybeans, dried beans, peas and lentils.

Adding probiotics and prebiotics to your diet

Food composition changes with cooking, so to get the most benefit from prebiotics and probiotics, it's important to pay attention to cooking methods. For example, boiling potatoes is better than baking them. When potatoes are boiled and then chilled, they develop a white starchy film, which is the most beneficial part. Serving beans and legumes hot increases their starch content, which is good for your gut.

Eating most fruits and vegetables while they are fresh and raw will provide healthful prebiotics. 

Researchers suggest gradually introducing these foods into your diet. Adding a lot of new foods containing prebiotics and probiotics may produce gas, cause bloating and lead to gut discomfort.

Anne Harguth, Nutrition, Mayo Clinic Health System, Waseca, Minnesota

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DEAR MAYO CLINIC: I've heard that all the stress of the holidays can lead to a heart attack. What's the link, and what can I do to reduce my risk?

ANSWER: It's easy to get caught up in the stress and chaos that accompany the holiday season. For some women, their busy lives become even more hectic, and the result can be overwhelming. Also, women often ignore the symptoms of heart disease.

Heart disease is the No. 1 killer for women and men. More women die of heart disease than of breast cancer. Taking care of your heart health involves avoiding risk factors or behaviors that contribute to heart disease, recognizing symptoms, and seeking treatment.

Risk factors for heart disease

Traditional risk factors for coronary artery disease include high cholesterol, high blood pressure, smoking tobacco and obesity. However, nontraditional risk factors, such as stress, anxiety and depression, also affect heart health.

People often underestimate the negative effects that psychosocial stress can have on their heart health. Psychosocial stressors are life situations that cause unusual or intense stress, such as divorce, family conflicts, death of a loved one, prolonged illness or a natural catastrophe. 

Studies have shown that depression and psychosocial stress are associated with heart attacks. High stress levels also have been shown to negatively affect health recovery after a heart attack. It's important to address both traditional and nontraditional risks for heart disease and recognize that they affect men and women differently. 

How does stress lead to heart attacks?

Psychosocial stress can be short-term or long-term, and both types have been associated with heart disease. Exactly how stress leads to a heart attack is still being studied.

Emotional stress can lead to an increase in blood pressure, or hypertension, which subsequently leads to heart disease and plaque buildup in the coronary arteries. Emotional stress also can lead to increased levels of stress hormones, or cortisol. These hormones affect platelets and autonomic tone, which is how your body controls involuntary functions such as heart rate and blood pressure. All these factors play a role in heart disease.

Stress can also lead to unhealthy mechanisms for coping with stress, such as stress eating or substance abuse, and not exercising, which in turn can lead to heart disease.

Short-term, extremely stressful situations can cause severe but usually temporary heart failure. This condition is called broken heart syndrome, also known as takotsubo cardiomyopathy, apical ballooning syndrome or stress cardiomyopathy.

What are the risk factors for heart disease in women?

Women of all ages should take heart disease seriously. Women under 65, and especially those with a family history of heart disease, need to pay close attention to heart disease risk factors. These include:

• Diabetes.
• Mental stress and depression.
• Smoking.
• Inactivity.
• Alcohol consumption.
• Menopause, due to low levels of estrogen and developing menopause before 40.
• Pregnancy complications, such as high blood pressure or diabetes, or even premature delivery.
• Inflammatory diseases, such as rheumatoid arthritis or lupus.

What are heart disease symptoms in women?

Women and men are equally likely to experience chest pain, pressure or discomfort. But women are more likely to have other associated symptoms, including:

• Neck, jaw, shoulder, upper back or abdominal discomfort.
• Shortness of breath.
• Pain in one or both arms.
• Nausea or vomiting.
• Sweating.
• Lightheadedness or dizziness.
• Unusual fatigue.

If you experience chest pain with the symptoms mentioned above, call 911 right away.

Managing holiday stress

For many women, the holiday season brings the most cherished moments in their lives, but it also can be among the most stressful times of the year. Often this is because people carry expectations influenced by memories and societal pressures ― a smiling, happy family photo on holiday cards, the smell of grandma's home cooking at Hanukkah, seeing a Christmas tree lit or singing your favorite Kwanzaa song. 

These sights, smells and sounds of the season become measures of happiness and satisfaction. However, these visions don't always match reality, and that can lead to stress.

At any time, but especially during the holidays, the key to coping is setting realistic expectations. Take a few moments as a family to write down what would make the holidays an enjoyable time with those you love. And let go of the things that add stress and no joy.

Other lifestyle changes that can help curb stress during the holidays and throughout the year include:

• Increase physical exercise.
• Practice relaxation exercises.
• Make a connection to your spirituality.
• Seek professional help.
• Eat a healthy diet.
• Limit alcohol.
• Stop smoking.
• Monitor your heart health.
  

Niti Aggarwal, M.D., is a cardiologist in Mankato and Rochester, Minnesota.

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DEAR MAYO CLINIC: A friend just underwent a rotator cuff repair and is recovering well. But I was wondering, what if you get to a point where repairing the tear is no longer an option? Is there anything else that can help with pain and improve shoulder function?  And what about stem cells or this platelet-rich plasma I hear about?

ANSWER: Shoulder pain, weakness and loss of range of motion can keep you from the activities you need and love to do, whether it's lifting boxes on the job, putting away dishes in the kitchen or hitting that pickleball serve.

Wear and tear, injury, certain medical conditions, and age can take a toll on shoulder function. Oftentimes, surgery can be avoided, with many people responding well to nonoperative treatments, such as physical therapy or injections, to decrease their pain and improve the use of their shoulder. Sometimes, surgery to repair the torn tendons may be necessary.

But other times, the condition of your shoulder has advanced beyond those options. In the past, this may have resulted in chronic pain and debility. Now, there are new treatments designed especially for more advanced shoulder issues.

Inserting a balloon or patch for stabilization

When a rotator cuff tear is so severe that it can't be repaired, your orthopedic surgeon may use a subacromial balloon spacer. This small device is inserted into the space where the damaged rotator cuff lies using minimally invasive arthroscopic surgical techniques. Once in place, the device is inflated with saline to cushion and stabilize the joint. The balloon typically dissolves within six to 12 months. 

Alternatively, your surgeon may implant a special donated tissue graft to cover or "patch" the top of the ball part of your shoulder joint. This procedure, called a tuberoplasty, acts similarly to the balloon to provide a cushion in place of the rotator cuff. 

After surgery, a physical therapist will help you retrain your muscles to move the shoulder using more optimal mechanics. Recovery from these procedures tends to be faster since the tendons don't need to heal as they would in traditional rotator cuff surgery. You can return to your daily activities with improved function, range of motion and less pain.

Using 3D printing for shoulder replacement 

Reverse shoulder replacement is another surgical option for treating patients with severe arthritis, irreparable rotator cuff tears or other shoulder damage. By using specially designed implants, your surgeon can change the mechanics of the shoulder to allow other muscles to move it.

Since no shoulder is the same, how closely the replacement implant fits your shoulder's anatomy and how the implant is placed play key roles in the success of a reverse shoulder replacement. Your surgeon is able to choose from metal and plastic implants that are available in a few different shapes and a range of sizes. A 3D-printed model of your shoulder can help your orthopedic surgeon precisely place the implant. 

The process begins with a CT scan before surgery to create a 3D model of your shoulder on a computer. This allows your surgeon to see how the implant should be placed, how to preserve as much bone as possible and how to identify the best way to secure the implant. A 3D guide is printed that duplicates the template from the computer.

During surgery, your surgeon places the 3D guide on the bone so the implant can be placed precisely as planned.

3D modeling also helps your surgeon determine if you need a customized implant.

Creating a customized implant

In most cases, your surgeon can choose a standard implant that will give you the shoulder function you need. But for some patients, their anatomy or bone damage won't allow a standard implant to fit appropriately. An implant that doesn't fit well can fail, leading to more surgery. 

In these cases, an implant can be created to precisely fit a patient. Using a computer-generated 3D model, the custom implant designed for the patient is printed using the same materials as a standard implant. While this is only being used in special cases, it may become the standard in time.

Robotic surgery

While robotics have been used in many other surgeries, including hip and knee replacements, for some time, the use of robotic surgery in the shoulder is just beginning. The technology is new and specialized.  

As mentioned before, putting the implants in the right position is important, and the robot helps your surgeon do this exactly as planned. During a shoulder replacement, your surgeon can use a robot to help reshape the socket precisely to get the best placement and position of the implant to help provide you with the optimal outcome. Although this technology is new, it may become the future of shoulder replacement.   

Stem cells and biological treatments

Stem cells and other therapies such as platelet-rich plasma are new and promising treatment options known as regenerative medicine. These are often called orthobiologics as they are made from your own body’s substances. Stem cells are cells that have the potential to heal and transform into more specialized cells such as muscle, tendon or bone cells. They are harvested from tissues in the body such as blood or fat.  Platelet-rich plasma takes blood from your arm and separates out the red blood cells, keeping healing and anti-inflammatory factors.  

When injected, these therapies try to stimulate your own body's cells to promote a healing response in the tissue. They have shown potential benefit in treating pain from arthritis, helping heal and recover from tendinopathies or muscle strains, and improving healing after surgery. 

While both treatments show promise in helping to decrease pain and potentially improve healing, they unfortunately will not regrow cartilage or tendons, and they will not "cure" arthritis. But, hopefully, we can get there in the future.  

Though promising, the data is still inconclusive, and further studies are needed to determine the best uses for them. Additionally, since they are considered experimental, they are rarely covered by insurance and can be very costly.  

Wider spectrum of treatments customized for you

There are new options to provide a wide spectrum of treatments for patients with advanced shoulder issues. Having multiple options allows your orthopedic surgeon to choose the one that targets your specific issues to achieve the best outcome. 

Scott Kuzma, M.D., Orthopedics & Orthopedic Surgery and Sports Medicine, Mayo Clinic Health System, La Crosseand Onalaska, Wisconsin

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DEAR MAYO CLINIC: I understand surgery is often included as part of the treatment plan for breast cancer. If I'm a candidate for lumpectomy but am also considering a mastectomy, what are some things I should keep in mind? Should my breast density be a factor in my decision-making?

ANSWER: Women diagnosed with breast cancer are almost immediately confronted with treatment decisions. If your surgical oncologist gave you a choice between a lumpectomy and a mastectomy to remove a tumor, that's often because either option will lead to a similar long-term health outcome.

A lumpectomy is commonly known as breast conservation surgery because it keeps most of the breast intact, whereas a mastectomy removes the entire breast. Regardless of which procedure you choose, the risk of breast cancer recurrence is roughly the same.

Lumpectomy is a treatment option for early-stage breast cancer. Compared with a mastectomy, it's less invasive and tends to have a quicker recovery. It also can help preserve the cosmetic appearance and sensation of the breast. Your healthcare professional will recommend radiation therapy after a lumpectomy to reduce the risk of breast cancer returning in the breast.

A mastectomy removes the whole breast. In many cases, radiation therapy is not needed after mastectomy. Individuals with a genetic predisposition for breast cancer, such as the BRCA1 or BRCA2 gene mutation, may opt for a mastectomy as a preventive measure following their diagnosis.

After a mastectomy, some women choose to forgo reconstructive surgery, opting for what is called an aesthetic flat closure. There can be many reasons for this, including wanting to limit future surgeries, reducing risks and complications, and desiring a faster return to daily life and activities.

For other patients, having a breast mound is part of how they identify as women. Multiple types of breast reconstruction procedures are available following either a lumpectomy or mastectomy. Breast reconstruction surgery can occur at the same time as breast cancer surgery, or you can plan your reconstruction weeks, months or years after treatment.

The surgical technique and cosmetic outcomes after mastectomy and reconstruction have improved over the past 20 years. More women can keep their nipple and areolar complex and, in many cases, a procedure can be performed to help improve sensation to the nipple and areolar complex.

Breast density also could be a factor in your decision-making. About half of people who have screening mammograms have dense breasts. Dense breast tissue is harder to see through on a mammogram image. Having dense breast tissue should not affect one's decision to undergo a mastectomy or lumpectomy.

However, dense breast tissue may influence the need for additional tests before surgery, such as an MRI. An MRI looks for abnormal blood flow within the breast and can "see through" dense tissue. This may help surgeons better determine the extent of disease and guide them in the removal.

Ultimately, determining the option that is best for you is a nuanced decision that can be based on a variety of factors, including cancer-based reasons, family history and genetics, and peace of mind. Choosing which surgical route to take is deeply personal, and there is no one "best choice" for every woman. After careful consideration and consultation with your healthcare team, you should make the decision that you determine is best for you, based on the specifics of your cancer and your individual needs and preferences. — Sarah McLaughlin, M.D., Surgical Oncology, Mayo Clinic, Jacksonville, Florida

Related posts:

• Mayo Clinic leads 4 decades of advances in breast cancer care
• Mayo Clinic research improves dense breast cancer screening and early detection
• Top 10 questions about breast cancer answered
• Mayo Clinic treats first person in the US with a novel radiopharmaceutical therapy for breast cancer
• Mayo Clinic Minute: MRI for dense breasts — what to know

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QUESTION: I'm a guy in my late 40s and trying to pay more attention to my health. But I'm confused about whether I should be screened for prostate cancer. Can you help?

ANSWER: The importance of all health screenings is that they can detect issues early. Prostate cancer is one of the most common cancers in the world, and the second-leading cause of cancer deaths among men in the U.S. 

While many prostate cancers grow slowly and remain localized, other types are aggressive and spread quickly. Screening can find prostate cancer early, when it's still confined to the prostate gland. That's when patients have the best chance for successful treatment. If caught early (stage 1), the survival rate after five years is almost 100%. At stage 4, the survival rate is 37% to50% at the five-year mark.  

It's recommended that men begin talking about prostate cancer screening with a healthcare professional around age 50. During this discussion, you and your clinician will decide if the prostate-specific antigen test is right for you based on your personal risk level and age, as well as the chance of overdiagnosis or underdiagnosis, possible biopsy complications, and testing intervals.

The screening is relatively simple. The most common is a prostate-specific antigen, or PSA, test. It's conducted by your primary care clinician once a year. Here's what you need to know about the PSA test:

• It's a blood test used to measure the amount of prostate-specific antigen in your blood. 
• High levels may indicate the presence of cancer. However, other conditions may also increase this level.
• Screening intervals are personalized. Based on test results, men with low long-term risk may decide to discontinue testing or lengthen the time between tests. Those with higher PSA levels may require more frequent screening.

Who's at risk?

Risk factors include age, family history and race. 

Age: The risk for prostate cancer is highest beginning at age 50 or older.

Family history: If you have a blood relative who has or has had prostate cancer, a family history of genes such as BRCA1 or BRCA2 that increase the risk of breast cancer, or a strong family history of breast cancer, your risk may be higher. 

Race: In the U.S., prostate cancer is deadlier for Black men than for men of other races. They're more likely to get prostate cancer and more than twice as likely to die from it than other men. Black men should consider being screened starting at age 40.

Active surveillance

Not all prostate cancers need to be treated — some can remain under active surveillance. When prostate cancer is found early, it can be watched for many years. If it becomes aggressive, treatment can begin. In active surveillance, regular follow-up tests may be performed to monitor the progression of your cancer.

Treatment options

Along with active surveillance, a full range of treatments for prostate cancer is available, including radiation, hormone therapy, chemotherapy, cryosurgery and surgery, including robotic removal of all or part of the prostate.

Many patients who have just a few sites of metastatic disease, meaning that the cancer isn't widely spread, also can benefit from aggressive treatment. This treatment combines radiation and oral or IV cancer medication therapy to put the cancer into remission and extend the patient's life. 

Another radiation technique includes intensity-modulated proton beam therapy with pencil beam scanning. This localized treatment can minimize significant adverse events from the treatment.

Talk with your healthcare professional to learn more about prostate cancer screening and if it's right for you.

Mohammed Solaiman, M.D., Family Medicine, Mayo Clinic Health System, St. Peter, Minnesota

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DEAR MAYO CLINIC: I've read so much about the health benefits of tracking my steps. But there's a lot of confusing information out there. How many is the right number? Are some "steps" better for you than others? Please help.

ANSWER: Whether you're tracking steps with your phone, a smartwatch or an old-school pedometer, the result is the same: you'll have a good indicator of how much you're moving during the day. The best device for you is the one you'll use. With many devices, you can set up alerts and goals that remind you to move. And that's what counts. The ultimate goal is to move 150 minutes per week.

Reaping the benefits

You're right about the health benefits of getting in your steps. Here's what walking can help you do:

• Control your blood pressure.
• Lose or maintain weight.
• Improve balance and coordination.
• Increase core strength.
• Manage stress and improve mood by releasing endorphins.
• Manage your diabetes.
• Reduce the risk of a heart attack.
• Reduce the risk of developing type 2 diabetes.
• Stay strong and active.

Walking also has been shown to:

• Improve sleep.
• Slow mental decline.
• Lower the risk of dementia.
• Reduce the risk of some cancers.
• Help you lead a longer life.
• Maintain independent living into older age.

If you're on a medically assisted weight-loss journey, whether that's bariatric surgery or a GLP-1 drug, being physically active will help burn calories, build strength, maintain muscle mass and bone density, and promote sustainable weight loss. It also can help medications work better.

Tracking steps

Is there a magic number of steps for reaping these health benefits? Not really. If you can get in 10,000 steps a day, great. Research has shown that 10,000 steps a day can lead to reductions in premature death, with a majority of that reduction happening between 4,000 and 8,000 steps. After 10,000, you'll still see benefits, but they start to plateau. 

How you get your steps doesn't really matter. Walking has a cumulative effect on your body across your day. So whether you walk your dog for 15 minutes in the morning and 15 minutes at night, go for a brisk 30-minute walk or spend an hour moving around the house or working in the yard, those steps all count.

Getting started

The best way to start tracking your steps is to take it slow and steady. Listen to your body — it will tell you whether you're trying to do too much. Work more steps into your day by parking farther away from entrances, walking in place while you're waiting for the timer on the microwave to go off, and making multiple trips to bring in packages rather than loading up in just one. You may want to consider getting a walking pad and use it while watching TV or doing food prep in the kitchen.

Setting the pace

When you're advised to go for a brisk walk, what does that mean? "Brisk" is different for everyone. The average walking speed to aim for is 3 to 3.5 mph, which a device can help you measure. If you can walk faster safely, great. However, walking slowly is better than not walking at all and will still give you the benefits of moving your body.

The talk test is an easy way to identify a proper intensity. If you're able to talk but find it difficult to carry on a full conversation, that's "brisk" for you. You may not be out of breath, but your breathing is definitely elevated. New research indicates that brisk walking can boost brain function and well-being, as well as physical health.

Even if you're able to get in a little bit of walking every day, your body responds to this exercise, and you gain the benefits.

By Mackenzie Long, Physical Therapy/Sports Medicine, Mayo Clinic Health System, La Crosse and Onalaska, Wisconsin

The post Mayo Clinic Q&A: Health benefits of counting steps appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've read that following the Mediterranean diet is good for your heart, but I'm not quite sure why. If I decide to give it a try, how would I get started? 

ANSWER: Extensive research over the years continues to pinpoint the Mediterranean diet as one of the best for your heart. Why? It helps reduce chronic inflammation in the body.

Not all inflammation is bad, but once it becomes chronic, it can lead to heart disease, type 2 diabetes, dementia and cancer. One of the main risk factors for chronic inflammation is a high-fat, high-sugar diet. 

The Mediterranean diet is the opposite of that. And the best part is that eating healthy with the Mediterranean diet feels more like eating and living well. Basically, it's a model eating plan for good health.

What the Mediterranean diet does

Built around plant-based foods, the Mediterranean diet:

• Replaces harmful fats with healthy, monounsaturated fats, which have been found to lower total cholesterol and low-density lipoprotein, also known as LDL, or "bad" cholesterol levels.
• Includes food rich in antioxidants and phytochemicals that help reduce inflammation in the arteries.  
• Supports healthy blood pressure by stressing potassium-rich foods and decreasing salt intake.
• Promotes whole grains, legumes, fruits and vegetables, which are high in fiber, support gut health and reduce blood sugar fluctuations. 
• Encourages healthy weight because it focuses on nutrient-dense, satisfying foods that naturally curb overeating.

Change up what you eat

If you're interested in trying the Mediterranean diet, these tips will help you get started:

Aim for 2 to 3 servings of fruit and 4 or more servings of vegetables daily.  

Expand your fruit and veggie horizon with pomegranates, figs, grapes, peaches, nectarines, cantaloupe, spinach, kale, Swiss chard, and collard and mustard greens. Wander through a farmers market for local choices. Swap in fruits and veggies when you're craving a snack.

Opt for whole grains.

Switch to 100% whole-grain bread, cereal and pasta. Experiment with whole grains, such as bulgur and farro.

Add in nuts and seeds.

These foods are high in fiber, protein and healthy fats. Try to eat 4 servings of raw or unsalted nuts and seeds per week. One serving is ¼ cup.

Use healthy fats.

Try olive, avocado or grapeseed oil instead of butter when cooking. Rather than putting butter or margarine on bread, try dipping it in flavored olive oil. 

Eat fish twice a week.

Fresh or water-packed tuna, salmon, trout, mackerel, sardines, and herring, along with seafood such as shrimp, crab and mussels, are high in healthy omega-3 fats. Opt to grill, steam, or bake fish and seafood rather than frying it.

Reduce red meat.

Substitute fish, poultry, eggs, or beans and lentils for red meat. If you eat red meat, make sure it's lean, keep portions small — usually about 3 ounces of cooked meat — and eat it sparingly.

Don't forget dairy.

Eat low-fat Greek or plain yogurt, cottage cheese, milk, and a variety of soft cheeses. Try cheeses made from goat or sheep milk, such as chèvre and feta. Stir fresh or frozen fruit into yogurt to avoid added sugars. 

Spice it up.

Herbs and spices boost flavor and lessen the need for salt.

Drink wine, alcohol sparingly.

While red wine is often a choice in the Mediterranean diet, it's optional. If you do drink wine or alcohol, limit your intake to one glass or less each day. Light to moderate alcohol consumption may reduce heart disease risk, but it's generally not advised to start drinking alcohol or increase your consumption. Remember to include water, since it's the best fluid for your body.

Modify your lifestyle

While much of the Mediterranean diet revolves around healthy eating, a large part includes slowing down and savoring life — something most of us can benefit from for our well-being and mental health. 

The basics of Mediterranean-style eating include:

• Sitting down at a table for at least two lunches or dinners per week.
• Taking time over the meal, not eating and running.
• Eating with friends and family.
• Engaging in physical activity with a goal of at least 150 minutes of moderate intensity exercise per week.

Plenty of eating plans are out there, but the Mediterranean diet is a holistic approach that encompasses healthy, delicious food and lifestyle choices that promote well-being. Many people who switch to this style of eating say they'll never eat any other way again.

For more information, talk to your healthcare professional or a registered dietitian nutritionist.

Janet McCann, Registered Dietitian Nutritionist, Mayo Clinic Health System, Eau Claire, Wisconsin

The post Mayo Clinic Q&A: What makes the Mediterranean diet so healthy for your heart?    appeared first on Mayo Clinic News Network.