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DEAR DR. ROACH: My mother died of lung cancer at 62. For 12-18 months afterward, a sibling passed of a cancer or an unusual disease. Here's the list: lung cancer, uterine cancer, kidney cancer, pancreatic cancer, and Lou Gehrig's disease. All but the last sibling drank and smoked. Two sisters (nonsmokers) lived to the age of 90. So, I'm curious if this is familial or just related to them being smokers. -- B.A.

ANSWER: I am sorry to read this list, which I'm sure doesn't adequately express the pain of losing your family members.

Most cancers are sporadic, meaning that there isn't a clear underlying cause. However, there are medical conditions that predispose individuals to cancers. For example, Lynch syndrome predisposes people to uterine, kidney and pancreatic cancer, but the hallmark cancer of Lynch syndrome is non-polyposis colon cancer, which you haven't reported in your family.

Lung cancer is not a Lynch-associated cancer, and amyotropic lateral sclerosis (ALS, also called Lou Gehrig's disease) is not a cancer. So, they're not related to any familial cancer syndromes. I don't know of any familial cancer syndrome that is likely to explain these cancers.

Smoking, on the other hand, is strongly related to many cancers. Although I see far too many cases of nonsmokers with lung cancer, especially in women, smoking is the cause of 90% of lung cancers. Smoking also increases the risk of kidney cancer by 36% and pancreatic cancer by 2.5 times the risk. Smoking increases the risk of ALS, although this isn't an issue in your last family member's case. Smoking is not a risk factor for uterine cancer, which is mostly related to excess estrogen.

If the population were to quit smoking entirely, there would be a whole lot less cancer, but it wouldn't completely stop cancer. Better treatments and possibly better preventive and screening maneuvers will still be necessary.

DEAR DR. ROACH: I am a male, age 66, and often have hard stools and/or constipation. I have been a runner for over 40 years. I realize I don't drink enough fluids in the day. I have been taking one stool softener daily (100 mg of docusate sodium) with my vitamins. This routine seems to help.

Is it safe to do this every day, or should I reduce this to a few days a week? -- G.P.

ANSWER: The usual first-line treatment for constipation is to increase fluid and fiber in the diet. I rarely see people whose water intake is so low that they get constipation, but an extra glass of water might be beneficial for you, especially if you increase your fiber intake. You can get fiber easily through fruits, vegetables and cereals. Fruits have additional benefits due to nondigestible sugars, especially apples, peaches, pears, cherries, raisins and grapes. You can also use a fiber supplement, such as psyllium.

Docusate is a stool softener, and it works by allowing more water into the bowel movements. It is very safe, even for daily use. It has almost no side effects. It may not be as effective as fiber, but if it is working for you, there is no reason to change it.

Let me give a quick reminder that people over 45 are recommended to have a screening test, such as a colonoscopy, on a regular basis. Many people did not get this done during the pandemic, so be sure you are up-to-date.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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