Dear Doctors: I keep hearing different things about at what age and how often a woman should be getting a mammogram. Can you please go over the latest advice?

Dear Reader: It’s true that screening guidelines regarding mammography have changed in recent years. These shifts arise when ongoing research, and the collection of data, suggest a new screening approach that is safer for the patient, or one that offers a better outcome. Various organizations, such as the American Cancer Society, the U.S. Preventive Services Task Force and the American College of Physicians, have slightly different guidelines. To avoid confusion, we’ll focus on the newest advice from the American Cancer Society, released in 2015, and then talk about the specific reasons these guidelines changed.

Women between the ages of 40 and 44 years should have the choice to begin having annual mammograms. Those who wish to do so should speak with their health care provider about the potential benefits and risks. For women between the ages of 45 and 54, the American Cancer Society recommends getting a mammogram each year. Starting at age 55, the organization recommends switching to having a mammogram every other year. However, women can still make the choice to continue annual yearly screenings. Women who are 55 and older should continue to have biennial breast cancer screenings if they are in good health and are expected to live another decade or more.

It’s important to note that these guidelines are for women of average risk. This means they don’t have a family history of breast cancer and have not tested positive for certain genes that are associated with elevated risk for breast cancer. Women who are considered to be at high risk for breast cancer are advised to get a mammogram and an MRI each year. Women with dense breasts, which can affect the accuracy of a mammogram, should discuss the potential efficacy of screening with their health care provider. And don’t forget, adult women of all ages are urged to perform a breast self-exam at least once each month, and to also have a clinical breast exam performed by a health care professional every year.

Although very rare, breast cancer can occur in men. It often presents as a firm lump beneath the nipple. Men with this symptom should see their doctor.

Changes to breast cancer screening guidelines were adopted because of a growing body of evidence that the disease occurs less often in women in their early 40s. Because their breasts are denser, younger women are at increased risk of receiving a false positive result in a mammogram. This would not only cause the woman unnecessary anxiety but would also lead to a range of follow-up procedures. Another concern was over-diagnosis -- that is, the discovery of a cancer that didn’t pose an immediate risk but would then lead to surgery, such as a lumpectomy, and possible follow-up treatments, such as radiation or hormone therapy. The risks of early annual screenings were therefore seen to outweigh the benefits. Ultimately, though, decisions about screening rest with the patient and her health care provider.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: A friend had to get one of his cervical discs replaced because it got damaged from surfing. He was surprised when his doctor said that getting a new disc is also why a constant itch along his right forearm finally went away. What’s the connection? Why would neck surgery fix that itch?

Dear Reader: You’re referring to a condition known as brachioradial pruritus. Pruritus is just a fancy word for itchiness. Brachioradial refers to the source of the itch -- a certain muscle located in the forearm. Known as the brachioradialis, it flexes the forearm at the elbow. Taken together, the term brachioradial pruritus refers to localized itching, tingling, burning or stinging sensations that run along the outer part of the forearm. It can affect one or both arms and, in rare cases, the itchiness can spread to the neck, shoulders and even the lower leg. The condition is more common in women than in men, particularly those with lighter skin tones, and it occurs most often between the ages of 45 and 65. Instead of irritants that directly affect the skin, the itchiness from this condition arises due to a nerve disorder. That’s why scratching the area won’t alleviate the itch. Some people with the condition have reported that scratching only makes the itchiness worse.

The exact cause of brachioradial pruritus isn’t quite clear. However, it’s generally understood to be related to spinal problems that affect the nerves that animate the arm. Conditions such as osteoarthritis, in which the cartilage of the joints wears away, or a herniated disc, as in your friend’s case, can lead to brachioradial pruritus. Sun damage appears to play a role, as well. Prolonged exposure to UV light from the sun, which can damage certain nerve fibers in the skin, may cause increasing sensitivity to sensations of pain and itch. Studies have indicated that people who take part in a lot of outdoor activities -- like tennis or golf, which expose them to the sun and, thus, to ultraviolet light -- may be at increased risk of developing the condition. Some theories suggest that brachioradial pruritus is caused by a combination of nerve damage and UV exposure.

Diagnosis includes a physical exam to pinpoint the location of the itching. This is usually followed by imaging tests, such as an MRI or an X-ray, to identify the presence of any spinal abnormalities. Treatments vary. Some people are helped by using ice packs on the affected areas. Topical products, such as cooling menthol creams or local anesthetic creams, may be prescribed. Physical therapy to stretch and strengthen the spine can also bring relief.

In your friend’s case, it appears that the herniated disc in his cervical spine had compressed a nerve. That, along with spending so much time in the sun while surfing, put him squarely in the at-risk category for the condition. In the course of replacing the damaged disc, his surgeon was able to release the pinched nerve, which allowed the maddening itch of brachioradial pruritus to abate.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I know that processed foods aren’t good for me and should be avoided, but I still have some questions. Could you please explain why they are unhealthy and provide some specific examples of such foods?

Dear Reader: Any food, when it’s changed from its original form, can be considered to be processed. That includes chopped spinach in the frozen food aisle, yogurt in the dairy case or whole-grain bread from your local bakery. To set apart the highly manipulated, salty, fatty and sugary foods we’ve grown to love and crave, they’ve been given a category of their own: “ultra-processed” foods. These include the flavored puffs and chips in the snack aisle, luncheon meats, manufactured ice cream products, processed cheeses, boxed baking mixes, many prepackaged frozen entrees, the majority of fast food menus, candy, sodas and other sugary drinks, instant noodles, energy drinks and even so-called energy bars, to name just a few.

Ultra-processed foods have gone through multiple steps, such as milling, grinding, dehydrating, frying, rolling, rehydrating and extruding. They also include a wide range of additives, which are used to arrive at a product that is markedly different from the original forms of its ingredients. Added salt, fats and sugars amp up flavor. Dyes are used to achieve a specific look. Ingredient lists often end with tongue twisters of chemicals used to create a specific texture or mouthfeel, and to prevent spoilage. Food industry whistleblowers have long claimed that many ultra-processed foods are carefully formulated to spark cravings, encourage overeating and create brand loyalty.

When eaten in moderation as an occasional treat -- heavy emphasis on “moderation” and “occasional” -- these types of foods can be fine. It’s when they become dietary staples that problems arise.

Our bodies are complex mechanisms. It takes a wide range of fresh foods to deliver the vitamins, minerals and other nutrients needed for optimal health. But ultra-processed foods are often low in fiber and nutrients. Many lean so hard on added salt to punch up flavor that a single serving puts a serious dent in your daily sodium budget. The empty calories of ultra-processed foods deliver unhealthful amounts of fat, salt and sugar, and they replace the healthful whole foods that truly feed the body. We now know that eating a diet high in these types of foods is linked to a range of illnesses, including increased risk of Type 2 diabetes, heart disease, stroke, obesity, depression, digestive issues, cancer and early death.

That said, it’s also important to be realistic and find a diet you’re able to follow long-term. Eating is pleasurable, and snack foods can be tasty and fun to eat. With that in mind, we advise our patients to aim for a diet that’s 80 percent good, 20 percent cheat. For those with existing health issues, such as diabetes or hypertension, scale that back to 90 percent good and 10 percent cheat. Focus on healthful eating, but allow yourself the occasional naughty detour. You’ll arrive at a dietary plan you can sustain -- and that sustains you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)