Trending
DEAR DR. ROACH: I recently read an article about a woman who had polycystic ovary syndrome (PCOS) and died from nonalcoholic fatty liver disease. The article seemed to infer a connection between the two conditions. I have PCOS. Should I be concerned that my doctor isn’t keeping an eye on my liver via a liver scan? How do I know if I’m at risk? -- A.A.
ANSWER: PCOS is an endocrine system disease that causes symptoms due to high amounts of androgen hormones, irregular menstruation, and a resistance to insulin. PCOS is common, with 10% to 13% of reproductive-aged women meeting the criteria for a diagnosis.
There’s absolutely a connection between PCOS and metabolic-associated steatotic liver disease (MASLD, the new name for what used to be called “nonalcoholic fatty liver disease”). Between 25% to 50% of women with PCOS have hepatic steatosis, which is nearly twice the rate than in women without PCOS.
MASLD is now the most-common chronic liver disease and leads to an increased risk for a series of progressive liver conditions: steatosis without fibrosis, fibrosis, steatohepatitis (MASH), and finally cirrhosis. Once a person has cirrhosis from any cause, they’re also at risk for liver cancer (hepatocellular carcinoma).
Screening is widely recommended, but I don’t think that all general physicians habitually screen all their at-risk patients (including PCOS patients). Self-advocating is wise; however, a liver scan isn’t the first general recommendation. In people with known or suspected hepatic steatosis and no other known cause of liver disease, then a test called the FIB-4 can help guide whether a scan is necessary.
It’s an easy test to calculate, and many or most patients will have all the parts of the test already done. If not, they’re easy to obtain. An abnormal FIB-4 test can guide a clinician to recommend further evaluation with a liver scan (“elastography”) or a referral to an expert in liver disease.
In addition to PCOS, other conditions that should prompt a clinician to consider a FIB-4 test include excess alcohol use; obesity with another risk factor such as high blood pressure or cholesterol; Type 2 diabetes or prediabetes; or persistently elevated liver-enzyme blood tests. This is a lot of people who should be considered for screening. A normal test should be repeated as often as every year in people who are at a higher risk and every few years in people who are at a lower risk.
DEAR DR. ROACH: If you had a school-age son, would you allow him to play organized football? Why or why not? -- P.G.
ANSWER: I don’t recommend high-school football, as the risk of injury is significantly higher than in other sports. The risk of concussion from playing four years of high-school football is about 25%, and the risk of a musculoskeletal injury is about 80%. Many of these injuries are relatively minor, and unlike professional and even college football, there fortunately doesn’t seem to be a risk of chronic traumatic encephalopathy among those who play at the high-school level.
As a parent, however, I recognize that the children themselves have a say in the matter. If I’d had a child who really wanted to play high-school football, it would’ve been a difficult decision. I recognize the physical and social benefits of sports but would attempt to convince my child to try a different sport.
Limiting full-contact practice and coaching according to the Heads Up Football program has been shown to reduce the risk of injury significantly, and a coach who uses this would make me less likely to forbid my child from playing football.
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. (c) 2026 North America Syndicate Inc.
All Rights Reserved