Three-time melanoma survivor John McCain appears cancer-free, has a strong heart and is in otherwise general good health, according to eight years of medical records reviewed by The Associated Press.
The Republican presidential nominee-in-waiting remains at risk for developing new skin cancers, and gets a thorough check by a Mayo Clinic dermatologist every few months.
"I do not see any worrisome lesions," Dr. Suzanne Connolly concluded after McCain's most recent exam, on May 12.
The details of McCain's health are contained in 1,173 pages of medical documents spanning 2000 to 2008 that his campaign made available to the AP to make the case that he's healthy enough to serve as president, as well as to counter the notion that he's too old. The Arizona senator will turn 72 in August and would be the oldest elected first-term president.
Like many aging Americans, McCain takes medicine to keep his cholesterol in check.
But Mayo internist Dr. John Eckstein, his longtime personal physician, lauded McCain's performance on a heart stress test — sweating it out for 10 minutes when Eckstein routinely sees patients decades younger quit at five or seven minutes.
"I think physiologically he is considerably younger than his chronologic age based on his cardiovascular fitness," Eckstein said in an interview Thursday. "I got a call from the cardiologist who said that he had not seen anyone that age exercise for that long in a long time."
McCain's most recent exams show a range of health issues common in aging: He frequently has precancerous skin lesions removed, and in February had an early stage squamous cell carcinoma, an easily cured skin cancer, removed. He had benign colon growths called polyps taken out during a routine colonoscopy in March.
The Vietnam veteran has degenerative arthritis from war injuries that might mean a future joint replacement. His blood pressure and weight were healthy, and his cholesterol good but not optimal — and he switched medication from the controversial Vytorin that made headlines this past winter to a proven standby, simvastatin.
His likely Democratic rival, Barack Obama, will be 47 in August. Obama, lean and agile and a frequent basketball player, says he has quit smoking. Neither he nor Democratic opponent Hillary Rodham Clinton has released health records.
It is McCain's three bouts of melanoma, the most dangerous form of skin cancer, that raise the biggest health concerns. He has had four separate spots of melanoma removed from his head and arm on three occasions — in 1993, 2000 and 2002. Three spots were very early stage, when they were in the uppermost skin surface and easily cut out.
But one, on his left temple in 2000, was invasive melanoma, what doctors call an "intermediate risk" melanoma because of its thickness — 2.2 millimeters. McCain required delicate surgery to remove and examine lymph nodes that showed no sign of spread.
"We don't have a crystal ball, but we have no way to say anything at the present time would preclude him from running for office," said dermatologist Connolly.
The 10-year survival rate for that intermediate melanoma is 65 percent, said Dr. Stuart Lessin, director of the melanoma risk-assessment program at Philadelphia's Fox Chase Cancer Center, who was not involved in McCain's care.
"He's not cured," Lessin said. Still, the biggest risk of recurrence is in the first few years, so at eight years out, the chances of melanoma returning at that spot and killing him is "in the single digits," he added. "He's pretty much out of the woods."
But every bout of cancer increases the risk of another new cancer. Given McCain's fair skin and history of sunburns, mostly from the 5 1/2 years he was held outdoors while in Vietnamese prison camps, he has a 5 percent to 8 percent chance of developing a fifth melanoma, Lessin calculated. Good checkups, however, mean any future melanoma should be caught in time to treat successfully, he said.
Early on in the primaries, a number of voters said McCain's age was a problem, but recent surveys suggest it may not be as big an issue. An ABC News-Washington Post poll conducted in April found 70 percent saying McCain's age would not make any difference to their vote. Other recent polls found similar results, with two-thirds or more saying his age doesn't matter.
McCain has shrugged off the issue by highlighting his stamina and strong genes. He has recalled his "rim-to-rim" Grand Canyon hike in 2006; he has campaigned with his energetic mother, age 96. He was a two-pack-a-day smoker until quitting in 1980.
During his first presidential run, eight years ago, McCain disclosed hundreds of pages of records to reporters as he sought then to counter what aides called a "whisper campaign" questioning his mental fitness. In those records, medical personnel concluded that his years in prison, including solitary confinement, left him with no psychological wounds. Aides said McCain has had no mental evaluations in the past eight years and none was included in the documents.
This time, the AP examined the documents over several hours Thursday in a conference room of a resort just outside of Phoenix and a few miles from the posh Mayo Clinic in Scottsdale, where McCain receives most of his medical care under a pseudonym — which the AP was asked not to disclose. Coincidentally, the release came the same week that McCain's close friend, Sen. Edward M. Kennedy, revealed that he had a cancerous brain tumor.
The documents include very personal details, such as the fact that he had earwax removed earlier this year and the dermatologist showed McCain's wife, Cindy, how to monitor possibly suspicious skin spots hidden by his waistband. Though he's known as temperamental, the doctors made a point of repeatedly writing in the documents that McCain was "pleasant."
Also revealed: He has occasional momentary episodes of dizziness, when he gets up suddenly. McCain first told a doctor about them in 2000 — a visit that also uncovered the melanoma — and intense testing concluded they were harmless vertigo. He didn't report any episodes at his most recent exam.