Q: I've been diagnosed with early-stage melanoma. I want the best care possible. I've heard about individualized cancer diagnosis and treatment, but I am not sure what it means. Can you explain? — Sally H., Charlotte, N.C.
A: Absolutely. Because labs can now determine your tumor's DNA mutations and characteristics, doctors can ID the subtype of cancer you have and gauge which treatments and medications will combat it most effectively. At the Cleveland Clinic, Roizen's home base, as well as at other leading cancer-care and research centers, melanoma, breast cancer, colorectal and non-small-cell lung cancer tumor cells can be analyzed and the best treatment options then selected.
In the case of melanoma, DNA analysis of tumors lets new treatments be used early on, before the cancer spreads. Identification of patients with the BRAF gene – about half of melanoma cases are associated with it – makes certain therapies the best choice. And for the 50 percent of folks without that mutation, there's a new agent (ipilimumab, or ipi) that causes remission in up to 15 percent of patients.
There also have been advances in analysis of your own DNA, so you can find out if you have a certain genetic mutation. Discovery may lead you to make the most effective treatment choices or to reduce your risk for cancer, the recurrence of a cancer or development of a second cancer. For example, we know a faulty CDKN2A and CDK4 gene indicates that you're at greater risk for melanoma. And the BRCA-1 or BRCA-2 mutation signals an increased risk for breast, ovarian, prostate or pancreatic cancer.
And treatments are improving: Watson, the Jeopardy-winning IBM supercomputer, is being used to evaluate the overwhelming volume of cancer research so doctors can develop the most up-to-date, individualized treatments possible.
You should go to a cancer center that's recognized for excellence and ask about having your tumor's genes (and yours) analyzed to discover the exact nature of your condition. Then talk to them about treatment options. By the way, new data indicate that increasing your HDL cholesterol level may decrease melanoma spread and increase survival. Good luck!
Q: I put off getting my flu shot last year because they ran out and it wasn't available when I asked. I finally got the shot in January, but came down with the flu a week later. This year, are the shots going to be available earlier and work better? — Murray D., Fairfield, Conn.
A: Oh, there are big changes. First, they've developed two types of vaccines, which increases the supply. One is made in an egg culture, and the other is made without using eggs. Now, those who are allergic to eggs can be vaccinated safely. (You have to be 18 to 49, and you don't have to have the allergy to receive it).
And, for the first time, the vaccine works against four (not just three) influenza strains. In the past, vaccines have been 60 percent to 90 percent effective in preventing the flu, depending on how accurately scientist predicted which strains (H1N1, H7N9, etc.) would be most prevalent and should be put into the vaccine. Adding one more strain to the vaccine increases the likelihood it will help you dodge the flu.
So, Murray, if the vaccine you got last year didn't target a strain you were exposed to, well, hello flu! Also, it takes about two weeks after inoculation for your immune system to get fully ramped up to fight off the flu. Either of those reasons could be why you got sick.
Also: There's a new quadruple high-dose vaccine for folks ages 65-plus; it compensates for diminishing immune response that can happen as you age.
If you haven't received your flu shot by the time you read this, get it pronto. But remember, flu season in the U.S. and Canada can last until May. So, it's never too late to get the inoculation.