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A new targeted treatment for early-stage breast cancer?

In the US, breast cancer is the most commonly diagnosed cancer in women, and the second leading cause of cancer-related deaths. Each year, an estimated 270,000 women — and a far smaller number of men — are diagnosed with it. When caught in early stages, it’s usually highly treatable.

A promising new form of targeted treatment may expand options available to some women with early-stage breast cancer linked to specific genetic glitches. (Early-stage cancers have not spread to distant organs or tissues in the body.)

The BRCA gene: What does it do?

You may have heard the term BRCA (BReast CAncer) genes, which refers to BRCA1 and BRCA2genes. Normally, BRCA genes help repair damage to our DNA (genetic code) that occurs regularly in cells throughout the human body.

Inherited BRCA mutations are abnormal changes in these genes that are passed on from a parent to a child. When a person has a BRCA mutation, their body cannot repair routine DNA damage to cells as easily. This accumulating damage to cells may help pave a path leading to cancer. Having a BRCA1 or BRCA2 mutation — or both — puts a person at higher risk for cancer of the breast, ovaries, prostate, or pancreas; or for melanoma. A person’s risk for breast cancer can also be affected by other gene mutations and other factors.

Overall, just 3% to 5% of all women with breast cancer have mutations in BRCAgenes. However, BRCA mutations occur more often in certain groups of people, such as those with triple negative breast cancer (TNBC), Ashkenazi Jewish ancestry, a strong family history of breast and/or ovarian cancer, and younger women with breast cancer.

Inherited BRCA mutations and breast cancer types

Certain types of breast cancer are commonly found in women with BRCA gene mutations.

  • Estrogen receptor-positive, HER2-negative cancer: Women with a BRCA2 mutation usually develop ER+/HER2- breast cancer — that is, cancer cells that are fueled by the hormone estrogen but not by a protein known as HER2 (human epidermal growth factor 2).
  • Triple negative breast cancer: Women with a BRCA1 mutation tend to develop triple negative breast cancer (ER-/PR-/HER2-) — that is, cancer cells that aren’t fueled by the hormones estrogen and progesterone, or by HER2.

Knowing what encourages different types of breast cancer to grow helps scientists develop new treatments, and helps doctors choose available treatments to slow or stop tumor growth. Often this involves a combination of treatments.

A new medicine aimed at early-stage BRCA-related breast cancers

The OlympiA trial enrolled women with early-stage breast cancer and inherited BRCA1/BRCA2 mutations. All were at high risk for breast cancer recurrence despite standard treatments.

Study participants had received standard therapies for breast cancer:

  • surgery (a mastectomy or lumpectomy)
  • chemotherapy (given either before or after surgery)
  • possibly radiation
  • possibly hormone-blocking treatment known as endocrine therapy.

They were randomly assigned to take pills twice a day containing olaparib or a placebo (sugar pills) for one year.

Olaparib belongs to a class of medicines called PARP inhibitors. PARP (poly adenosine diphosphate-ribose polymerase) is an enzyme that normally helps repair DNA damage. Blocking this enzyme in BRCA-mutated cancer cells causes the cells to die from increased DNA damage.

Results from this study were published in the New England Journal of Medicine. Women who received olaparib were less likely to have breast cancer recur or metastasize (spread to distant organs or tissues) than women taking placebo. Follow-up at an average of two and a half years showed that slightly more than 85% of women who had received olaparib were alive and did not have a cancer recurrence, or a new second cancer, compared with 77% of women treated with placebo.

Further, the researchers estimated that at three years:

  • The likelihood that cancer would not spread to distant organs or tissues was nearly 88% with olaparib, compared to 80% with placebo.
  • The likelihood of survival was 92% for the olaparib-treated group and 88% for the placebo group.

The side effects of olaparib include low white cell count, low red cell count, and tiredness. The chances of developing these were low.

The bottom line

Olaparib is already approved by the FDA to treat BRCA-related cancers of the ovaries, pancreas, or prostate, and metastatic breast cancer. FDA approval for early-stage breast cancer that is BRCA-related is expected soon based on this study. These findings suggest taking olaparib for a year after completing standard treatment could be a good option for women who have early-stage breast cancer and an inherited BRCA gene mutation who are at high risk for cancer recurrence and, possibly, its spread.

Follow me on Twitter @NeelamDesai_MD

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Caring for an aging parent? Tips for enjoying holiday meals

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The holidays are supposed to be a time of joy and celebration, and the meal is a centerpiece of the occasion. But when you’re a caregiver for an aging parent, the joy can be overshadowed by stress.

Whether you’re observing winter holidays — such as Hanukkah, Christmas, Kwanzaa, or New Year’s Eve — or holidays that fall during another time of year, take steps in advance to ensure that you and your loved one can enjoy the meal together with as little stress as possible. These tips can help.

Consider the dining schedule

Your mom or dad might normally eat at a different time than the planned holiday meal. If the meal times don’t match, give your parent a nutritious snack to stave off hunger, or find out if it’s possible to serve the holiday meal at a time that’s good for your parent. If other festivities are on the docket, consider that timing as well. Your parent likely has a limited amount of energy to spend visiting with others, so allow plenty of time to eat.

Serve your parent easy-to-eat food

Holiday meals often feature special-occasion foods that may be overly rich or hard for your parent to cut, chew, swallow, or keep on a fork or spoon. Talk about this beforehand, if that’s possible. Know which foods your parent should avoid, such as nuts. Serve safer choices in small amounts, and help by cutting up hard-to-eat foods before they come to the table or arrive on a plate.

Another option is serving something simple for your parent to eat that won’t need much supervision and won’t make a mess. Rice or fine pasta with vegetables, pureed beef or fish stew (no bones!), or mashed root vegetables and beans are some examples. If you’re not hosting the holiday event, ask if it’s okay to bring a meal that’s right for your parent.

Remember medicines

If your parent normally takes prescribed drugs at meals, don’t let this holiday be a time to get off schedule. Go over the medication list in advance and set a timer on your phone to remind you of dosing times.

Work in shifts with other guests

Have a conversation ahead of time with other guests who can help. When assisting a parent during a meal, you may not get much of a chance to eat your own food or chat with people at the table. Build in a break by arranging for another guest (perhaps a sibling) to take a turn helping out.

Plan the bathroom break

When you have to go, you have to go. And aging parents, like young children, sometimes need to excuse themselves mid-bite. A bathroom trip before the meal might reduce that risk, but it’s no guarantee. Work out in advance who’s going to assist your parent if nature’s call arrives during the meal.

Keep fluids handy

Make sure your parent is staying hydrated and getting enough fluids before, during, and after the meal. Also, keep an extra glass of water handy, and a straw if necessary, in case your parent is having a hard time swallowing food. Note also that moistened food is easier to swallow, so consider adding a little extra sauce to a parent’s meal.

Watch alcohol intake

While alcohol may be offered at the holiday meal, it doesn’t mean it will be safe for your parent. Alcohol consumption can lead to falls in older adults, and can interfere with medications. Ask your parent’s doctor if a little libation is allowed. such as a half-glass of wine. If not, consider offering your parent non-alcoholic beer, wine, or champagne if they’d like it. And mind your own alcohol intake: while you’re acting as a caregiver you’ll need to stay in control.

Arrange your parent’s exit well in advance

Gatherings can be tiring and stressful for older adults, and your parent might be ready to leave before the holiday meal officially concludes, especially if guests linger. Decide on a realistic exit time and let other guests know about it in advance, so everyone can plan accordingly.

If all goes well, you and your parent will both enjoy the holiday meal and wind up feeling the glow of meaningful family connection, sharing, and love — all of which are great for health.

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Anti-inflammatory food superstars for every season

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Berries and watermelon in the summer, kale and beets in the winter. The recipe for anti-inflammatory foods to enjoy can change with the seasons.

Your heart, your brain, and even your joints can benefit from a steady diet of these nutritious foods, and scientists think that their effects on inflammation may be one reason why.

Inflammation: How it helps and harms the body

Inflammation is part of your body’s healing mechanism — the reason why your knee swelled and turned red when you injured it. But this inflammatory repair process can sometimes go awry, lasting too long and harming instead of helping. When inflammation is caused by an ongoing problem, it can contribute to health problems. Over time, inflammation stemming from chronic stress, obesity, or an autoimmune disorder may potentially trigger conditions such as arthritis, heart disease, or cancer. It may also harm the brain. Researchers have found a link between higher levels of inflammation inside the brain and an elevated risk for cognitive decline and impairment. Regularly adding anti-inflammatory foods to your diet may help to switch off this process.

Three diets that emphasize anti-inflammatory patterns

Research hasn’t looked specifically at the anti-inflammatory benefits of eating foods that are in season. “But it’s generally accepted that eating what’s in season is likely to be fresher and obviously there are other benefits, including those for the environment,” says Natalie McCormick, a research fellow in medicine at Harvard Medical School. Eating foods that are in season may also help your grocery bill.

When it comes to anti-inflammatory foods, the goal should be to incorporate as many as you can into your overall diet. “Our emphasis now is on eating patterns, because it seems that interactions between foods and their combinations have a greater effect than individual foods,” says McCormick.

Three diets in particular, she says, contain the right mix of elements: The Mediterranean diet, the DASH diet, and the Alternative Healthy Eating Index. These diets are similar in that they put the emphasis on foods that are also known to be anti-inflammatory, such as colorful fruits and vegetables, whole grains, legumes, and healthy fats such as olive oil and nut butters. But just as importantly, these diets also eliminate foods — such as highly processed snacks, red meat, and sugary drinks — that can increase levels of inflammatory markers inside the body, including a substance called C-reactive protein.

Mixing and matching different foods from these diets can help you tailor an anti-inflammatory approach that fits your personal tastes, as can choosing the freshest in-season offerings. Whole grains, legumes, and heart-healthy oils can be year-round staples, but mix and match your fruits and vegetables for more variety. Below are some great options by season.

Winter anti-inflammatory superstars

In the cold winter months, think green. Many green leafy vegetables star during this season, including kale, collard greens, and swiss chard. Root vegetables like beets are another great and hardy winter option. Reach for sweet potatoes and turnips. Other options to try are kiwi fruit, brussels sprouts, lemons, oranges, and pineapple.

Spring anti-inflammatory superstars

When the spring months arrive, look for asparagus, apricots, avocados, rhubarb, carrots, mushrooms, and celery, as well as fresh herbs.

Summer anti-inflammatory superstars

Summer is prime time for many types of produce, and you’ll have lots of choices. Berries are a great anti-inflammatory option. Try different varieties of blueberries, blackberries, and strawberries. Go local with marionberries, huckleberries, gooseberries, and cloud berries, which grow in different parts of the US. Also reach for cherries, eggplant, zucchini, watermelon, green beans, honeydew melon, okra, peaches, and plums.

Fall anti-inflammatory superstars

Nothing says fall like a crisp, crunchy apple. But there are a host of other anti-inflammatory foods to try as well, such as cabbage, cauliflower, garlic, winter squash, parsnips, peas, ginger, and all types of lettuce.

Whenever possible, when you choose an anti-inflammatory food try to substitute it for a less healthy option. For example, trade a muffin for a fresh-berry fruit salad, or a plate of French fries for a baked sweet potato. Making small trades in your diet can add up to big health benefits over time.