Jolie underwent what’s called a prophylactic double mastectomy. That means she had both of her breasts removed even though she hadn’t been diagnosed with breast cancer. She said she did this because she carries a gene, called BRCA1, that significantly increases the odds of developing breast or ovarian cancer.

A related gene, BRCA2, also greatly boosts the chances of developing breast cancer. (Men with these mutations also have an increased risk of breast cancer.) You can learn more about BRCA1 and BRAC2 at the National Cancer Institute’s website.

In the general population, about 12 out of 100 women (12%) will develop breast cancer at some point during their lives. Among women who have inherited a harmful mutation in BRCA1 or BRCA2, 60 out of 100 (60%) will develop breast cancer. Women who have at least two close relatives—a mother, sister, or daughter—who have had breast or ovarian cancer are also at much higher risk. (Jolie’s mother died of ovarian cancer at age 56.) These women are good candidates for prophylactic mastectomy.

Some women, like Jolie, undergo prophylactic mastectomy before they have ever been diagnosed with breast cancer. Others have both breasts removed when a tumor is found in one breast.

The use of prophylactic mastectomy doubled between 1998 and 2005, according to a report in the journal Current Oncology Reports, and is likely still rising. One reason is more widespread use of genetic tests for BRCA1 and BRCA2.

It’s also possible that high-visibility celebrities who undergo prophylactic mastectomy because they are at high risk for developing breast cancer, like Jolie and Sharon Osbourne, and those like Christina Applegate, who had a double mastectomy after a tumor was found in one breast, are making women more aware of this option.

Get good information

If you or a loved one has been diagnosed with breast cancer, it’s important to take some time to weigh your options. A University of Michigan study showed that nearly three-quarters of women who opted to have prophylactic mastectomy were actually at very low risk of developing cancer in the healthy breast. According to the researchers, those women didn’t have a good medical reason for doing it and were “not expected to benefit in terms of disease-free survival.”

That’s not to say their decisions were wrong. They made the best personal choices for their physical and mental health. About 90% of the women who had a preventive mastectomy said they were “very worried” about facing cancer again, and the prophylactic mastectomy eased this fear. A new study from the University of Pittsburgh indicates that most women who undergo prophylactic mastectomy were glad they did it and would recommend to other women in their situation.

But the University of Michigan research suggests that women diagnosed with breast cancer be given more and better information about their chances of developing cancer in the other breast and about the risks and benefits of prophylactic mastectomy. All surgery carries the risk for complications and the recovery for mastectomy—and reconstructive surgery should a woman opt for that—take a toll, albeit usually a temporary one.

Taking time to make the decision, and talking it over with a trusted and knowledgeable expert, is an important part of the decision-making process. Having as much information as possible before choosing prophylactic mastectomy is as empowering as making the decision itself.

What is driving this migration to retail health clinics? “For the majority of patients it is convenience,” says lead study author, Dr. Ateev Mehrotra, associate professor of medicine at the University of Pittsburgh and health policy researcher at the nonprofit RAND Corporation (he’ll be joining Harvard Medical School’s Department of Health Care Policy in June). You can walk into a retail health clinic without an appointment, and many clinics are open nights and weekends. In fact, nearly half of the visits in the study were on the weekends or other off-hours when doctors’ offices are typically closed.

The other attraction of retail health clinics is price, Dr. Mehrotra and his colleagues found. “Not the actual price, but the transparency of the cost,” he says. Clinics offer a menu of prices and services, which means there are fewer surprises when the bill arrives. And health insurance covers all—or a percentage of—the costs of services provided at these clinics, just as it does for care delivered at a doctor’s office.

As consumers increasingly turn to retail health clinics, the number of clinics has grown to meet demand—up to 1,423 this year and an estimated 3,200 by the end of 2014. And the types of services they offer has expanded beyond immunizations and common ailments such as strep throat and sinus infections. Last month, for example, Walgreens’ announced that its Take Care Clinics will now help manage chronic conditions such as high blood pressure, diabetes, high cholesterol, and asthma.

Quality comparison

Retail health clinics are often staffed by nurse practitioners instead of doctors. That’s not an issue for people who are visiting for routine vaccinations or an antibiotic prescription for an ear infection—but are these clinics equipped to manage chronic conditions?

The research comparing nurse practitioners with doctors on several measures of care has been reassuring, Dr. Mehrotra says. “People who went to the nurse practitioner did just as well as those who went to a doctor.”

In some aspects of care, retail health clinics may actually outperform physician’s offices. “Whatever they do is guided by evidence-based protocols,” says Regina Herzlinger, Nancy R. McPherson Professor of Business Administration at Harvard Business School, and author of Who Killed Health Care? Not only are nurse practitioners required to follow specific care guidelines, but they must also keep meticulous records on the care they’ve provided, she says. “They have a record of what they’ve done that’s very detailed.”

A key outstanding question is whether visiting retail health clinics might interrupt continuity of care between doctors and their patients. Dr. Mehrotra found that individuals who received care at a retail clinic were less likely to follow up within the year with their primary care doctor, although that lack of follow-up didn’t seem to affect the quality of care they received overall.

In the retail health clinic setting, the burden of continuity in record keeping often falls on the patient. Although clinics can send health records to a patient’s primary care doctor, there’s a good chance the two offices use incompatible electronic medical record systems, rendering the clinic’s records unusable to the physician. “It’s really up to the patient to make sure that the excellent records these retail medical clinics keep is embedded in their personal health record with their primary health care provider,” Professor Herzlinger says. Getting a printed copy of your record from the retail health clinic and bringing it to your doctor can help prevent any discontinuity of care.

Retail health clinics in the future

Today, retail health clinics are most appropriate for people with simple, acute health conditions such as a respiratory or urinary tract infection. “It’s generally people who don’t have a primary care doctor and who overall are healthier,” Dr. Mehrotra says.

That target group might change as more retail clinics expand their services to offer chronic disease care, and as the number of primary care doctors shrinks. “There is a tremendous shortage of primary care doctors,” says Professor Herzlinger. “Many of the people who use these clinics don’t have physicians, and can’t get physicians.”

What will happen to retail health clinics as the Affordable Care Act rolls out and the number of insured Americans rises? “We can only speculate,” Dr. Mehrotra says. “My own instinct is that as more people get insurance, they will increase the demand for primary care physicians. Given our fixed supply of doctors, wait times are likely to go up. This may drive demand to retail clinics.”

Angina occurs when an artery that nourishes part of the heart, a coronary artery, becomes clogged with cholesterol-filled plaque. Most of the time enough blood flows past the plaque. But when the heart needs to work harder, say when climbing a flight of stairs, the plaque prevents extra blood from reaching that section of the heart.

Doctors often use the term “typical angina” to describe the angina symptoms that men relate. Symptoms more commonly described by women have been dubbed “atypical angina”—suggesting that women are somehow experiencing an unusual manifestation of heart trouble.

The use of different terminology only adds to the mistaken perception that coronary heart disease is a man’s disease, says Dr. Catherine Kreatsoulas, a heart and stroke research fellow at the Harvard School of Public Health. “By the time they’re age 70, men and women have equal rates of heart disease,” she says. “And then women surpass men.”

Gender bias

To explore gender differences in angina symptoms, Dr. Kreatsoulas and her colleague looked at the terms that men and women use to describe angina pain. Both women and men in the study used terms like “chest pain,” “pressure,” and “tightness.” It wasn’t that women experienced different symptoms than men. Instead, they sometimes used different language to describe the same symptoms.

When women used terms like “pressing” or “crushing” instead of the more straightforward “chest pain,” it was because “they wanted to give the doctor a deeper understanding of the type of chest pain they had. They were very explicit and very descriptive in their language,” Dr. Kreatsoulas says. But, she adds, many women “are really exhibiting typical angina symptoms.”

This work, published online this week in JAMA Internal Medicine, brings up a very important point, says Dr. Paula Johnson, associate professor of medicine at Harvard Medical School and chief of the Division of Women’s Health at Brigham and Women’s Hospital. “People may describe similar symptoms in different ways, and we [doctors] have to be competent in our ability to hear patients and understand the language they use.”

Consider all possibilities

It’s important to keep in mind that this was a small study, cautions Dr. Johnson. To prove definitively that women’s symptoms are no different than men’s would require a much larger study. Also, Dr. Kreatsoulas and her colleagues looked only at one type of coronary artery disease—the kind caused by plaque obstructing blood flow to part of the heart. Women are actually more likely to have non-obstructive coronary heart disease—heart disease that occurs with little or no plaque visible in the arteries. To diagnose women accurately “requires understanding the range of symptoms, and also understanding what the disease may look like in women,” says Dr. Johnson.

Although men and women generally have the same angina symptoms, there are no absolutes. In addition to the more common chest pain, pressure, tightness, and heaviness, there are less common signs that may signal angina. These include:

• unusual shortness of breath
• unusual fatigue
• unexpected sweating
• unexplained weakness

By any name or description, chest discomfort is crucial for women—and their doctors—to pay attention to. Dr. Kreatsoulas says she hopes her research will help undo the gender bias that currently exists in diagnosing angina. “We want to abolish the term ‘atypical angina,’” she says. And that means acknowledging the possibility of angina no matter how a women describes suspicious chest-related symptoms.

Chelation therapy is an FDA-approved therapy—for treating mercury, lead, and other types of heavy-metal poisoning, as well as for iron overload (hemochromatosis) and some types of anemia. A chelating agent infused into the bloodstream binds to these toxins. The kidneys filter out the chelating agent and bound metals, which are then urinated away.

How might chelation therapy work for heart disease? The theory is that the chelating agent (usually ethylenediaminetetraacetic acid [EDTA]) binds to calcium in fatty plaques lining arteries. When it pulls out the calcium, plaque is supposedly swept away too, clearing arteries in much the same way that a drain cleaner opens clogged pipes. It’s a wonderful analogy, but one that hasn’t been backed by solid science.

Questioning TACT

Whether chelation therapy actually works for heart disease was the focus of the 10-year, $31 million Trial to Assess Chelation Therapy (TACT) funded by the National Institutes of Health. The TACT results appear in tomorrow’s JAMA. The trial, which included only people who’d had heart attacks, found that chelation therapy slightly reduced the risk of heart problems—especially the need for bypass procedures. A home run for chelation therapy? Not according to the three top editors at JAMA. In an unusual editorial accompanying the TACT paper, the editors say that the results “should serve to dissuade responsible practitioners from providing or recommending chelation therapy for patients with coronary disease and should discourage patients with previous MI [heart attack] from seeking this therapy with the hope of preventing subsequent cardiovascular events.”

In fact, the TACT has been embroiled in controversy since it was proposed. It has been challenged on grounds ranging from possible ethics violations to the safety of the chemicals used in the research. Even experts who haven’t quarreled with the study’s methods question the meaning of its results.

“The reason why we’re so uncertain about what to conclude is this chelation mixture had many components to it. It wasn’t just chelating agents,” says Dr. Elliott Antman, professor of medicine and Associate Dean for Clinical/Translational Research at Harvard Medical School. In addition to the main chelating chemical, EDTA, the infused solution contained vitamins, magnesium chloride, potassium chloride, and a cocktail of other ingredients. “We don’t know which of these components is contributing to the results,” he says.

Also unclear is why the benefit from chelation therapy was almost exclusively confined to people with diabetes. The combined uncertainties surrounding this trial make it too tenuous to use for making heart disease treatment recommendations. “On the basis of this trial, we do not feel that chelation therapy is ready for clinical use,” Dr. Antman adds.

Costs—and risks

More than 100,000 Americans with heart disease use chelation therapy each year, no doubt drawn by the health claims made by its practitioners. Yet this treatment doesn’t come cheap—or without safety risks.

Each treatment costs $75 to $125, and people often undergo dozens of these three-hour-long infusions over a period of several months. All in all, a treatment course can exceed $5,000—and it isn’t typically covered by health insurance. That would be money well spent if it truly prevented heart attacks and strokes. But neither TACT nor prior studies suggest that’s the case.

Then there are the side effects, which can range from headaches to a drop in calcium and blood pressure levels. In rare cases, people who’ve undergone chelation therapy have been left with permanent kidney damage.

“We don’t know what the implications of chelation are in a person who has a normal heavy metal balance in the body, and whether we are potentially shifting something in a way that might be harmful,” Dr. Antman says.

No substitute for healthy living

When it comes to heart disease, no treatment—whether it comes in a pill, surgical procedure, or infusion—takes the place of healthy living. “One of the things that’s most concerning here is that individuals rely on chelation therapy instead of adhering to evidence-based recommendations,” Dr. Antman stresses.

Those recommendations are encapsulated in “Life’s Simple 7,” seven lifestyle changes from the American Heart Association that have been proven to improve heart health:

1. Get active
2. Control cholesterol
3. Eat better
4. Manage blood pressure
5. Lose weight
6. Reduce blood sugar
7. Don’t smoke

“It doesn’t have to be hard,” Dr. Antman says. “It’s a commitment over the life term to live a heart-healthy lifestyle.”

These “unusual” symptoms are actually quite common. They can mask depression—and delay an important diagnosis—especially in older people. “Sometimes it’s hard to diagnose depression in older adults because they don’t come in and say, ‘I’m depressed.’ They’re more likely to present with physical symptoms that they don’t connect with what they’re feeling…pain, memory problems, poor sleep, a change in appetite,” says Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance and assistant professor of medicine at Harvard Medical School.

She’s even seen people fall more frequently because they’re depressed. The connection might not seem logical, until you consider that depression can make people more inattentive to their surroundings.

Older people in particular—and older men especially—display their depression in unusual ways. “Older men are more likely to present with irritability or grumpiness as a symptom of depression than women,” says Dr. Fabiny. “So the stereotype of the grumpy old man could be a sign of a depressed old man.”

A new report from the Centers for Disease Control and Prevention shows that depression is more common among women (10.7% of adult women) than men (7.7% of adult men). And though depression tends to peak between ages 45 and 64, it can emerge at any time of life.

Older men and women with depression often don’t want to talk about it because their generation still harbors a stigma about mental illness. “Older people still have the idea that, ‘I’m not crazy. I don’t want people to think I’m crazy,’” Dr. M. Cornelia Cremens, assistant professor of psychiatry at Harvard Medical School, told me last year for an article in the Harvard Women’s Health Watch.

Dr. Fabiny says she often doesn’t say the word “depression” when talking to her older patients. Instead, she’ll use terms like “sad” or “blue.”

To diagnose depression, she’ll look for signs other than sadness, including:

• trouble sleeping
• lack of energy
• fatigue
• trouble concentrating or remembering
• loss of appetite
• aches and pains that don’t go away

Because of the stigma, Dr. Fabiny says her older patients are more willing to take medicine to treat their depression than meet with a psychologist or psychiatrist. Yet antidepressants tend to be less effective in older adults, they can take up to three months to start working, and the risk of side effects is greater. “Research has shown that a combination of medication and psychotherapy [talk therapy] is really the most effective,” Dr. Fabiny says.

Any treatment, though, is better than none. Leaving depression to fester and grow can cause repercussions that extend far beyond persistent sadness. “There’s a higher rate of mortality in older adults who are depressed and have untreated depression. And it so profoundly affects quality of life. People suffer—and they can also lose functional capacity,” according to Dr. Fabiny. Depression has even been linked to an increased risk of dementia.

If you have one or more of the symptoms listed above that can’t be traced to an illness or ailment, a frank talk with a trusted doctor about the possibility of depression might be a good step forward.

Though my family and I tried to be sympathetic, it was hard for us to fully comprehend my mother’s migraines or understand why she had to miss so many events because of them. When you’re on the outside looking in, you can’t begin to appreciate how severely disabling—and life disrupting—chronic migraine can be.

The “unseen” pain

Migraines are often misunderstood, or dismissed as “just a headache.” Yet they have the capacity to disrupt a person’s life, relationships, and sense of well-being. A study from Thomas Jefferson University in Philadelphia, released last week in PLoS One, found that chronic migraine sufferers experience as much social stigma as people with epilepsy—a disease that produces far more obvious and dramatic symptoms.

Some of that stigma is external—for example, getting treated differently by friends or colleagues. “Migraines are the unseen and undocumented pain that takes them away from work,” says Dr. R. Joshua Wootton, of pain psychology at the Arnold Pain Management Center at Beth Israel Deaconess Medical Center, and assistant professor of anesthesia at Harvard Medical School. “There’s no empirical test for migraine yet. That’s why people who report these problems with chronic pain are often not believed or are thought to be exaggerating in the work environment.”

Yet much of the stigma, the study found, is internal. Migraine sufferers often anticipate that their headaches will elicit a negative reaction from friends and colleagues, or that they’ll be less productive because they have to miss work so often. Such subjective experiences of stigma can be as damaging to health as overt discrimination or the loss of social relationships.

Treating migraines

Effective migraine treatments are available—but many migraine sufferers don’t take advantage of them, either because they don’t seek help or they mistakenly believe they’re just suffering from regular headaches. “I think 80% of all migraineurs can be effectively helped, but only about a quarter of them are effectively helped at the present time,” says Dr. Egilius Spierings, associate clinical professor of neurology at Harvard Medical School.

The gold standard for migraine relief is a class of drugs called triptans, which include sumatriptan (generic, Imitrex, others), rizatriptan (generic, Maxalt), and zolmitriptan (generic, Zomig). When taken at the first twinge of a migraine, triptans can relieve pain, nausea, and light sensitivity. “These medications have been on the market for about 20 years now,” Dr. Spierings says. “They have been used widely, and are generally very safe and well tolerated, and also very effective.”

As my colleague, Heidi Godman, has written in this blog, there are also drugs that work in advance to prevent migraines—including beta-blockers, antidepressants, anti-seizure drugs, and Botox. Although preventive medicines don’t work quite as well as the triptans, says Dr. Spierings, they can reduce migraine frequency in some people who get them regularly.

Part of migraine prevention involves avoiding the sights, smells, situations, and foods that trigger these headaches. Keeping a headache diary can help identify triggers, which may include loud noises, bright lights, strong scents, hunger, fatigue, and foods such as chocolate, aged cheeses, alcohol, or MSG.

The emotional component

Migraines aren’t just a physical condition. Living with chronic pain, or the constant worry that a migraine can strike at any moment, can take an emotional toll, too. Migraines have been linked to an increased risk of depression. A study presented last February at the American Academy of Neurology’s annual meeting found that women with a history of migraines are 41% more likely to be depressed than those without the condition.

When you can’t find effective ways to manage your migraines, “that frequently results in feeling helpless, hopeless, and as if everyone is against you,” Dr. Wootton says.

If you’re having these feelings, it can be helpful to see a psychiatrist or psychologist—particularly at a center that specializes in pain management. “If you have considerable anxiety and/or depression, addressing those issues is important because they negatively affect migraine. They also make it much more difficult to cope with a condition like migraine,” Dr. Spierings says.

Mental health professionals can offer behavioral techniques (such as meditation) to address chronic pain—and the stress associated with it. They can also help counter any negative perceptions about migraine.

Migraine can be a frustrating condition to treat because there is no quick “cure.” My mother has tried just about everything, and some therapies have been more effective than others. Probably the safest, surest way to migraine relief is to work with your primary care physician, neurologist, or headache specialist. With some trial and error, you may find a treatment that finally relieves your pain.

Yet a University of Michigan study presented last week at the American Society of Clinical Oncology’s Quality Care Symposium showed that nearly three-quarters of women who had this procedure were actually at very low risk of developing cancer in the healthy breast. In other words, many women are unnecessarily exposing themselves to the potential risks of a double mastectomy—including pain, infection, and scarring. The researchers concluded that most of the women in their study who chose prophylactic mastectomy didn’t have a good medical reason for doing it and were “not expected to benefit in terms of disease-free survival.”

Clearly these women are making what they feel is the best decision to protect their health. The new study suggests that more and better information about breast cancer recurrence—and the risks and benefits of prophylactic mastectomy—are needed as women consider this procedure.

A growing choice

More and more women are turning to prophylactic mastectomy. A 2010 report in the journal Current Oncology Reports showed that the use of prophylactic mastectomy doubled between 1998 and 2005, and is likely still rising. Fear seems to be one of the main drivers of this increase. In the University of Michigan study, for example, 90% of women who had a preventive double mastectomy said they were “very worried” about their risk of cancer recurrence.

Other possible reasons for the rise in prophylactic mastectomy are more sensitive breast cancer screening methods, which diagnose breast cancer at earlier stages, and improved breast reconstruction techniques. High-visibility celebrities with breast cancer who have chosen to have prophylactic mastectomies are also an influence. “I have a number of people come into my office and ask about how their situation compares to that of Christina Applegate or Giuliana Rancic,” says Dr. Laura Dominici, a breast surgical oncologist at Brigham and Women’s Hospital and assistant professor of surgery at Harvard Medical School. (Allyn Rose, a 24-year-old Miss America contestant, recently announced her plans to have a prophylactic double mastectomy—not because she’s had breast cancer, but because she’s genetically at risk for the disease.)

The real risk

Many women who’ve been diagnosed with breast cancer believe they’ll be safer and spare themselves the stress of future treatment if they have both breasts removed—even if their surgeon isn’t recommending it, says Dr. Judy Garber, director of the Center for Cancer Genetics and Prevention at the Dana Farber Cancer Institute, and professor of medicine at Harvard Medical School.

The average woman diagnosed with cancer in one breast has a less than 1% risk of developing cancer in the second breast. Women are considered at high risk for a second breast cancer—and are therefore what surgeons would consider good candidates for prophylactic mastectomy—only when they test positive for the BRCA1 or BRCA2 gene or another gene that significantly increases breast cancer risk, or they have at least two close relatives (mother, sister, daughter) who have had breast or ovarian cancer.

It’s also important to keep in mind that prophylactic mastectomy won’t guarantee a cancer-free future. “I think it is very important that women understand that, although the procedure reduces risk for future new breast cancers, it has absolutely no impact on their risk of cancer recurrence,” says Dr. Dominici.

Important decision

Women considering prophylactic mastectomy often make this important decision during a very emotional period. “You hope women will take the time to make a good decision and not just have surgery at a time when their fear is the greatest,” Dr. Garber says.

A better strategy may be to delay decision making until after cancer treatment has ended, when a woman may have a different perspective or be in a better frame of mind to make a decision. “Women electing to have both breasts removed when diagnosed with a cancer in one breast need to be sure that they understand the prognosis from their current cancer, as well as their risk of a future cancer,” says Dr. Dominici.

Prophylactic mastectomy isn’t the only way to help prevent breast cancer recurrence. Other options include taking the drug tamoxifen or making lifestyle changes such as exercising and cutting back on alcohol.

“Women shouldn’t feel that having a bilateral mastectomy is going to be the only thing that’s going to save them. It isn’t. There are other ways to approach this,” Dr. Garber says.

Could all this talk of the undead be foreshadowing a real-life zombie apocalypse? In fiction, yes. But not in real life.

In the 1980s, Harvard University ethnobotanist Wade Davis uncovered a potential medical explanation for cases of zombie-like living deaths in Haiti. A neurotoxin found in animals like the pufferfish created the appearance of death—minus the permanence. Davis described his findings in a book, The Serpent and the Rainbow, which horror director Wes Craven later turned into a movie.

Toxins might be fine for creating a couple of zombies, but to launch any type of apocalyptic scenario there must be an infective agent and an efficient route of transmission. So far, the prion is the only agent that causes anything remotely related to zombieism. Prions are oddly shaped proteins that cause abnormal folding of proteins in the brain. Essentially, they turn the brain’s centers of higher thought into spongy mush.

Prions were behind a disease called kuru, which once infected members of a cannibalistic New Guinea tribe. They got it from eating human brains. People with kuru exhibit symptoms like poor coordination, personality changes, loss of speech, and open sores. Sound familiar? (Prions are also responsible for the more widespread animal infection known as mad cow disease.)

How a zombie virus might spread

Here’s the transmission pattern found in most zombie tales: zombie bites human, human dies, then human—who is no longer human but zombie—rises from the grave and starts looking for more flesh to gnaw on. If we’re trying to follow medical logic, people don’t die and come back from the grave. So how might a real-world zombie pandemic spread?

Dr. Steven Schlozman, a zombie enthusiast and professor of psychiatry at Harvard Medical School, came up with a scenario in his 2011 novel, The Zombie Autopsies. He imagined a scenario that turns normal human beings into flesh-craving monsters. (The book will soon be made into a movie by George Romero, who wrote, directed, and produced the classic zombie film “Night of the Living Dead.”)

In Dr. Schlozman’s book, warped scientists attach a prion to an airborne, influenza-like virus. It doesn’t take more than a few sneezes and coughs to produce a full-on zombie pandemic that efficiently wipes out two-thirds of the world’s population. True to his medical roots, Dr. Schlozman gave the hypothetical disease a complicated name and an acronym: ataxic neurodegenerative satiety deficiency syndrome (ANSD). It describes the brain erosion, stumbling walk, and insatiable hunger that afflict the infected. The prion destroys most of the brain, but leaves just enough working tissue behind to let the humans-turned-zombies walk (albeit in a highly uncoordinated way). It also interferes with the hypothalamus—the part of the brain that regulates feelings of hunger, which explains the insatiable need for flesh. “They just stumble into whatever they can and take a bite,” Dr. Schlozman says.

Rest easy

Although a pandemic that creates zombie-like symptoms is theoretically possible, a real-life zombie apocalypse shouldn’t be high up on our list of worries, says Dr. Schlozman.

“What I always say is we’re humans, so we have plenty of ways to do ourselves in without zombies,” he says.

But if you are the type of person who likes to be prepared for everything, the CDC offers a handy (tongue-in-cheek) zombie apocalypse preparedness guide. It recommends coming up with an emergency plan and stocking up on water, food, medications, and other necessary supplies. If the apocalypse never actually transpires, at least you’ll be ready for any real emergencies that come your way.

According to a study in the Archives of General Psychiatry, dementia is more common among people who become depressed in middle age or later in life than among those who aren’t depressed. In that study, age of onset was also linked to the type of dementia—individuals with late-life depression had about double the risk for Alzheimer’s disease, while those whose depression began in midlife faced three times the risk for vascular dementia (which is caused by poor blood flow in the brain).

Depression is often overlooked in older adults. “I think older individuals are more in denial about having depressive illness,” says Dr. M. Cornelia Cremens, assistant professor of psychiatry at Harvard Medical School and a geriatric psychiatrist in the senior health practice at Massachusetts General Hospital. “They’ll say, ‘Well, I’m 83 years old—who wouldn’t be depressed?‘” Ignoring sadness or dismissing it as a normal side effect of aging could allow potentially treatable memory issues to progress unchecked.

As I write in the October 2012 Harvard Women’s Health Watch, researchers have long known that depression and dementia often go hand in hand. The two conditions may simply share common causes. And the Archives study suggests that depression late in life may be a sign of brain changes that can make an individual more prone to developing dementia.

Recognizing depression

The signs of depression are slightly different in older adults—and many of them can mimic memory loss and illness. If you are experiencing these symptoms, or see them in a loved one, a visit to a primary care physician or psychiatrist for an evaluation is appropriate:

• feelings of helplessness, hopelessness, or worthlessness
• lack of energy; fatigue
• irritability, pessimism
• loss of interest in activities
• difficulty concentrating or remembering
• confusion
• trouble sleeping
• appetite loss or overeating
• aches and pains that don’t go away

“If somebody appears to have the beginning of dementia and they are depressed, it’s very important to treat their depression, and to treat it as aggressively as possible,” Dr. Cremens says. Older individuals who are depressed should also be evaluated for dementia, she adds. Screening tests such as the Mini-Mental State Exam and the Montreal Cognitive Assessment are short questionnaires that doctors use to identify cognitive impairment.

One in eight women will be diagnosed with breast cancer, and many more will be affected by it through a friend or loved one. My mother had breast cancer. Fortunately, she was cured. With my lineage, I know there’s a good chance the disease is in my future, too.

So when I heard that researchers at Kansas State University have developed a blood test that can rapidly detect breast cancer (as well as non-small cell lung cancer) in its earliest stages, I was intrigued. With breast cancer—as well as most other cancers—early detection is essential. The sooner the disease is found, the better the chance treatment will be successful.

How the test works

According to cancer researchers Stefan Bossmann and Deryl Troyer, their experimental test can identify cancer before symptoms appear by detecting unique enzyme patterns given off by cancer cells. The test exposes a tiny amount of a person’s blood to iron nanoparticles coated with amino acids and a dye. The particles interact with cancer enzymes to form signature patterns, which doctors can detect.

“We can see cancers that do not show up with current imaging technology, and that are too small to be seen by other methods,” says Dr. Bossmann, who is a professor of chemistry at Kansas State University. Cancers from different types of cells (breast vs. lung, for example) give off slightly different enzyme signatures.

The researchers say their test can detect very early breast cancers (stages 0 and 1), as well as early lung cancers (stages 1 and 2), within an hour, with 95% accuracy. They discovered this after testing their method on 32 participants with various stages of breast or lung cancer, as well as on a 12-person control group without cancer.

Questions and cautions

“These findings are very exciting, but extremely preliminary,” says Dr. Judy Garber, director of the Center for Cancer Genetics and Prevention at the Dana Farber Cancer Institute, and professor of medicine at Harvard Medical School. The study was very small, it hasn’t yet been published, and it still leaves several unanswered questions.

For example, what happens if the test does identify a very tiny, very early cancer? Will a follow-up CT or MRI scan be able to detect it to pinpoint its location? If not, will doctors still need to wait until the cancer grows before they can remove it? Also, will the test lead to real increases in survival, or will patients who test positive be subjected to unnecessary tests and treatments for an early-stage cancer that might never have spread? (This is currently part of a big debate about the prostate-specific antigen blood test for prostate cancer.)

A British team is about to launch a large study to find a different type of blood test for early breast cancer. By taking blood samples from thousands of women attending breast cancer screening clinics, they hope to find genetic markers in DNA that signal an increased risk for the disease.

“The bottom line is that screening for early cancer in healthy people must be done with great care, and tests must show not only that they can detect cancer early, but also that it makes a difference when they do,” Dr. Garber says.

“This is an interesting application of nanotechnology on a difficult problem,” she adds. “It is very early in its development, and will need to be validated in large population-based screening studies.”

Dr. Bossmann agrees that his research is still in its preliminary stages. “It was very encouraging, but this is maybe the fifth step on a long, long way,” he says. Next, he and his colleagues plan to study the test in people with pancreatic cancer. They’re also launching a study using blood samples from more than 200 women with breast cancer, in collaboration with the University of Kansas. He says it could be five years before the test comes into practical use—and that’s only if it proves effective in large-scale studies.

No medical miracles

As much as we long for a test that will spot breast cancer early enough to save our mothers, sisters, or even ourselves, we need to remember that there are no overnight successes in medicine. There is only meticulously conducted research, tested and retested in large groups of people until a positive result is achieved.

A rapid and accurate test for early-stage breast cancer may very well be perfected someday. Until then, the best thing women can do is to follow established screening guidelines, which for now means talking to their doctor about their risks, and getting regular mammograms.