Dear Doctor: There's apparently a serious measles outbreak going on in Europe right now. Does that mean that our family shouldn't go on our planned trip to Italy this spring?

Dear Reader: It's true that there has been a troubling surge in the number of cases of measles in Europe. After a record low of 5,273 reported cases in 2016, health officials say the number of people who contracted this extremely contagious disease quadrupled to more than 20,000 last year. There were 35 deaths from the measles throughout Europe last year, but due to the likelihood of incomplete reporting, health officials suspect that number is actually higher.

The measles virus is spread by coughing or sneezing. Because the live virus can remain in the air and on surfaces for up to two hours after being expelled by an infected individual, it is extremely contagious. Simply by walking through a room where, an hour or two before, someone with the measles either coughed or sneezed, you can contract the virus.

Symptoms include a high fever, runny nose, cough, red and watery eyes, and a signature rash of red spots. The rash typically begins at the head and then spreads to the rest of the body. Complications are common and include middle ear infections, diarrhea and dehydration, pneumonia, encephalitis, which is swelling of the brain, and even death.

At this time, 15 countries in Europe are experiencing large measles outbreaks. Italy had 5,006 reported cases of measles in 2017, which is second only to Romania, with 5,562 cases. Germany reported 927 cases, France had 520, the United Kingdom had 282, and Spain reported 152 cases. Switzerland had 105 cases.

The spike in outbreaks has been attributed to multiple factors -- people deliberately not becoming vaccinated, a shortage in some regions of the MMR vaccine, and the lack of access to medical care by some marginalized groups. As has been the case here in the United States, vocal groups of anti-vaccine activists have been lobbying against the practice of vaccination.

In terms of your upcoming trip, the Centers for Disease Control and Prevention issued a Watch Level 1 travel notice for Italy in January of this year. This means epidemiologists have evaluated the situation and made the following recommendations:

-- Travelers headed to Italy should be vaccinated against measles with the MMR (measles, mumps and rubella) vaccine prior to departure. This includes infants between 6 and 11 months of age, who should have one dose of the MMR vaccine.

-- Adults and children 1 year and older should have received two doses of the MMR vaccine, separated by at least 28 days.

If you or anyone in your family hasn't been fully vaccinated against measles, then they will be at risk of contracting the disease if they come into contact with someone who is ill -- whether in Italy or at the local grocery store. If you're not sure whether you've been vaccinated, another dose of the MMR vaccine won't hurt. Your primary care physician can also confirm immunity through blood work.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I don't have a history of breast cancer in my family, but now that there's an at-home test for the BRCA mutations, should I get tested just in case? It has to be less expensive than going to a doctor, and it might provide some peace of mind.

Dear Reader: Having peace of mind that you don't have a serious disease cannot be understated. For women, knowing that they're at lower risk of developing breast cancer can be especially reassuring.

Now for some background on the genes that the at-home test assesses: BRCA1 and BRCA2. For starters, they're tumor-suppressor genes, producing proteins that aid in the repair of damaged DNA molecules. If the proteins produced by the BRCA genes don't work appropriately, abnormal cells with DNA mutations will not be repaired but will instead divide to create more abnormal cells. This is one of the ways cancer can develop.

Among women with a mutation in the BRCA1 gene, 72 percent will develop breast cancer in their lifetime and 44 percent will develop ovarian cancer, research has found. Among those with a BRCA2 mutation, 69 percent will develop breast cancer and 17 percent will develop ovarian cancer. Among women with a family history of breast cancer, 20 percent of those cancers are related to the BRCA gene.

Certain ethnic and geographic groups are more likely to have BRCA mutations, with Ashkenazi Jews especially likely to have such mutations. Although the risk of such a mutation is 1 in 400 among the general population, it is 1 in 40 among Ashkenazi Jews. The three most common mutations -- two on BRCA1 and one on BRCA2 -- account for 90 percent of the mutations among Ashkenazi Jews and most cases of genetic-related breast cancer in general. Two percent of Ashkenazi women carry one of these three genes.

The at-home test that you mentioned was recently approved by the FDA to measure mutations in one of these three genes. Such testing was previously more difficult to get because of patent issues and insurance coverage, but with this test, patients can pay out-of-pocket to get BRCA testing.

The big caveat is that the test detects only three of the BRCA mutations, meaning that it won't pick up the multitude of other possible mutations in the BRCA genes. These other mutations have to be identified by more involved tests that assess the complete BRCA genes. Nor does it identify mutations beyond the BRCA genes that can increase the risk of breast cancer.

That's not to say it can't be useful for some people. Ashkenazi Jewish women, whom we've established are more likely to have one of these three mutations, would be good candidates for such screening. Not only can the test assess their lifetime risk of breast cancer, a positive test could lead them to take measures to decrease their risk, such as avoiding the use of hormone replacement therapy or oral contraceptives. They could also consider whether to have prophylactic, or preventive, mastectomies.

Women with a close family history of breast cancer, however, would be better advised to undergo complete DNA sequencing of the BRCA genes. This specialized test, ordered by a physician, is more likely to detect other breast cancer-related mutations. In the future, with our greater abilities to quickly test for genetic abnormalities, at-home tests will be more comprehensive. But, for now, this is a good start.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I've read that memory is linked to the heart's ability to pump blood, with a reduced ability leading to poorer memory. Is there anything I can do to keep the blood flowing to my brain?

Dear Reader: Our brains, like the rest of our bodies, rely on optimal blood flow for optimal functioning. But in the case of the brain, that means a larger volume than you would expect. While the brain accounts for just 2 percent of a person's total weight, a series of specialized anatomical processes ensure that it gets a whopping 12 percent of the blood that flows through the body. And according to the results of an intriguing study published last fall, there appears to be a link between the brain's blood supply and cognitive function.

The study, published online in the journal Neurology, looked at a group of individuals with an average age of 73 who are taking part in the Memory and Aging Project at Vanderbilt University Medical Center in Nashville. This is an ongoing study that tracks the health and cognitive abilities of the participants and analyzes the resulting data. In this particular study, researchers selected 314 men and women, 39 percent of them diagnosed with mild cognitive impairment. That means these study subjects had exhibited a decline in memory, language, thinking or judgment that was slight but measurable. The other study participants had normal cognitive function. None had heart problems or disorders, and none had dementia.

Using imaging techniques, researchers calculated how much blood each person's heart pumped in relation to his or her body size, a value known as "cardiac index." They also measured the resulting volume of blood flow in the brain. They found that a lower cardiac index correlated to reduced blood flow to the left and right temporal lobes, the memory-processing areas of the brain. The lead author of the study characterized the resulting reduction in blood flow as comparable to what you would expect to see in individuals who were 15 to 20 years older.

All of which brings us to the heart. Reaction to the study is that the findings bolster what previous research has long suggested -- there is a strong connection between the health of the heart and the health of the brain.

But the solution may not be as simple as joining a gym or heading out for a brisk walk. That's because of those physiological mechanisms we mentioned earlier in the column, the ones that dole out a proportionally greater blood flow to the brain than to other parts of the body. Whether these mechanisms are directly affected by the health of the heart, or whether their decline is related to advancing age or the onset of cognitive decline is not yet known. The researchers themselves state that their findings reveal a link between cardiac index and blood flow to the brain, but do not suggest it is the cause.

Still, we think it wise to safeguard the health of your heart. Don't smoke, and if you do smoke, please quit. Eat well. Exercise daily. And see your family physician for an annual checkup so if a problem crops up, it can be caught early.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)