All posts by CPTFeditor

Talcum Powder and Ovarian Cancer

Diana Zuckerman, PhD, Cancer Prevention & Treatment Fund

A growing body of evidence suggests that using talc in the genital area can increase a woman’s chances of developing ovarian cancer. And the more years she uses talc, the more likely she is to develop ovarian cancer.

A study published in 2016 suggests that the body develops inflammation as a result of the talcum powder, and this is what can result in cancer years later.[1] The authors of the study are from the prestigious Brigham and Women’s Hospital in Boston, and their study was supported by a grant from the National Institutes of Health.

The study compared approximately 2,041 women living in Massachusetts and New Hampshire who had been diagnosed with ovarian cancer, and compared them to 1,578 women of the same age and geographic location.

The study found that the women who used talc in the genital area, whether or not they used it elsewhere in their body, were significantly more likely to have been diagnosed with epithelial ovarian cancer. Most reported using Johnson & Johnson baby powder or Shower to Shower powder. Many body powders are now made with cornstarch instead of talc; women who used those powders but did not use talc were not considered talc users.

Overall, the women using talc were about 33% more likely to develop ovarian cancer. However, among women who were sterilized prior to menopause (underwent a tubal ligation or hysterectomy) or who took hormone therapy for menopausal symptoms, using talc was even more likely to predict developing ovarian cancer.

The results of the 2016 study are consistent with the conclusions of the well-respected International Agency for Research on Cancer (IARC), which is part of the World Health Organization.[2] IARC found that there was an “unusually consistent” increased chance of developing ovarian cancer among women who reported using talcum powder in the genital area.

How big a risk is talc for developing ovarian cancer? Perhaps a better question is: why take the risk?

References

  1. Cramer, DW, Vitonis, AF, Terry, KL, Welch, WR,Titus, LJ. “The Association Between Talc Use and Ovarian Cancer: A Retrospective Case–Control Study in Two US States.” Epidemiology May 2016. 27(3): 334-346.
  2. IARC Monographs Volume 93, p. 412. http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8F.pdf

Cancer of the Immune System (ALCL) and Breast Implants: Plastic Surgeons Study 173 Women

Diana Zuckerman, PhD, Cancer Prevention & Treatment Fund

In 2015, plastic surgeons who have been well known for defending the safety of breast implants published a study of 173 women with cancer of the immune system caused by breast implants. [1]   The study was paid for by a plastic surgery medical association and written by plastic surgeons who have defended the safety of breast implants for decades.

ALCL (Anaplastic Large Cell Lymphoma) develops near a breast implant but is not breast cancer – it is a cancer of the immune system.  The authors of this study point out that the first silicone breast implant was implanted in 1962 and the first publicly reported case of ALCL in a woman with silicone breast implants was in 1997. The authors reviewed 37 medical articles reporting on 79 patients and collected information about an additional 94 women with ALCL caused by breast implants.

Results

Physicians first identified these 173 women with ALCL based on either seromas (a collection of fluid under the skin), a mass attached to the scar capsule surrounding the implant, a tumor that eroded through the skin, in a lymph node near the breast, or discovered during surgery to replace a breast implant. Whether the women had silicone gel or saline breast implants didn’t seem to make a difference, but many of the women had at least one textured breast implant.  Cosmetic augmentation patients and women who had breast implants to reconstruct their breasts after undergoing a mastectomy were both at risk of developing ALCL because of their implants.  Of the women whose ALCL spread outside of their scar capsule surrounding the implant, about half died from ALCL.

The authors pointed out that ALCL can be difficult to diagnose.  Although the fluid and scar capsule usually appear abnormal, they sometimes look normal. The authors recommend “that all fluid and capsule tissue from patients with seromas” should be tested for ALCL.  They point out that if the tumor is inside the capsule, removing both implants and the capsules may be the only treatment necessary.  However, if the tumor has developed just outside the capsule, chemotherapy with or without radiation is needed and usually effective.  Unfortunately, aggressive ALCL that has spread beyond the scar capsule area is usually fatal, regardless of treatment.

2017 Update

In March 2017, the U.S. Food and Drug Administration (FDA) reported that it had received 359 reports of ALCL among women with breast implants. Unfortunately, many cases of ALCL are not reported to the FDA.  The FDA’s announcement came after the World Health Organization (WHO) officially named the disease “breast implant associated ALCL (BIA-ALCL)” in 2016. In 2014, the National Comprehensive Cancer Network (NCCN) has also released a worldwide oncology standard for surgeons and oncologists to test for and diagnose the disease.

To read the official summary of this article, click here: http://www.ncbi.nlm.nih.gov/pubmed/25490535

To read about another study on ALCL, click here.

To read more about what you need to know about ALCL, click here.

Reference

  1.  Brody GSDeapen DTaylor CRPinter-Brown LHouse-Lightner SRAndersen JSCarlson GLechner MGEpstein AL. Anaplastic Large Cell Lymphoma Occurring in Women with Breast Implants: Analysis of 173 Cases. Plastic and Reconstructive Surgery. Vol 135: 695, 2015.

Breast Implants and Cancer of the Immune System (ALCL): A History of Who Knew What When

Maura Duffy, Cancer Prevention & Treatment Fund

Experts now agree that breast implants can cause a type of cancer of the immune system.  The FDA finally admitted this risk of cancer in 2017, but other experts – including plastic surgeons — were aware of the risk years before.  Why did it take so long for FDA, the media, and women with implants to find out that choosing breast implants could increase their chances of developing a potentially fatal disease?

Anaplastic large cell lymphoma (ALCL) is a rare type of cancer of the immune system that usually develops in the lymph nodes, skin, lungs, or liver. However, ALCL sometimes develops in the breast area of women with breast implants.

In 2008 Dutch researchers published a report of 11 women with breast implants and ALCL, and concluded that the implants seemed to be associated with ALCL.[3]  Although published in the Journal of the American Medical Association (JAMA), this information was not widely reported.

The link between ALCL and breast implants was first reported by the U.S. Food and Drug Administration (FDA) in January of 2011. In 2013, researchers at MD Anderson Cancer Center studied 60 women with breast implants who were diagnosed with ALCL in the breast. Since ALCL was thought to be diagnosed in only 1 woman in half a million, this was much higher than would be expected.[3] In 2014, the National Comprehensive Cancer Network (NCCN), a nonprofit network of cancer experts, released a worldwide oncology standard for surgeons and oncologists to test for and diagnose “breast implant associated ALCL (BIA-ALCL).  In 2016, the World Health Organization (WHO) officially named the disease “breast implant associated ALCL (BIA-ALCL)”.

And yet, it was not until March 2017 that the FDA finally updated its website to officially report that breast implants could cause ALCL. At the time of the FDA announcement, the agency reported that they had received 359 reports of ALCL among women with breast implants. Reports to the FDA of problems from medical devices are acknowledged to be the “tip of the iceberg” since surgeons frequently do not do these online reports.

How did women find out they had ALCL before the official announcement of BIA-ALCL was made? Most of them approached their doctors with symptoms such as pain, lumps, swelling, or asymmetry in their breasts years after getting implants.  Since breast implants are a “foreign body,” the body forms scar tissue around the implant to protect their body from this “foreign invader.”  The scar tissue surrounding the implant is known as the scar capsule. It is natural for the body to form scar tissue, and the scar tissue is only a problem if it tightens or hardens around the implants, causing pain and hardness known as “capsular contracture.”  Breast implant-associated ALCL is almost always found in the scar capsule surrounding the implant, not the breast tissue itself. It has been reported in women both with and without capsular contracture, as well as women with silicone gel or saline breast implants.[4]

ALCL is diagnosed by testing the fluid that collects around the implant, called a seroma.[5] Seroma is usually not caused by ALCL.  It is important to understand that even when ALCL is in the breast, it is not breast cancer, but rather a cancer of the immune system.  Most breast implant-associated ALCL has cancer cells within the fluid inside the scar capsule. That ALCL can be treated by removing the implant and the surrounding scar tissue. This surgery is known as a capsulectomy.

One study of nine women who had a capsulectomy after being diagnosed with BIA-ALCL found that all nine were disease free when they were studied 3.5 years later, and they did not require chemotherapy nor radiation treatment. However, some types of ALCL are more aggressive and need to be treated with chemotherapy or radiation. [6]

In December 2013, the study of 60 patients with breast implants and ALCL reported that the ALCL was more likely to be fatal for women who had a solid ALCL tumor than for women who had ALCL cancer cells in the surrounding fluid (known as effusion ALCL). All of the patients with effusion-type ALCL were still alive 5 years after their diagnosis, compared to only 75% of the patients with solid ALCL tumors. ALCL returned in only 14% of patients with effusion-type ALCL. Patients with solid ALCL tumors had a 50% recurrence rate.[7]

Longer studies with more patients are needed to determine if certain kinds of breast implants are more likely to cause ALCL.  Preliminary data indicate that most, but not all, women with BIA-ALCL had textured breast implants at some point.  Meanwhile, women with all types of implants should have routine follow-ups and should immediately see a doctor if one or both of their breasts become swollen.

For women with silicone implants, FDA recommends getting a breast coil MRI three years after getting the implants, and every two years after that.[8]

Although plastic surgeons and breast implant manufacturers admit that breast implants can cause ALCL, they claimed it was very rare.  For example, Allergan, a manufacturer of many different types of breast implants, claimed that “A woman is more likely to be struck by lightning than to get this condition.”[9]   However, 400 people are injured or killed by lightning every year,[10] which is why most people avoid situations where lightening can harm them.

In fact, the Australian version of the FDA now estimates that 1 in 1,000 women with breast implants will develop BIA-ALCL, [11] which is not nearly as rare as plastic surgeons and manufacturers have claimed.

Many women would not want to take the chance of developing cancer as a result of breast implants, and this is especially true for women who underwent mastectomies that were not medically necessary in an effort to reduce their chances of cancer returning.

It is also important to note that the link between breast implants and autoimmune diseases has been hotly debated for two decades, with many women reporting serious autoimmune symptoms that went away when their implants were removed.[11]  The scientific evidence regarding ALCL and implants once again raises questions about the possible impact of breast implants on autoimmune disease or symptoms such as joint pain, body pain, memory loss, and chronic fatigue.

For many years, women with breast implants were assured by implant companies, plastic surgeons, and the FDA that breast implants did not cause breast cancer or any other type of cancer. Evidence of a link to some types of cancer and to autoimmune diseases, including studies conducted by researchers at FDA and the National Cancer Institute, was dismissed. However, as everyone knows from data on lung cancer and smoking, it can take decades to determine if an exposure causes cancer or other serious diseases. Even a very strong carcinogen, such as tobacco, is very unlikely to cause lung cancer for at least 30 years.  For this reason, it is essential that physicians and researchers take a closer look at the link between breast implants and cancer of the immune system, as well as other immune disorders.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Mazzucco, AE. Next Steps for Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol, 2014. Early release publication. June 16, 2014.
  2. S. Food and Drug Administration. 26 January 2011. Web. June 25, 2012, <http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm241090.htm>
  3. “Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants: Preliminary FDA Findings and Analyses.” January 2011. Center for Devices and Radiological Health. U.S. Food and Drug Administration. Web. June 25, 2012, <http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239996.htm>
  4. “FDA Questions and Answers about Anaplastic Large Cell Lymphoma (ALCL).” U.S. Food and Drug Administration. 26 January 2011. Web. June 25, 2012, <http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm241086.htm>
  5. Kim B, Roth C, Young VL, Chung KC, van Busum K, et al. Anaplastic large cell lymphoma and breast implants: results from a structured expert consultation process. Plastic and Reconstructive Surgery. 2011 Sep;128(3):629-39.
  6. Aladily TN, Medeiros JL, Amin, MB, Haideri N, et al. Anaplastic Large Cell Lymphoma Associated with Breast Implants: A Report of 13 Cases. Am J Surg Pathol. 2012 June 36(6).
  7. end Miranda, et al. Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients. J Clin Oncol. 9 December 2013.
  8. FDA Update on the Safety of Gel-Filled Breast Implants.” June 2011. Center for Devices and Radiological Health. U.S. Food and Drug Administration. Web. June 25, 2012, http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf target=”_blank”>http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf>
  9. Edwards, Jim. “Breast Implant Maker Challenges FDA on Cancer Link.” CBS Money Watch. 27 January 2011. Web. 25 June http://www.cbsnews.com/8301-505123_162-42847224/breast-implant-maker-challenges-fda-on-cancer-link/ target=”_blank”>http://www.cbsnews.com/8301-505123_162-42847224/breast-implant-maker-challenges-fda-on-cancer-link/
  10. Cooper, Mary Ann, MD. “Medical Aspects of Lightning.” National Weather Service. Web. 25 June 2012.http://www.lightningsafety.noaa.gov/medical.htm
  11. Mazzucco, Anna, Ph.D and Zuckerman, Diana, Ph.D. “ALCL and Breast Implants: 2017 Update.” Breast Implant Information. Web. March 14, 2017. <http://www.breastimplantinfo.org/implantalcl/>

NCHR Comments on CPSC Agenda and Priorities for FY2018-2019

Diana Zuckerman, PhD, National Center for Health Research: July 26, 2017

 

Diana Zuckerman, PhD, President of National Center for Health Research 
Comments on the U.S. Consumer Product Safety Commission 
Agenda and Priorities for FY2018/2019

The National Center for Health Research is a nonprofit research center staffed by scientists, medical professionals, and health experts who analyze and review research on a range of health issues. Thank you for the opportunity to share our views concerning the Consumer Product Safety Commission’s (CPSC) priorities for fiscal year 2018 and 2019. We respect the essential role of the CPSC, as well as the challenges you face in selecting the most important priorities.

Two priorities that are clearly consistent with CPSC priorities are the safety of children’s products. We are very concerned about exposures to phthalates in children’s toys and other products as well as endocrine-disrupting chemicals and other safety concerns related to recycled tire crumb rubber and other artificial turf (including “poured in place” surfaces).

The CPSC has been a champion for children with its careful analysis of phthalates in toys and products for children under 3 years of age. As you know, products specifically for children under 3 are not the only ones that pose risks: we need to also be concerned about phthalates in many products used by pregnant women and children. Through dust and other means, phthalates migrate from many products into our environment and bodies. Phthalate metabolites are detectable in nearly all people in this room and in the U.S.[1] Many phthalates are endocrine disruptors that can have long-term effects on our health and children’s development, including their ability to learn.

Our Center was instrumental in shaping the law resulting in permanent and temporary bans on six phthalates in children’s toys and child care articles.[2] However, these bans need to be expanded. Over 2 years ago, CPSC proposed the rule “Prohibition of Children’s Toys and Child Care Articles Containing Specified Phthalates” following the Chronic Hazard Advisory Panel (CHAP).[3][4] This rule is absolutely essential in providing additional protections for children.

We support the permanent bans on four additional phthalates (DIBP, DPENP, DHEXP, and DCHP) and making permanent the interim ban on DINP.[3] However, the CHAP report also recommended an interim ban on DIOP, which should also be included in the rule. We strongly disagree with the proposal to lift the interim bans on DNOP and DIDP. While they may not affect male hormones, they are associated with organ toxicity and altered development.

The CHAP report also recommended additional studies on three other phthalates (DMP, DPHP, and DEP) and six phthalate alternatives.[4] The final rule should include a timeline for the completion of these studies that reflects the potential damage these phthalates can cause.

It is also important for CPSC to expand its work on phthalates to include products that can cause prenatal exposures as well as those that can harm older children and other vulnerable adults. Phthalate exposure has been found to increase risk for early puberty and problems with reproduction.[5][6][7] This is especially important because a new meta-analysis of 185 studies shows that male sperm counts are less than half what they were just a generation ago.[8]  Phthalate exposure also affects pregnant and breastfeeding women and thus their children, which can affect brain and reproductive system.[4][9] Phthalates in household dust can be extremely harmful regardless of what products it comes from.

Artificial turf made with recycled tire crumb rubber and other products raises similar issues because it is widely used and can release chemicals that affect the health of children of all ages, pregnant women, and other adults. Artificial turf is currently used on more than 12,000 athletic fields and numerous playgrounds in the U.S. and most parents are unaware of the risks it poses.[10]

Scientific evidence suggests that crumb rubber, “poured in place” (PIP) rubber and other artificial turf pose potential safety hazards when used on playground and playing field surfaces. Rubber from recycled tires and even from “virgin tires” and “virgin rubber products” is not comprised only of rubber from a rubber plant.  Instead it includes phthalates, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), heavy metals, and other chemicals known or suspected to harm human health.[11][12][13][14] In addition to disrupting hormones, some PAHs may increase a person’s chance of developing cancer.[15][16] While one time or sporadic exposures are unlikely to cause long-term harm, repeated exposures over years, especially during critical developmental periods clearly raise the likelihood of harm.

Artificial turf made with crumb rubber and poured rubber products can also cause short-term harms. For example, crumb rubber generates dust which may exacerbate asthma for children.[17][18] These products heat up much more than ambient temperature, which can cause heat stress and burns.[19][20][21]
In addition, some studies have indicated increased risk for joint injuries and mild traumatic brain injury.[22][23] In other words, we can conclude that grass is a relatively safe alternative. We can’t say that of artificial turf, whether crumb rubber or other products.

As is often the case when researchers are paid by those with conflicts of interest, some studies suggest that the risk is minimal. However, the studies that are more reassuring do not comprehensively evaluate health risks from exposure to recycled tire crumb material. In addition, many studies of air quality pertaining to crumb rubber and similar products use stationary measures, while particulate matter becomes airborne during activity, so these measurements may not accurately reflect exposures during play activities.[24] Our conclusion from the research is that definitive studies of the harm caused by crumb rubber and other rubber products are difficult to conduct, but there are clear reasons to be concerned about children being harmed by them.

We are encouraged that the CPSC is working with other federal agencies to investigate the safety of crumb rubber on playgrounds and playing fields.[8][25][26]

However, we strongly urge you to broaden your investigation to include other synthetic rubber products and to provide warnings to families and athletes as soon as possible. The public has limited access to information about the chemicals that make up these products, which can affect our health and that of our children. All Americans rely on the CPSC to protect us and our children from unsafe products.

In summary, we strongly urge the CPSC to consider our views as it finalizes the proposed rule on phthalates in children’s toys and child care articles, and consider how these rules could be expanded to cover other products that expose children and adults to harmful substances.

References

  1. National Health and Nutrition Examination Survey (NHANES). (2016) Phthalates and Plasticizers Metabolites – Urine (PHTHTE_H); years of content 2013-2014. https://wwwn.cdc.gov/Nchs/Nhanes/2013-2014/PHTHTE_H.htm
  2. Federal Register. (2014) Consumer Product Safety Commission. Prohibition of Children’s Toys and Child Care Articles Containing Specified Phthalates. Docket No. CPSC-2014-0033. http://www.gpo.gov/fdsys/pkg/FR-2014-12-30/pdf/2014-29967.pdf
  3. Federal Register. (2014) Consumer Product Safety Commission. Prohibition of Children’s Toys and Child Care Articles Containing Specified Phthalates. Docket No. CPSC-2014-0033. http://www.gpo.gov/fdsys/pkg/FR-2014-12-30/pdf/2014-29967.pdf
  4. Consumer Product Safety Commission. (2014) Chronic Hazard Advisory Panel On Phthalates and Phthalate Alternatives.https://www.cpsc.gov/PageFiles/169876/CHAP-REPORT-FINAL.pdf
  5. Bourguignon JP, Juul A, Franssen D, Fudvoye J, Pinson A, Parent AS. (2016) Contribution of the Endocrine Perspective in the Evaluation of Endocrine Disrupting Chemical Effects: The Case Study of Pubertal Timing. Hormone Research in Paediatrics. 86(4):221-232.
  6. Wang YX, Zeng Q, Sun Y, Yang P, Wang P, Li J, Huang Z, You L, Huang YH, Wang C, Li YF, Lu WQ. (2016) Semen phthalate metabolites, semen quality parameters and serum reproductive hormones: A cross-sectional study in China. Environmental Pollution. 211:173-82.
  7. Hannon PR, Flaws JA. (2015) The effects of phthalates on the ovary. Frontiers in Endocrinology. 6:8.
  8. Levine H, Jøgensen N, Martino-Andrade A, Mediola J, Weksler-Derri D, Mindlis I, Pinotti R, Swan SH. (2017) Temporal trends in sperm count: a systematic review and meta-regression analysis. Human Reproduction Update. 1-14.
  9. Ejar Ejaredar M, Nyanza EC, Ten Eycke K, Dewey D. (2015) Phthalate exposure and childrens neurodevelopment: A systematic review. Environmental Research. 142:51-60.
  10. Synthetic Turf Council. About synthetic turf. https://syntheticturfcouncil.site-ym.com/page/About_Synthetic_Turf
  11. Llompart M, Sanchez-Prado L, Lamas JP, Garcia-Jares C, Roca E, Dagnac T. (2013) Hazardous organic chemicals in rubber recycled tire playgrounds and pavers. Chemosphere. 90(2):423-431.
  12. Marsili L, Coppola D, Bianchi N, Maltese S, Bianchi M, Fossi MC. (2014) Release of polycyclic aromatic hydrocarbons and heavy metals from rubber crumb in synthetic turf fields: Preliminary hazard assessment for athletes. Journal of Environmental and Analytical Toxicology. 5:(2).
  13. California Office of Environmental Health Hazard Assessment (OEHHA). (2007) Evaluation of health effects of recycled waste wires in playground and track products. Prepared for the California Integrated Waste Management Board.http://www.calrecycle.ca.gov/publications/Detail.aspx?PublicationID=1206
  14. Kim S, Yang J-Y, Kim H-H, Yeo I-Y, Shin D-C, Lim Y-W. (2012) health risk assessment of lead ingestion exposure by particle sizes in crumb rubber on artificial turf considering bioavailability. Environmental Health and Toxicology. 27, e2012005.http://doi.org/10.5620/eht.2012.27.e2012005
  15. U.S. National Library of Medicine, National Institutes of Health. (2017) Tox Town (Environmental health concerns and toxic chemicals where you live, work, and play): Polycyclic aromatic hydrocarbons (PAHs). https://toxtown.nlm.nih.gov/text_version/chemicals.php?id=80
  16. Armstrong B, Hutchinson E, Unwin J, Fletcher T. (2004) Lung cancer risk after exposure to polycyclic aromatic hydrocarbons: a review and meta-analysis. Environmental Health Perspectives, 112(9), 970.
  17. Shalat SL. (2011) An evaluation of potential exposures to lead and other metals as the result of aerosolized particulate matter from artificial turf playing fields. Submitted to the New Jersey Department of Environmental Protection. http://www.nj.gov/dep/dsr/publications/artificial-turf-report.pdf
  18. Mount Sinai Children’s Environmental Health Center. (2017) Artificial turf: A health-based consumer guide. http://icahn.mssm.edu/files/ISMMS/Assets/Departments/Environmental%20Medicine%20and%20Public%20Health/CEHC%20Consumer%20Guide%20to%20Artificial%20Turf%20May%202017.pdf
  19. Thoms AW, Brosnana JT, Zidekb JM, Sorochana JC. (2014) Models for predicting surface temperatures on synthetic turf playing surfaces. Procedia Engineering. 72:895-900.
  20. Penn State’s Center for Sports Surface Research. (2012) Synthetic turf heat evaluation- progress report. http://plantscience.psu.edu/research/centers/ssrc/documents/heat-progress-report.pdf
  21. Serensits TJ, McNitt AS, Petrunak DM. (2011) Human health issues on synthetic turf in the USA. Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology, 225(3), 139-146.
  22. Balazs GC, Pavey GJ, Brelin AM, Pickett A, Keblish DJ, Rue JP. (2015) Risk of anterior cruciate ligament injury in athletes on synthetic playing surfaces: A systematic review. American Journal of Sports Medicine. 43(7):1798-804.
  23. Theobald P, Whitelegg L, Nokes LD, Jones MD. (2010) The predicted risk of head injury from fall-related impacts on to third-generation artificial turf and grass soccer surfaces: a comparative biomechanical analysis. Sports Biomechanics. 9(1):29-37.
  24. U.S. Environmental Protection Agency. (2017) Federal research on recycled tire crumb used on playing fields. https://www.epa.gov/chemical-research/federal-research-recycled-tire-crumb-used-playing-fields
  25. U.S. Consumer Product Safety Commission. Crumb rubber information center.https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/Crumb-Rubber-Safety-Information-Center
  26. U.S. Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (ATSDR). (2016) Federal research action plan on recycled tire crumb used on playing fields and playgrounds. https://www.atsdr.cdc.gov/frap/index.html

When Should Women Start Regular Mammograms? 40? 50? and How Often Is “Regular”?

Diana Zuckerman, PhD and Anna E. Mazzucco, PhD, Cancer Prevention and Treatment Fund

In recent years, there has been a growing concern that annual mammograms starting at age 40 may do more harm than good for many women. That is why the U.S. Preventative Services Task Force, an expert group that reviews the latest research findings, recommends that mammography screening for most women start at age 50 rather than 40, and that the frequency be every two years (instead of annually) through the age of 74.

The Task Force is widely used as a gold standard for determining medical treatment and screening. In this case, they recommended raising the age to 50 after the American College of Physicians recommended the same thing, and they also recommended that women continue to undergo mammograms until age 74. They say that there is no evidence of what the benefits might be for women 75 and older.

For many years, the American Cancer Society (ACS) recommended annual mammograms starting at age 40, but in October 2015, they issued new recommendations that moved in the direction of those of the medical experts. They now recommend that women at average risk of breast cancer start mammography at 45, that they undergo annual mammograms from 45 – 54, and continue to undergo mammography every other year after that. In contrast, some experts point out that screening mammograms usually do more harm than good, because there is no evidence that they save lives or result in less radical surgery.[1] Experts do not recommend MRIs for screening women of average risk, but clinical studies are being done to determine whether they should be.

So What Is Best for You?

A key reminder: These recommendations are for screening mammograms. Mammograms are still needed at almost any age if a lump is found. The mammography recommendations also do not apply to all women, only for the average woman. Experts agree that women at especially high risk of breast cancer, such as those with mothers or sisters who had breast cancer, may want to start mammograms between the ages of 40 and 50 or in rare cases, even earlier.

The bottom line is that mammograms have the potential to help detect breast cancer earlier. However, like most medical procedures, there are risks as well as benefits.

Whether to start at age 50, age 40, or earlier or later or never depends on several different factors.

For most women, who are not at especially high risk of breast cancer, regular mammograms do not need to start before age 50. Or, to be cautious, a woman can get one mammogram earlier (around age 45), and then if it is normal, wait until she is 50 for her next mammogram. This is the advice that the National Center for Health Research and their Cancer Prevention and Treatment Fund have been giving since 2007.

Women at higher risk of breast cancer should not wait until they are 50 to have regular mammograms. Please remember that the higher age– 50– is only a guideline (not a strict rule), and only for women with no symptoms and who are not at high risk of breast cancer. In addition, if a woman finds a lump on her breast, a mammogram is still very important, regardless of the woman’s age. For a woman at high risk of breast cancer because of her family history or environmental exposures, regular screening before age 50, or even before age 40, may be a very good idea.

Women who are carriers of the BRCA genetic mutation were previously recommended to begin yearly mammograms between ages 25-30, since this mutation puts them at much higher risk of getting breast cancer. Newer studies have found that starting yearly mammograms before age 35 has no benefit and may instead be harmful. Women end up with higher exposure to radiation from mammograms over their lifetime, which increases their chance of getting radiation-induced breast cancer that they may not have gotten otherwise.[2]

Most women who have a mother, sister, or grandmother who had breast cancer at the age of 50 or older, or who are at high risk of breast cancer because of obesity or other reasons, may want to have regular mammograms (every two years) starting between ages 40 and 50. If their relatives had breast cancer at a young age, women may consider mammograms even before age 40. Unfortunately, younger women tend to have denser breasts, which often look white on a mammogram. Since cancer also shows up as white, mammograms are less accurate for younger women (and other women with dense breasts). For those women, a breast MRI is likely to be more accurate than a mammogram, and they are safer than mammograms.

Breast MRIs are more expensive than mammograms, costing an average of $2,000 (compared to about $100 for a mammogram). The Task Force says there isn’t enough information to recommend for or against MRIs. For that reason, insurance may not cover the cost. If you want insurance to pay for an MRI, you probably need your doctor to recommend it because of your high risk. Women with dense breasts are at higher risk, especially women with mothers or sisters who had breast cancer at a young age. It is logical that they could potentially benefit from regular breast MRIs, but research is lacking to draw conclusions.

Which Kinds of Cancer Risks Can Help Me Decide?

A 2011 article by Dr. John Schousboe and his colleagues examined mammography for women at different ages and with different risk factors. They concluded that mammography screening once every two years (biennial) had health benefits and was cost effective for all women 40-79 with high breast density or with both a family history of breast cancer and a breast biopsy, regardless of breast density. Biennial mammography was also beneficial for women aged 50-69 with average breast density and women 60-79 with low breast density and either a family history of breast cancer or a previous breast biopsy. Annual mammography was not cost-effective for any group.

The study’s authors concluded that each woman’s decision about mammography screening should be based on the following risk factors: age, breast density, history of breast biopsy, family history of breast cancer, and personal beliefs about the benefits and harms of screening. This study supports the Task Force guidelines that women at an average risk of breast cancer can start biennial screening at age 50, and that women at a higher breast cancer risk should consider screening before age 50.[3]

The chances of getting breast cancer increase with age, and the disease is much more common after age 50. So, from a public health and cost-effectiveness perspective, annual screening mammograms do the most good after age 50. Earlier mammograms are less accurate and more likely to result in unnecessary anxiety or unnecessary biopsies. Unlike Schousboe and his colleagues, the Task Force did not recommend routine screening for women 75 and older, because there was not enough evidence to conclude whether or not the benefits outweigh the risks. However, the American Cancer Society recommends that screening every other year continue for older women whose health is good enough that they are likely to live at least 10 years. That is a difficult standard to implement: How many doctors want to tell their healthy older patients that they don’t need mammography because they are not likely to live at least 10 more years?

Isn’t More Frequent Mammography Better?

Remember that mammograms expose women to radiation, which can increase the risk of breast cancer. Increasing the age of mammograms to age 50 for most women, and reducing the frequency to every two years could save lives because it would drastically reduce radiation exposure. Experts believe that less frequent mammograms also means a lower false alarm rate, and that means fewer unnecessary tests, anxiety, and possibly fewer unnecessary surgeries.[4][5]

The Big Debate: Do Mammograms Save Lives?

Between 1975 and 2000, dramatic improvements in treatments for breast cancer became available. Surgery options were improved, important chemotherapy agents were discovered, and tamoxifen, a hormonal treatment for estrogen-sensitive breast cancer, came into widespread use. At the same time, mammography became more popular. In 2000, about 70% of women 40 and over reported that they had a mammogram within the previous two years. Mammography rates more than doubled between 1987 and 1999, but more recently rates have decreased slightly.

The result of these important advances has been a dramatic decrease in the number of breast cancer deaths, even while more cases of breast cancer were being diagnosed. The five-year survival rate for breast cancer increased from 75% between 1974 and 1976, to 91% between 2005 and 2011.[6] Have the survival rates improved because of mammography or because of better treatments?

This became a full-fledged medical controversy in recent years. Two issues were at the root of the debate: 1) Was mammography simply uncovering more tiny, slow-growing abnormalities or cancers that would never have developed into a health threat even if they had never been discovered? and 2) Were we doing more harm than good by subjecting so many women to cancer treatment without knowing whether some of these breast abnormalities or very early cancers would really become dangerous? Since 2009, researchers have debated whether some tiny cancers disappear on their own without treatment. More important, experts agree that most ductal carcinoma in situ (DCIS) will never become an invasive breast cancer, even without treatment.

Regular screening mammography can possibly help diagnose cancer earlier, but the latest research suggests it may not have as much benefit for earlier diagnosis as expected. In January 2017, the Annals of Internal Medicine published a Danish study which examined whether the use of mammography can prevent the number of bigger, more advanced cancers that are difficult to treat.5 Dr. Karsten Juhl Jorgenson and colleagues looked at 30 years of data and compared women living in areas covered by screening programs to those in areas without the programs. Overall, mammography was not associated with fewer advanced cancers. However, in the areas with screening programs, diagnoses of non-advanced cancers increased. It is estimated that up to one third of diagnosed breast cancer cases would never have caused noticeable health problems or death.

Other research indicates mammography may not be saving lives, except possibly for the highest risk women. Researchers estimate that for 1,000 40-year-old women who have annual mammograms, two fewer women will die of breast cancer.[7] During that time, approximately 600 of these 1000 women will have false alarms, and approximately 5 – 10 will have unnecessary surgical treatment that could be harmful to them. This latest research did not consider the benefits compared to the risks of regular mammography (every two years) after age 50. It is possible that starting less frequent mammography at 50 (and for women at high risk between the ages 40 and 50) could provide benefits that may outweigh the risks for most women. Although about 90% of worrisome findings from mammograms turn out to be false alarms — not cancer — many experts continue to believe that the overall benefits have been established for women over 50.

Having fewer women die of breast cancer does not, however, mean that fewer women die.  None of the studies that evaluate the impact of mammography do so in terms of lives saved. Instead, they evaluate the number of women who die of breast cancer specifically.

What about breast self-exams? The Task Force recommends against teaching women to do breast self-exams, because evidence suggests the risks outweigh the benefits. There are many “false alarms,” and by the time a cancer is large enough to be felt in a self-exam, it will soon be found anyway, in the shower or while dressing. The Task Force and the American Cancer Society no longer recommend that doctors do breast exams on their patients for the same reason. Nevertheless, women should be familiar with how their breasts normally look and feel and report any changes to a doctor right away.

For more information:

U.S. Preventive Services Task Force, Breast Cancer Screening Final Recommendations, http://screeningforbreastcancer.org 

For information about insurance coverage for free mammograms: http://www.hhs.gov/blog/2016/01/11/bottom-line-mammograms-are-still-covered.html

Related Content:
Should I “upgrade” to digital or 3D? A mammography guide
Breast implants and mammography: what we know and what we don’t know
DCIS: Mostly good news

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References:

  1. BMJ 2016;352:h6080
  2. Berrington de Gonzalez A, Berg CD, Visvanathan K, and Robson M. (2009). Estimated Risk of Radiation-Induced Breast Cancer From Mammographic Screening for Young BRCA Mutation Carriers. Journal of the National Cancer Institute, 101(3): 205-209. doi:10.1093/jnci/djn440
  3. Schousboe JT, Kerlikowske K, Loh A, and Cummings SR. (2011). Personalizing Mammography by Breast Density and Other Risk Factors for Breast Cancer: Analysis of Health Benefits and Cost-Effectiveness. Annals of Internal Medicine, 155:10-20.
  4. Hubbard RA, et al. (2011). Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Annals of Internal Medicine, 155(8):481-92.
  5. Braithwaite D, et al. (2013). Screening Outcomes in Older US Women Undergoing Multiple Mammograms in Community Practice: Does Interval, Age or Comorbidity Score Affect Tumor Characteristics or False Positive Rates? Journal of the National Cancer Institute,105(5):334-341.
  6. Siegel, RL, Miller, KD, & Jemal, A (2016). Cancer statistics, 2016. CA: A Cancer Journal for Clinicians, 66(1), 7-30. doi:10.3322/caac.21332
  7. Welch G, et al. (2013). Quantifying the benefits and harms of screening mammography. JAMA Internal Medicine.

Third-hand smoke

Noy Birger and Celeste Chen, Cancer Prevention & Treatment Fund

You know that smoking and being exposed to other people’s cigarette smoke (second-hand smoke) is dangerous, but did you know that residue from cigarette smoke, which remains on just about every surface exposed to that smoke, is also harmful? This is called third-hand smoke.

Third-hand smoke or smoke residue clings to hair and fabrics, including clothing, carpets, drapes, and furniture upholstery.[1]  The residue reacts with other chemicals and materials in the air, combining to form substances that cause cancer.[2] This toxic mix is then breathed in or absorbed through the skin.

One particular chemical found in third-hand smoke, NNA, has been scrutinized because it can directly interact with and damage DNA, possibly paving the way for cancer to grow. Researchers believe that NNA behaves similarly to a byproduct of nicotine called NNK, which has long been known to cause cancer.

In a 2014 study, researchers confirmed that NNA not only breaks up DNA just like NNK does, but also attaches itself to DNA. By breaking up and attaching to DNA, NNA is able to produce cells that grow when they shouldn’t, creating tumors and causing damaging genetic mutations.[3]

Third-Hand Smoke Is Sneaky

Many public buildings ban indoor smoking, and the majority of people who smoke are aware of the health risks–to them and everyone around them–and therefore confine their smoking to outdoors, away from children and non-smokers. But even after the cigarette has been put out, you can carry dangerous nicotine residue back inside on your hair and clothes, and consequently put others at risk of developing cancer.[1]

Children are particularly vulnerable. Like adults, they can absorb the tar and nicotine leftovers through their skin. The effect on children is greater because they are smaller and still developing. Also, children are more likely to put their residue-covered hands on their nose or in their mouth.[4] Chemicals such as NNA that are produced when smoke residue mixes with chemicals in the air can cause developmental delays in children.[1] Parents should know that if they smoke in the car, their children can absorb the cancer-causing chemicals from the car upholstery, even if the children weren’t inside the car when the parent was smoking

Third-hand smoke is a new health concern.  While we know that the residue combines with the air and other pollutants, like car exhaust fumes, to make a cancer-causing substance, we don’t yet know for certain that it causes cancer in humans and if so, how much exposure is dangerous.[5] Figuring out the answer will be challenging, because most people exposed to third-hand smoke are also exposed to second-hand smoke. We know that non-smokers develop lung cancer, for example, but we usually don’t know if a non-smoker developed cancer because he or she was exposed to third-hand smoke, or for other reasons unrelated to smoking.

Bottom Line

Smokers with children or who live with non-smokers should never smoke inside the home or in their car, and clothing worn while smoking should be washed as soon as possible. If you smell cigarette smoke in a place or on someone, it means you are being exposed to third-hand smoke. An expert on helping people quit smoking recommends that after quitting, people should thoroughly clean their homes, wash or dry clean clothing, and vacuum their cars to remove the dangerous smoke leftovers.[2] Ideally, it would be best to replace furnishings that may have absorbed the chemicals from third-hand smoke, such as sofas, and re-carpet floors, re-seal and re-paint walls, and replace contaminated wallboard. Even if a smoker hasn’t quit yet, it’s a good idea to vacuum and wash clothes, curtains and bedding regularly to reduce their and their loved ones’ exposure to the dangerous chemicals that form when smoke residue mixes with the air.[3]

All articles on our website are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. “The dangers of thirdhand smoke.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 July 2017. http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
  2. Sleiman M, Gundel LA, Pankow JF, Peyton J, Singer BC, Destaillats H. Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. Proceedings of the National Academy of Sciences. January 6, 2010 www.pnas.org/cgi/doi/10.1073/pnas.0912820107.
  3. American Chemical Society (ACS). “Major ‘third-hand smoke’ compound causes DNA damage and potentially cancer.” ScienceDaily. ScienceDaily, 16 March 2014. www.sciencedaily.com/releases/2014/03/140316203156.htm.
  4. Winickoff JP, Friebely J, Tanski SE, Sherrod C, Matt GE, Hovell MF, et. al. Beliefs About the Health Effects of “Thirdhand” Smoke and Home Smoking Bans. Pediatrics. (123.1)74-79.
  5. Ballantyne C, What is third-hand smoke? Is it hazardous? Scientific American. January 6, 2009. http://www.scientificamerican.com/article.cfm?id=what-is-third-hand-smoke.

Libertarians Score Big Victory In ‘Right-To-Try’ Drug Bill

Sarah Karlin-Smith, Politico: August 3, 2017

The Senate unanimously approved a bill Thursday that would allow people facing life-threatening diseases access to unapproved experimental drugs, providing a victory for libertarian advocates who see government regulators thwarting patients’ rights.

The bill, S. 204 (115), passed swiftly and easily in a Senate bitterly divided over health care. The powerful pharmaceutical lobby, which had quietly opposed an earlier version, kept an unusually low profile. The industry has been focused on fighting off any efforts to go after drug pricing, which President Donald Trump has said he would tackle. […]

The legislation would allow patients with serious diseases — anything from a late-stage cancer to multiple sclerosis — to request access to experimental drugs directly from drug companies without having to go through the FDA, which has its own compassionate use program that approves 99 percent of requests.

But the right-to-try bill doesn’t require drugmakers to make the experimental treatments available. In the 37 states that have similar laws on the books, Goldwater can point to only one doctor who says he has utilized a state right-to-try law for a patient — and that medicine was being made available to certain patients by the FDA anyway.

That’s led some critics to call it “right-to-ask” — and it may give desperately ill people false hopes. […]

And if the experimental drugs do become widely used outside the standard clinical trial system, it could undermine some of the rigorous science needed to know whether medicines are safe and effective. Many drugs that start the clinical trial process flop. Some are harmful.

“You have a situation where patients think they want to take a risk and don’t necessarily understand what risk they are taking,” said Diana Zuckerman, president of the National Center for Health Research, which lobbied against the bill.

And while the revised bill would require annual reports on whether the drugs used by these patients helped — or potentially harmed — them, patient safety experts are concerned it may not be enough. […]

 

Read the original article here.

Cigarette Maker Stocks Plunge on FDA Announcement, But Health Experts Are Skeptical

Emma Court, Marketwatch: July 28, 2017

A Food and Drug Administration announcement Friday that included a proposal to lower nicotine levels in cigarettes to non-addictive levels sent cigarette maker shares plunging. […]

Health experts said that the Friday announcement focused on important public health priorities, including examining the effect flavors, such as menthol, have in attracting young people to tobacco products and approaching any changes so as to avoid a spike in black market activity.

But they also expressed skepticism about the real-world effects of Friday’s news, and concern about its pushback of reviews for products like cigars and hookah tobacco until 2021 and things like e-cigarettes until 2022. The aforementioned products are already on the market but have come more recently under FDA regulation. […]

And the announcement’s intent matters less than “not just what they ask for, but what they require,” said Diana Zuckerman, president of the National Center for Health Research.

Extending the product review timeline keeps harmful products on the market longer, Dobbins said.

For its part, the FDA said that extending the review deadlines will give the regulator more time along with giving companies “additional time to develop higher quality, more complete applications informed by additional guidance from the agency.” […]

Though the Friday announcement appeared to be a negative for cigarette makers, it could be “an opportunity over the long term for reduced-risk products,” said Wells Fargo Securities analyst Bonnie Herzog, such as Altria and Philip Morris’ smokeless iQOS devices. “We see this as an opportune entry point for long-term investors and would recommend building positions on today’s broad weakness.” […]

Read the original article here.

Fat Moms and Fat Babies? Weight Gain During Pregnancy

Heidi Mallis, Anna E. Mazzucco, PhD, and Jenna Carroll, Cancer Prevention and Treatment Fund

The obesity epidemic in the U.S. is affecting newborns and pregnant women. Being overweight or obese during pregnancy causes health problems for the mother and her baby. Several studies have examined ways to reverse the current trend.

The National Academy of Medicine (formerly the Institute of Medicine) offers guidelines for weight gain during pregnancy.[1] The report concludes that women today are heavier when they become pregnant than women used to be, and they gain more weight during their pregnancy than before. This can harm the health of both the mother and the baby.

What Are the Risks Associated With Being Overweight or Obese During Pregnancy?

An obese woman is less likely to go into labor naturally (or even to have it induced successfully), which means she is much more likely to have a Caesarean section. Obesity during pregnancy also increases the risk of several birth defects, such as cleft palate, intestinal tract abnormalities, and heart defects.[2]

When a baby’s birth weight is greater than 10 pounds, known as macrosomia (which merely means heavy birth weight), the baby is likely to grow up to be an obese child. Obese children tend to remain obese during their teenage years and as adults.

A study conducted by researchers at Virginia Tech College of Veterinary Medicine showed that a diet high in saturated fat among pregnant mice was associated with the offspring developing chronic disease in adulthood. The adult offspring had signs of hyperglycemia (high levels of sugar in the blood), insulin resistance, obesity, and hypertension, despite being fed healthy rodent food.[3]  This finding is significant because it shows that a child’s healthy eating habits can’t necessarily make up for a mother’s poor eating habits during pregnancy.

There is also evidence that children may have a higher risk of developing asthma if their mothers are overweight when they get pregnant. Obesity increases the amount of cytokines (which are small proteins) circulating in the body that cause inflammation, which is a type of immune response. When a pregnant woman’s body is in a constant state of inflammation due to excess fat (as opposed to weight gain from the developing fetus), it affects the lung development of the baby in the womb and may lead to a higher risk of asthma symptoms in childhood.[4]

A study of pregnant women in the Netherlands found that women who had excessive weight gain during pregnancy were eating more, were not physically active, and also were not getting enough sleep. The relationship between too little sleep and obesity has been known for several years: people who do not get enough sleep tend to eat more, and people who are obese tend to have sleep apnea, resulting in less sleep.[5]

Pregnancy Weight Gain: Too Much Isn’t Good But Neither Is Too Little!

While these studies make it clear that gaining an unhealthy amount of weight during pregnancy isn’t beneficial for the mother or the baby, research also suggests that gaining too little weight during pregnancy isn’t a good thing either.   A study published in 2014 found that babies from mothers who gained less than the recommended amount of weight tended to have higher levels of pesticides in the fluid in their umbilical cords than those from mothers who gained the recommended amount of weight.[6]

The reason may be because many pesticides get stored in body fat.  Women who don’t gain enough weight during pregnancy may use more of their body fat to nourish their growing baby, which means that the pesticides stored there will enter the blood of both the mom and the baby.

While we don’t know exactly how which pesticides or how great the exposure of pesticides are harmful to a growing baby, many experts recommend avoiding pesticide and toxin exposures during this sensitive time of growth and development.  Studies have shown that pesticide exposures in the womb can cause problems with brain, reproductive and immune system development.  For more information on pesticides and children’s health, see our article here.[7][8][9] For information on avoiding unsafe chemical exposures both before and during pregnancy, check out this article.

Gaining too little weight can also increase a mother’s chances of giving birth too early, or having a baby that is much smaller than average, which can sometimes lead to other health problems for the baby later in life.[10][11] Overall, studies support the Institute of Medicine recommendations for healthy weight gain, neither too little or too much.  And, having a healthy weight and balanced nutrition before getting pregnant will make it easier to keep weight gain during pregnancy within the recommended range.

Risk of Diabetes During Pregnancy

About 5% of pregnant women develop gestational diabetes, which means that a woman has high blood sugar while carrying her baby but has never had diabetes before.

Research indicates that women with gestational diabetes should avoid certain foods. A long-term study found that when pregnant women with gestational diabetes ate more than 4 servings of refined grains (found in most bread and pasta) per day, their children were 80% more likely to be obese by age 7 compared to children of women who ate less than 2 servings of refined grains per day.[12]

Artificially sweetened beverages also have health risks for women with gestational diabetes.  Women who consumed at least one artificially sweetened beverage daily during pregnancy had children who were more likely to be obese or overweight by age 7 – possibly twice as likely.[13] The more artificially sweetened beverages women drank during pregnancy, the more likely it was that their children were obese or overweight.  Drinking water instead of one or more artificially sweetened beverages per day lowered the risk. Click here for more information about managing gestational diabetes.

Tips for Maintaining a Healthy Weight During Pregnancy

Many women find that their usual strategies for keeping their weight down don’t work during pregnancy. For example, when clothes get tight or the scale shows a few extra pounds, that is usually a reminder to watch what you eat; but those clues are not helpful for a women who is pregnant.

The following suggestions can help a woman stay healthy during pregnancy:

PRE-PREGNANCY BMI TOTAL WEIGHT GAIN FOR ONE BABY (LB.) TOTAL WEIGHT GAIN FOR TWINS (LB.)
Underweight: BMI less than 18.5 kg 28-40 No guideline available
Normal weight: BMI between 18.5-24.9 kg 25-35 37-54
Overweight: BMI between 25.0-29.9 kg 15-25 31-50
Obese: BMI greater than 30.0 kg 11-20 25-42
  • Discuss these guidelines with a health care provider to create a personalized plan that best meets your pregnancy needs.
  • Maintain a healthy diet, emphasizing foods that are low in fat and high in fiber. In addition to prenatal vitamins, aim for foods that are a natural source of folic acid (also called folate), such as orange juice, green leafy vegetables, beans, peanuts, broccoli, asparagus, peas, and lentils. Folic acid can reduce the risk of birth defects of the brain and spine.
  • Participate regularly in physical activity. The American College of Obstetricians and Gynecologists recommends a minimum of 30 minutes of moderate physical activity a day for pregnant women (unless there are medical or obstetric complications). Of course, avoid activities with a high risk of falling or abdominal harm.[13]

By maintaining a healthy weight, it is possible to reduce the risk of complications during pregnancy and delivery, and decrease the chances of your child developing health problems later on.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Institute of Medicine (2009, May). Weight gain during pregnancy: re-examining the guidelines. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf (Accessed November 30, 2009).
  2. Rowlands I, Graves N, de Jersey S, McIntyre D, Callaway L (2009, October 12). Obesity in pregnancy: outcomes and economics. Seminars in fetal and neonatal medicine: 1744-65.
  3. Liang C, Oest M, Prater M (2009, September 11). Intrauterine exposure to high saturated fat diet elevates risk of adult-onset chronic diseases in C57BL/6 mice. Birth Defects Res B Dev Reprod Toxicol. -Not available-, ahead of print.
  4. Scholtens S, Wijga A, Brunekreef B, Kerkhof M, Postma S, Oldenwening M, de Jongste J, Smit H (2010, April). Maternal overweight before pregnancy and asthma in offspring followed for 8 years. International Journal of Obesity. 34(4):606-13
  5. Patel SR, Hu FB (2008). Short sleep duration and weight gain: a systematic review. Obesity, March 2008; 16(3): 643-653.
  6. Vizcaino E, at al. Gestational Weight Gain and Exposure of Newborns to Persistent Organic Pollutants. Environmental Health Perspectives. May 2014.
  7. Forns J, Lertxundi N, Aranbarri A, Murcia M, Gascon M, Martinez D, et al. 2012. Prenatal exposure to organochlorine compounds and neuropsychological development up to two years of life. Environ Int 45(1): 72-77.
  8. Herbstman JB, Sjodin A, Apelberg BJ, Witter FR, Halden RU, Patterson DG, et al. 2008. Birth delivery mode modifies the associations between prenatal polychlorinated biphenyl (PCB) and polybrominated diphenyl ether (PBDE) and neonatal thyroid hormone levels. Environ Health Perspect 116(10):1376-1382.
  9. Hertz-Picciotto I, Park HY, Dostal M, Kocan A, Trnovec T, Sram R. 2008. Prenatal exposures to persistent and non-persistent organic compounds and effects on immune system development. Basic Clin Pharmacol Toxicol 102(2):146-154.
  10. Stotland NE, et al. Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol. 2006 Sep;108(3 Pt 1):635-43.
  11. Mumbare S, et al. Maternal Risk Factors Associated with Term Low Birth Weight Neonates: A Matched-Pair Case Control Study. Indian Pediatr 2012;49: 25-28.
  12. Zhu, Yeyi, et al.  Maternal dietary intakes of refined grains during pregnancy and growth through the first 7 years of life among children born to women with gestational diabetes. American Journal of Clinical Nutrition. June 2017.
  13. Yeyi Zhu, Sjurdur F Olsen, Pauline Mendola, Thorhallur I Halldorsson, Shristi Rawal, Stefanie N Hinkle, Edwina H Yeung, Jorge E Chavarro, Louise G Grunnet, Charlotta Granström, Anne A Bjerregaard, Frank B Hu, Cuilin Zhang; Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study. Int J Epidemiol.June 2017.
  14. Centers for Disease Control and Prevention (2008, April 27). Healthy Weight: Adult BMI Calculator. U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html(Accessed October 19, 2009).
  15. American College of Obstetricians and Gynecologists (2002, January). ACOG Committee Opinion No. 267: Exercise during pregnancy and postpartum period. 99 (1): 1-3.

FDA Deal Would Relax Rules on Reporting Medical Device Problems

Sheila Kaplan, The New York Times: July 11, 2017

WASHINGTON — Makers of cardiac defibrillators, insulin pumps, breast implants and other medical devices might be able to delay reporting dangerous malfunctions to the Food and Drug Administration under an agreement heading for a vote in Congress.

Device makers will still have to quickly report any injuries or deaths related to their products. They would have more time, though, to file reports on devices that may not be working properly, and have the potential for injury.

The deal is part of a pact between the F.D.A. and the $148 billion device industry. Renegotiated every five years, the agreement includes the fees that device makers must pay for the agency to review their products. It is scheduled for a vote in the House of Representatives on Wednesday. […]

But consumer advocates point to recent problems where initial reports of device malfunctions did not involve any injuries, but later evidence — sometimes additional devices showing flaws or reports indicating patients were harmed — began to surface. They pointed to cardiac defibrillators that ran out of batteries; the power morcellator, designed for laparoscopic surgery to remove uterine fibroids, which spread cancer through patients’ bodies; a type of breast implant that is linked to a rare cancer; and the superbug-bearing duodenoscope, whose design flaws made it virtually impossible to disinfect. […]

Textured breast implants have been linked to a rare form of cancer.Critics of relaxing the rules say this is not the right time to ease oversight when so much already goes undetected.

“It often takes months or even years for the F.D.A. to detect patterns of failure,” said Jack Mitchell, director of health policy for the National Center for Health Research in Washington. “Post-market surveillance of medical devices continues to be dangerously slow and clearly inadequate to protect patients from risky devices.” […]

 Read the original article here.