Category Archives: Skin Cancer

Tanning beds: safe alternative to sun?

By Heidi Mallis, B.A and Diana Zuckerman, PhD
Updated 2015

For many years, tanning beds were advertised as a safe alternative to a natural suntan, but in fact, there was no evidence that was true.  No U.S. government agency evaluated sun lamps, tanning beds, or tanning booths to make sure they were safe.  As a result, nearly 30 million people in the U.S. were using tanning beds each year1, 2.3 million of whom were adolescents.2

Research evidence was growing about the risks of tanning beds.  According to the American Academy of Dermatology and the World Health Organization, indoor tanning increases a person’s chances of developing melanoma by 59 percent, and the risk goes up with each use.3

Finally, in 2014 the U.S. Food and Drug Administration (FDA) announced that all sun lamps and UV lamps intended for use in sun lamp products must come with warnings include the following:

  • This product is contraindicated for persons under the age of 18 years;
  • This product must not be used if skin lesions or open wounds are present;
  • This product should not be used on people who have had skin cancer or a family history of skin cancer
  • People repeatedly exposed to UV radiation should be regularly evaluated for skin cancer3

As evidence grew of the link between tanning beds and skin cancer, especially for men and women in their 20s, more than 60% of states passed some kind of legislation restricting the use of tanning salons by children under 18 and two states, California and Vermont, have passed complete bans of indoor tanning for minors.4

What does this mean for you?

Tanning beds expose the user to a lot of artificial UV radiation in a short period of time. Just one 8-20 minute session exposes a person to more UV radiation than an entire afternoon spent in natural sunlight. In fact, doses of UV radiation emitted by high pressure sunlamp products may be up to 10 to 15 times higher than that of the midday sun, which is more intense than UV radiation found in nature.

A study conducted by Dr. S. Elizabeth Whitmore and Dr. Warwick Morison of Johns Hopkins University School of Medicine found that ten tanning sessions in two weeks produced evidence of a suppressed immune system among participants. This means that the body is less capable of fighting off infectious agents.5 Tanning bed use is also associated with faster skin aging because the UV radiation destroys skin fibers and damages elasticity. Characteristics of skin aging include wrinkles, dark spots, and a leathery texture.6

The International Agency for Research on Cancer lists tanning beds in its highest cancer risk category, “carcinogenic to humans.” This means that there is enough evidence to conclude that tanning beds can cause cancer in humans. Prior to 2009, the agency, which is part of the World Health Organization (WHO), previously classified tanning beds as “probably carcinogenic.” The change came after an analysis of more than 20 epidemiological studies indicating that people who begin using tanning devices before age 30 are 75% more likely to develop cutaneous melanoma, the most serious type of skin cancer7

Skin cancer is the most common form of cancer, with more than one million cases diagnosed each year in the U.S. There are three types of skin cancer: squamous cell, basal cell, and melanoma. Squamous cell carcinomas typically occur on surfaces exposed to the most sunlight, such as the ears or face. This type of skin cancer can spread quickly to other organs in the body. Basal cell carcinomas account for 8 out of 10 skin cancers. They grow very slowly and rarely spread to other parts of the body (as a result, they are highly treatable). Melanomas are the third and most dangerous type of skin cancer. They are less common than basal and squamous cell carcinomas but much more serious.8 Melanomas usually present as a change to an existing mole or an entirely new mole that is black or has a blue-black area. Their diameter is typically larger than that of a pencil eraser. If caught early, melanomas are often completely curable. However, they are much more likely to spread to other parts of the body if not found early.9

Risk factors for all three types of skin cancer include:

  • Lifetime exposure to UV radiation (from natural or artificial sources)
  • Family history of skin cancer
  • Geographic location (people who live close to the equator as well as in the mountains are exposed to higher levels of UV radiation)
  • Fair skin that freckles or burns easily
  • Severe sunburns as a child
  • Radiation therapy

Here are a few ways to lower your risk and avoid wrinkles and other skin damage:

  • Avoid direct sun exposure during midday hours (from 10 am-4 pm),
  • Use sunscreen with a sun protection factor (SPF) of at least 15
  • Regularly check your skin for any new moles, sores, or scaly patches (and visit a dermatologist if you notice the lesion changing form or color), and
  • Avoid using a tanning bed or booth (especially if you are a child, teenager, or young adult).10

Keeping track of moles and other changes to your skin are an easy way to improve your skin health. However, the U.S. Preventive Services Task Force suggests that if you are not at an increased risk of developing skin cancer, there is no need for yearly skin checks by a dermatologist.11

Continue to monitor any existing or new moles and contact your doctor if you detect any significant changes in size, shape, or color.

 

Running and skin cancer prevention

By Danielle Pavliv
2015

Exercise reduces your risk of cancer and many other diseases, but running outdoors can increase your risk of skin cancer if you don’t follow a few simple rules.

Running is one of the most popular forms of exercise. It can be done anywhere, doesn’t require a gym or any special equipment (although some people prefer to use a treadmill)-just a good pair of shoes and comfortable clothing. Running outside — whether on a track, in the woods, or on a path by the river — can be a wonderful and restorative way to exercise. Nature and exercise are both great ways to improve your mood.

Running regularly can lower the risk of many health problems including heart disease, stroke, osteoporosis and bone fracture, diabetes, and obesity.[end Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. Canadian Medical Journal. 2006; 174(6):801-809.] In addition, it can improve mental health and blood pressure.[end Paluska SA, Schwenk TL. Physical activity and mental health: Current concepts. Sports Medicine. 2000;29(3):167-180.] However, many people don’t take proper precautions when they decide to go running outside, and the results can be deadly.

Imagine this: it’s a nice day outside, so you decide to go for a jog, wearing running shorts and a t-shirt. You probably don’t spend too much time thinking about what to wear — you simply notice what the temperature is, put on something comfortable, and go. Sunscreen seems like a hassle, and you think you’ll probably sweat it off anyway. It’s not like you will be laying out at the pool or playing golf all day, so how much harm can a 30-minute run cause anyway?

While many of us try to protect our skin when spending time outside, data show that just over half of all American adults usually take at least one of these three precautions:  seeking shade, using sunscreen, or wearing sun-protective clothing.[end Sun-Protective Behavior Rates. Skin Cancer. Centers for Disease Control and Prevention. August 2011. Available at: http://www.cdc.gov/cancer/skin/statistics/behavior.htm.] People who don’t do any of these are at much higher risk for skin cancer.

Skin cancer

Skin cancer is the most common of all cancers. In the U.S., accounting for almost half of all cancers and affecting over 2 million people each year. One in 5 Americans will develop skin cancer during their lifetime.[end Robinson JK. Sun exposure, sun protection, and vitamin D. Journal of the American Medical Association. 2005;294(12):1541-1543.] There are three types of skin cancer: basal cell, squamous cell, and melanoma. Basal cell carcinomas are the most common type of skin cancer. They rarely spread to other areas of the body, and are very treatable. Squamous cell carcinomas, on the other hand, can spread to organs and other areas in the body and can be fatal if they are not caught early. The third type of skin cancer, melanomas, are the least common but most dangerous — they kill more than 8,600 Americans every year.[end Skin Cancer Statistics. Centers for Disease Control and Prevention. April 2012. Available at: http://www.cdc.gov/cancer/skin/statistics/.] If found early, however, melanomas can be treated. Melanomas are most often caused by ultraviolet radiation from the sun or tanning beds. They usually resemble moles and are often black or brown. Most change over time, including an increase in size.[end National Cancer Institute. Signs and symptoms of melanoma. U.S. National Institutes of Health. January 11, 2011. Available at: http://www.cancer.gov/cancertopics/wyntk/skin/page8.] In recent years, incidence of melanoma has increased significantly, especially in those with fair skin. While melanoma is more prevalent in men than women, rates of diagnoses and death are increasing for both men and women.

Is exercising outside more risky than just relaxing outside?

In 2006, Dr. Christina Ambros-Rudolph and colleagues at the Medical University of Graz in Austria conducted a study to see if marathon runners are at higher risk of melanoma than people who don’t run as regularly.[end Ambros-Rudolph CM, Hofmann-Wellenhof R, Richtig E, Müller-Fürstner M, Soyer HP, Kerl H, Dermatol A. Malignant Melanoma in Marathon Runners. Archives of Dermatology. 2006;142(11):1471-1474.] They examined over 200 runners and found that they are at increased risk for skin cancer. In fact, runners who trained the most intensively had the highest rates of skin lesions. Almost all of the athletes wore shirts and shorts that did not totally cover their arms, back and legs, and only 56% wore sunscreen. Although there was a clear link between sun exposure and skin lesions, the researchers found another reason the athletes who had more intense workouts were more prone to skin cancer. Endurance exercise such as long-distance running suppresses immune function in the body, which is why extreme athletes are often more susceptible to infections than others. This can release a type of protein called cytokines, limiting the ability of the body’s immune system to fight off potential cancers. In addition, sweating a lot while outside is linked to skin cancer. The wetter your skin, the more UV rays are absorbed, which means that exercising on sunny days can be much more dangerous for your skin than just sitting or laying down in the sun.

How to stay safe outside

You don’t have to give up running outside — there are plenty of ways to protect yourself outside for exercise or any other activity. Try to do as many of these as possible each time you go out in order to lower your risk for melanoma or other types of skin cancer:

  • Use a generous amount of sunscreen with a sun protection factor (SPF) of 30 or higher, even on cloudy days — cloud cover only blocks out one type of UV rays. Reapply often, especially if you are sweating or in the water. Use a water-resistant sunscreen that will stay on when you swim or sweat.
  • Avoid the sun between 10 a.m. and 4 p.m., when UV rays are the strongest. If you want to go for a run outside, try to do it early in the morning or right before sunset.
  • Put on some sunglasses with high UV absorption to protect your eyes, and a hat to protect your face.
  • Wear clothes made of tightly woven fabrics that you cannot see through. Try to avoid regularly exposing areas of your body such as your shoulders, neck and chest. To prevent overheating, wear light-colored clothing that reflects the sun’s rays.
  • Look for shade: try to do your stretches and other exercises in a shaded area.

Choosing a sunscreen

The American Academy of Dermatology recommends that everyone wears a water-resistant sunscreen of at least 30 SPF daily.[end American Academy of Dermatology Sunscreen Website. Stats and Facts. Prevention and Care. Sunscreens. 2012. Available at: http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens.] Further, they recommend using a broad-spectrum sunscreen that protects against both types of UV rays (UVA and UVB). You can use the Environmental Working Group’s website to find out which sunscreen really work and don’t contain a lot of harmful and even cancer-causing ingredients. The Food and Drug Administration (FDA) didn’t regulate sunscreen until June 2012. Prior to that date, there was no guarantee that the sunscreen you were slathering on your body actually protected you or did what the label claimed. Now, manufacturers are required to label their products accurately and are held to safety and effectiveness standards.[end FDA sheds light on sunscreens. U.S. Food and Drug Administration. June 2012. Available at: http://www.fda.gov/forconsumers/consumerupdates/ucm258416.htm.] When choosing a product, remember that a sunscreen with twice the SPF does not mean you can stay outside in the sun twice as long before you get a sunburn. The intensity of UV radiation matters just as much as how long you are in the sun, which is why it’s so important that you limit your exposure from 10 a.m. to 4 p.m.[end Jou PC, Feldman RJ, Tomecki KJ. UV protection and sunscreens: What to tell patients. Cleveland Clinic Journal of Medicine. June 2012;79(6):427-436.]

Make sure to regularly check your body for any new moles or scaly patches. If they change size, form or color, visit a dermatologist. If you have skin cancer in your family, you will likely want to get your moles checked regularly.

Sun damage is permanent and irreversible, so it’s important to take good care of your skin throughout your life. Remember — a tan is a sign of skin damage. There’s no such thing as a “healthy” tan!

For more information about the most dangerous type of skin cancer, see http://dev.stopcancerfund.org/t-skin-cancer/treating-skin-cancer-melanoma/

Good news for coffee drinkers: the health benefits outweigh the risks for most people

By Morgan Wharton and Jessica Cote
Updated 2015

latte-249102_640Most Americans drink coffee every day.12 The caffeine in coffee helps us stay alert but also may cause jitteriness and interfere with sleeping. A few studies suggest that decaffeinated coffee also has health benefits, perhaps because of antioxidants or acids in the coffee bean.13

What Are The Health Benefits Of Drinking Coffee?

For years medical experts advised people to drink less coffee, mostly because of research suggesting coffee might increase the risk of heart disease. However, numerous studies conducted recently have discovered coffee’s unexpected health benefits. Like all well-designed research, most of these studies considered the impact of age, sex, body mass index (BMI), physical activity, tobacco use, and whether family members had developed cancer. By controlling for those factors, researchers made sure they could separate coffee’s impact on health from the effects of people’s lifestyle, family history, and previous health problems.

Colorectal Cancer

Meta-analyses are a kind of statistics that combine data from several comparable studies to make one very large study. These results are usually more accurate than any one study can be. Taken together, three meta-analyses suggest that drinking about four or more cups of coffee per day may reduce the chances of getting colorectal cancer by 11-24%.141516

Endometrial (uterine) Cancer

Using data from 67,470 women who participated in the Nurses’ Health Study, researchers found that women who drank four or more cups of coffee per day were 25% less likely to develop endometrial cancer than women who drank only one cup of coffee per day. Compared to women who did not drink any coffee, those who drank four cups or more per day were 30% less likely to develop endometrial cancer. Decaffeinated coffee was just as effective as caffeinated coffee, but caffeinated tea did not lower the risk of endometrial cancer.17

Liver Cancer And Cirrhosis (Scarring of the Liver/Chronic Liver Disease)

One study found people who drank one or two cups of coffee per day had a slightly lower risk of getting the most common type of liver cancer compared to non-drinkers, but people who drank three or four cups of coffee were about half as likely as non-drinkers to get this kind of liver cancer. Meanwhile, people who drank five or more cups per day had an even lower risk than that (about one-third the risk of non-drinkers).18

Similarly, a study in Japan found a 76% decrease in the risk of that type of liver cancer in people who drank at least five cups of coffee per day compared to those who did not drink coffee. The strongest benefit was seen in individuals with hepatitis C, a disease which increases a person’s risk of developing liver cancer, although the researchers were not sure why.19

A study of 120,000 Americans over an 8-year period found a 22% decrease in the chances of developing cirrhosis for each daily cup of coffee. In Norway, a 17-year study of 51,000 citizens found that those who drank two or more cups of coffee per day were 40% less likely to develop cirrhosis compared to those who did not consume coffee.20

Skin Cancer

Using data from two enormous studies, the Nurses’ Health Study and the Health Professionals Follow-up Study, researchers found that men and women who drank more than three cups of caffeinated coffee per month were 17% less likely to develop basal cell carcinoma compared to people who drank less than one cup per month. Basal cell carcinoma is the most common and least dangerous type of skin cancer. Drinking decaffeinated coffee did not affect basal cell carcinoma.21

A 2014 study in the Journal of the National Cancer Institute found that the more coffee participants drank, the less likely they were to develop malignant melanoma over a 10 year period. Melanoma is the most dangerous form of skin cancer. Almost 450,000 whites, aged 50-71, participated in the study. Researchers found that drinking four or more cups of coffee per day was linked to a 20% lower risk of getting malignant melanoma. Once again, drinkers of decaffeinated coffee lost out. Their risk of getting melanoma was no different from that of non-coffee drinkers. Coffee drinking, however, did not affect the least dangerous form of melanoma, called melanoma in situ.

Remember that no matter how much coffee with caffeine you drink, the best way to prevent skin cancer is still to limit your time exposed to the sun and ultraviolet light! 22

Type 2 Diabetes

People in Finland consume more coffee than almost any other nation, and a study of 14,000 people over 12 years  found that men who drank 10 or more cups of coffee daily had a 55% lower risk of developing type 2 diabetes than men who drank 2 cups of coffee a day or fewer.  Even more dramatic, women who drank 10 or more cups per day had a 79% lower risk of developing type 2 diabetes than those who drank fewer than 2 cups daily.23

A different Finnish study of 5,000 sets of identical twins found that individuals who drank more than seven cups of coffee per day had a 35% lower risk of type 2 diabetes than their twins who drank two cups or fewer per day.24 Because identical twins are so biologically similar, the difference in disease risk is very likely caused by coffee consumption levels. Studies of fewer people in other countries have found less dramatic but similarly positive results.

Parkinson’s Disease

A study of more than 8,000 Japanese-American men found that men who did not drink coffee at all were three to five times more likely to develop Parkinson’s disease within 30 years than men who drank four and a half cups or more of coffee per day.25

Suicide

Because suicide may be related to alcohol intake, medications, and stress levels, suicide studies took those factors into account.  A 10-year study of 128,000 people in California found that the risk of suicide decreased by 13% for every additional cup of coffee consumed per day. Even one cup of coffee per day seemed to reduce the risk of suicide. A different 10-year study of 86,000 women found a 50% lower risk of suicide for those who drank two or more cups of coffee per day compared to women who did not drink coffee.26

Brain Power and Aging

A study of 676 healthy men born between 1900 and 1920 suggested that coffee helped with information processing and slowed the cognitive decline typical of aging. Cognitive functioning was measured by the Mini-Mental State Examination, a 30 point scale. Men who regularly consumed coffee experienced an average decline of 1.2 points over 10 years, while men who did not drink coffee saw a decline of 2.6 points over 10 years. Men who drank three cups of coffee per day declined only 0.6 points over 10 years.27

Even old mice are sharper with caffeine: a study using a mouse model of Alzheimer’s disease showed that coffee actually reversed the cognitive decline and slow-down in processing that occurred with age. Mice given caffeine in their water showed signs of recovering their memory during testing.28

What about the risks?

Childbearing

Two separate studies found that 300 mg of caffeine (two to three cups of coffee) decreased a woman’s chances of getting pregnant by more than a third. This same amount of coffee also increased the chances of women having low birth-weight babies by 50%. These studies took into account potentially influential  factors such as contraception used in the past and infertility history.29

Hip Fracture

According to data from the Nurses’ Health Study, women aged 65 and over who drank more than four cups of coffee per day had almost 3 times as many hip fractures over the next six years as women who did not drink coffee. Researchers took important factors into consideration such as how much calcium the women consumed each day.30

Parkinson’s Disease among post-menopausal women taking estrogen-only hormone therapy

Other researchers used data from the Nurses’ Health Study to evaluate the risk of Parkinson’s disease among women who drank coffee while using estrogen medication after menopause. For women who were NOT using estrogen therapy, those who drank four or more cups of coffee per day were about half as likely to develop Parkinson’s disease as women who did not drink coffee. For women who did use post-menopausal estrogen, however, those who drank four or more cups of coffee were about twice as likely as those who didn’t drink coffee to develop Parkinson’s.31

Heart Disease

Two different meta-analyses found that people who drank five or more cups of coffee per day were 40-60% more likely to develop heart disease compared to those who did not drink coffee at all. Other studies have also shown that high coffee use (five to ten cups per day) increases the risk of heart disease, while moderate consumption (three to four cups daily) was not associated with a higher risk. Only coffee drinkers who consumed more than nine cups a day had a greater risk of dying from heart disease.32 It is important to consider that people drinking close to 10 cups of coffee a day are likely to have other health problems, such as stress or sleep deprivation, and this could contribute to higher risk of heart disease and death regardless of coffee use.

Bottom line

For most people, drinking coffee seems to improve health more than harm it. Many of coffee’s health benefits increase with the number of cups per day, but even one cup a day lowers the risk of several diseases. However, women who want to get pregnant or already are pregnant and women over 65 should probably limit their coffee intake because, in their case, the risks may outweigh the health benefits.

Even though many studies show coffee has benefits, it’s still not clear why. How can one popular beverage help metabolism (for example, lowering the risk of type 2 diabetes) and also protect against a range of cancers? Until further research can solve that puzzle, most adults should continue to enjoy their cup (or two, or three) of Joe. Finally, remember that nearly all studies on coffee and health have been done on adults. Coffee may affect children and teens differently.

Which sunscreen should you use?

By Isabel Platt and Laura Gottschalk, PhD
Updated 2016

Sunscreen-infographic

 

Other than the 15 minutes of sunshine we all need for our daily requirement of vitamin D, staying out of the sun should always be the first choice for skin cancer prevention.  However, there are ways to reduce the damage your skin gets from the sun. Wearing protective clothing, hats, and limiting sun exposure during the sunniest parts of the day are all great ideas. When sun exposure can’t be avoided, however, sunscreen can also help protect from some of the damaging effects of the sun.

But what kind of sunscreen is best? Spray or lotion? SPF 15 or SPF 70? Waterproof or moisturizing? It seems like new rules come out every year. To clear up mixed messages, here is a guide to choosing the best sunscreen for you and your family.

SUNSCREEN PREVENTS CANCER

Spending too much time in the sun puts you at risk for skin cancer. There are three types of skin cancer: basal cell, squamous cell, and melanoma. Basal cell cancers, the most common, are slow growing and are the easiest to treat. Squamous cell cancers detected at an early stage are curable and cause minimal damage. Melanoma is the least common but most dangerous kind of skin cancer. If not caught early, it can spread throughout the body and become fatal.

Most melanomas result from sun exposure.33 The number of men and women in the U.S. diagnosed with melanomas increased by nearly 2% each year between 2000 and 2009, and even more among Caucasians.1 34 35 If you have fair skin, you are especially likely to get melanoma from sun exposure. The easiest way to reduce your risk of melanoma is to apply sunscreen to exposed areas every day as part of your morning routine, but don’t forget that it only lasts about 2 hours so you may need to apply it again later in the day.36 If you need another reason to wear sunscreen, a new study found that applying sunscreen every day reduces aging of the skin by 24%.37

Protecting your kids from sunburns is especially important. Getting sunburns during childhood increases the risk of cancer later in life.1 So get your kids into the routine of applying sunscreen every morning (after they brush their teeth) before going to school or to camp, no matter how cloudy it is outside.

WHICH SPF TO USE?

Sun protection factor (SPF) choices range from SPF 8 all the way up to SPF 100+. According to the Food and Drug Administration (FDA), SPFs below 15 protect against sunburns, but they do not prevent damage that can cause skin cancer.38 On the other hand, very high SPFs are misleading since SPF 30 protects against 97% of UV rays, SPF 50 protects against 98%, and SPF 100 protects against 99%. Sunscreens with the highest SPFs cost more and provide little additional protection, and they also encourage people to stay out in the sun longer and reapply less frequently. For effective sun protection, look for an SPF between 15 and 50.

In addition, make sure to choose “broad-spectrum” sunscreen, which guards against both UVB and UVA rays. While only 10% of UV radiation from the sun is UVB, this type of radiation is the primary cause of sunburns, wrinkling, and skin cancer.1 UVA rays penetrate deep into the skin to cause premature aging, and with enough exposure can also damage DNA to cause cancer.

You may be surprised to learn that the FDA does not check the ingredients in sunscreens to test if they are safe and effective. Many of the active ingredients in sunscreens have been used for so long that they are generally believed to be safe and effective, but that is different from being proven to actually be safe and effective. The FDA is currently working on a plan to start testing sunscreen ingredients for safety and effectiveness.

Consumer Reports rated the effectiveness of sunscreens but not their safety.  This is the list of the top sunscreen lotions and sticks from their 2016 report.  However, all of them are made with endocrine disrupting chemicals.  The sunscreens that are made with the safer ingredients (zinc oxide and titanium dioxide) scored very poorly in the Consumer Reports report.

Lotions

1. La Roche-Posay Anthelios 60 Melt-in Sunscreen Milk (note that this is much more expensive than other sunscreens listed)

2. Pure sun Defense Disney Frozen SPF 50

3. Coppertone Water Babies SPF 50

4. Equate (Walmart) Ultra Protection SPF 50

5. Ocean Potion Protect & Nourish SPF 30

6. Aveeno Protect + Hydrate SPF 30

Sticks

1. Coppertone kids stick SPF 55

2. Up & Up (Target) Kids stick SPF 55

LOTION OR SPRAY? WATERPROOF OR WATER-RESISTANT?

Avoid powder makeup and instead use liquid makeup products that contain SPF. Loose powders contain zinc and titanium that can be carcinogenic if inhaled.39 For this reason, the FDA no longer allows the manufacture of powder make-up with SPF, but some of these products are still on the market.

In addition, be sure to avoid sunscreen sprays, especially for kids. Sprays make it easy to inhale the chemicals that are found in the sunscreens. This can pose a safety issue, especially for small children who tend to squirm a lot while sunscreen is put on them. The FDA has also expressed concern about sprays but has not yet limited their use.8 Sunscreen lotion provides better protection against burns that cause skin cancer and aging, without the risk of inhaling dangerous chemicals. If a spray sunscreen is the only available option, first spray it in your hands before applying it to children. Do the same before applying it to the face of adults.

Waterproof sunscreens are no longer for sale. The FDA issued new guidelines that sunscreens can only be labeled as “water resistant” and must say whether they protect for 40 or 80 minutes while sweating or swimming.7 So be sure to reapply your water resistant sunscreen right after getting out of the water.

WHICH INGREDIENTS TO AVOID?

Even when sunscreens are approved by the FDA it does not mean that all the chemicals in them are entirely safe. Try to stay away from Vitamin A and oxybenzone. Vitamin A is found in about 25% of sunscreens because manufacturers claim that it prevents skin aging.40 However, the National Institutes of Health (NIH) has shown that the combination of sunlight and Vitamin A on the skin can increase your risk of cancer.41 The Environmental Working Group (EWG) recommends avoiding oxybenzone, which can potentially cause allergic reactions and interfere with hormones.42

THE BOTTOM LINE

So what should you do to prevent sunburns, aging, and skin cancer? Apply a generous amount of SPF 15 – 50 sunscreen lotion every morning, wear a hat and sunglasses, and generally try to stay in the shade. Reapply your sunscreen after extended sun exposure, sweating, and swimming. Always check the expiration date on sunscreens before you buy and use them, and stay away from tanning beds and sun lamps. If you are fair-skinned or have a family history of skin cancer, be extra careful.

Every year, the Environmental Working Group researches sunscreens on the market and rates them for safety and how well they work. To see how your sunscreen compares, visit their website. If your sunscreen is poorly rated, you can browse their site to find good alternatives.

Airport Security and Radiation

Laura Covarrubias, Cancer Prevention and Treatment Fund

Following the September 11th attacks in 2001, the Transportation Security Administration (TSA) was created and given responsibility for protecting the public from security threats in transportation systems, such as airports. Although metal detectors were once the main security devices used at American airports, the TSA introduced new technologies after terror attempts were made using hidden explosives (in shoes and underwear, for example). These backscatter and millimeter scanners have begun replacing metal detectors and are designed to scan a person to determine what weapons or explosives they may have beneath their clothing. Currently, there are about 250 backscatter and 264 millimeter wave scanners in the United States. The TSA hopes to have 1,800 scanners of either type installed by the end of 2014 – which would mean that nearly every airport in the country will have one.

Backscatter scanners look like two large blue boxes. People raise their arms and stand sideways between these two boxes when they are scanned.

In contrast, millimeter wave scanners look like circular glass phone booths, and the person being scanned stands with their arms raised while part of the scanner rotates around them:

If you are not sure which scanner is in use at your airport, ask a TSA official at the security checkpoint.

Privacy

When a millimeter scan is used, the machine determines if the person has any potentially harmful items on his or her body. If so, only the outline of a standard human body is shown with potentially dangerous objects highlighted in yellow. If no dangerous objects are detected, the security officer will only see an empty green screen. The security official does not see an image of the actual individual when the millimeter scan is used.

In contrast, when a backscatter scan is used, a blurred, colorless image of the individual (without clothing) is produced. A security officer views the image and determines if further screening is necessary. In an effort to increase passenger privacy, the TSA updated the software on backscatter machines to make it harder to see details in the images. Still, some people argue that both types of machines violate their privacy.

Radiation

While metal detectors and millimeter scans both use non-ionizing radiation, which until recently was assumed to be safe (see our article Can Cell Phones Harm our Health?), backscatter scans use ionizing radiation, which is used in x-rays and known to potentially increase the risk of cancer. Backscatter scans work a little differently from x-rays. X-rays work by sending high-energy radiation to the body and recording the radiation that passes through the body. Dense parts of the body (like bones) block some of the radiation, resulting in lighter areas on the recorded image.  Backscatter scanners also send radiation toward the body, but at much lower energy than an x-ray. Because it is not as strong as the radiation used in x-rays, the radiation does not pass through the body. Instead, the outer layers of the body “scatter” the radiation, which bounces off the body and back toward the machine. Most of the radiation that is absorbed by the body is deposited in the outer layers (like the skin and ribs), although a 2012 study showed that radiation from these scans may penetrate to other organs.[1] Because the radiation is concentrated in the skin, there are concerns that this could cause skin cancer.

All data on backscatter scans are provided by TSA, a government agency that does not allow independent researchers to examine the machines they use.[2] Researchers must therefore make educated guesses using data provided by the TSA, or they must make models of the scanners based on information that the agency releases.

Scientists differ in their opinions regarding whether small doses of radiation increases the risk of cancer.[3] Some scientists think that very small doses-like those received during backscatter scans-pose zero risk to the individual. Other scientists think that there isn’t enough research on the effects of such low doses of radiation to be able to say how it will affect a person’s cancer risk. However, radiation risk accumulates during a person’s lifetime. This means that even though a single exposure may be very small, it is “added” to every other exposure the person has ever encountered.

The TSA states that backscatter scans use such low doses of radiation that estimating the potential effects of the scan is extremely difficult. [4] 2011 report using information from the TSA found that these backscatter scans expose people to the same amount of radiation that they receive from 3 to 9 minutes of normal daily life or from 1 to 3 minutes of flight. To put this into perspective, we would expect only 6 of the 100 million airline passengers each year to develop a cancer in their entire lives due to the backscatter scans.

Dr. David Brenner, a researcher at Columbia University, produced a different estimate based on the risk that the scanners are to the entire population, not just to an individual. Dr. Brenner multiplied the risk associated with one scan by the number of scans conducted each year to estimate the number of people who may develop cancer in one year because of the scanners. Because up to one billion scans may be performed each year, Brenner estimated that each year 100 people would develop cancer because of their exposure.

In April 2010, a group of scientists from the University of California, San Francisco wrote a letter of concern to Dr. John Holdren, the Assistant to President Obama for Science and Technology, about the backscatter scans. These researchers pointed out that because backscatter scans only penetrate outer layers of the body, it is possible that these layers receive a higher concentration of radiation than previously believed. Because of this, conventional estimates would be inaccurate.[5] This higher concentration of radiation could pose particular risk to certain groups such as:

  • The elderly (due to their susceptibility to skin cancer)
  • Women who have the BRCA gene mutation
  • People with weakened immune systems (such as those with HIV or cancer)
  • Children and adolescents (who have smaller bodies but receive the same amount of radiation as adults with larger bodies)5

The scientists also expressed concern that sperm may mutate because the testicles are close to the surface of the skin and are exposed to radiation during these backscatter scans. In addition, they noted that the effects of radiation on the cornea (the outer surface of the eye) and the thymus (a part of the immune system located in the chest) have not been studied. While this letter only outlined concerns of the scientists and did not present new data, it called for further testing of backscatter scans. The scientists called for more rigorous and independent studies to ensure that the scans are safe for the entire population, as well as for all parts of the body. When Dr. Holdren received the letter, he sent it along to the Food and Drug Administration (FDA). The Food and Drug Administration does not have authority to regulate backscatter scanners because the devices are classified as electronic devices, not medical devices. However, the FDA has experience in regulating radiation-emitting devices used in medicine, such as mammography devices. In a joint reply with the TSA, the FDA stated that the radiation exposures from the backscatter scans were within established legal limits, even for frequent fliers.[6] In reply to the scientists’ concerns that the radiation dose to the skin would be higher, the FDA wrote that their calculations showed that a person would have to pass through the scanner 1000 times in a year in order to begin to absorb the annual limit of what is considered safe.[7]

Not everyone agrees with the FDA, and some people have pointed out that TSA agents operating the scanners may improperly manage the devices or that mechanical errors may occur, either of which could cause the machines to emit more radiation than they are supposed to. From May 2010 to May 2011, there were 3,778 calls for mechanical problems on backscatter machines, but only 2% of those machines were evaluated for radiation safety. Anyone who is concerned about the radiation from the scanners has the legal right to refuse to undergo a scan, as long as they agree to a full-body pat-down by a security officer.

For more information on other types of radiation, see our article Everything You Wanted to Know About Radiation and Cancer, But Were Afraid to Ask.

References:

  1. Schmidt T, Hoppe M. Estimation of organ and effective dose due to Compton backscatter security scans. Medical Physics. 2012;39(3396).
  2. Mehta P, Smith-Bindman R. Airport full-body screening: what is the risk? Archives of internal medicine. 2011;171(12):1112-5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21444831. Accessed March 17, 2012.
  3. Brenner DJ. Are x-ray backscatter scanners safe for airport passenger screening? For most individuals, probably yes, but a billion scans per year raises long-term public health concerns. Radiology. 2011;259(1):6-10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21436091
  4. Cerra F. Assessment of the Rapiscan Secure 1000 Body Scanner for Conformance with Radiological Safety Standards. 2006. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Assessment+of+the+Rapiscan+Secure+1000+Body+Scanner+for+Conformance+with+Radiological+Safety+Standards#0. Accessed June 18, 2012.
  5. Sedat J, Agard D, Shuman M, Stroud R. Letter to Dr. John P. Holdren. 2010.
  6. Rabin R.C.. X-Ray Scans at Airports Leave Lingering Worries. The New York Times. August 6, 2012. Available at http://well.blogs.nytimes.com/2012/08/06/x-ray-scans-at-airports-leave-lingering-worries/. Accessed August 7, 2012.
  7. McCrohan J, Shelton Waters K. Letter to Dr. John P. Holdren. 2010.

 

Arsenic and Lead in our Juice (and You Thought Poisoned Apples Were only in Fairy Tales!)

Langan Denhard and Brandel France de Bravo, MPH, Cancer Prevention and Treatment Fund

Arsenic—it’s a scary word with dangerous connotations.Recent studies show that arsenic is present in many everyday beverages and food.In response, Congressman Frank Pallone and Congresswoman Rosa DeLauro introduced a bill named Arsenic Prevention and Protection from Lead Exposure in Juice (APPLE) in early February 2012. If it becomes law, it would require the FDA to set limits within the next two years on the amount of arsenic and lead allowed in fruit juices and other foods.[1]

What are the Dangers of Chronic Arsenic Exposure?

There are two types of arsenic: organic and inorganic.Organic arsenic is usually non-toxic and harmless when consumed.However, the FDA has identified two strains of organic arsenic that can cause cancer: dimethyl arsenic acid (DMA) and monomethyl arsenic acid (MMA).Recent testing by the FDA found small amounts of these strains in apple juice. Inorganic arsenic has been linked to increases in bladder, skin, and lung cancers when consumed in high quantities.It also increases the risk of cardiovascular disease and type 2 diabetes, and weakens the body’s immune system, making it harder to fight respiratory infections and flu. Exposure to high levels of arsenic can cause diarrhea, fatigue, nausea, skin discoloration, and in rare instances, death. Very little research has examined what happens to children exposed to low levels of inorganic arsenic over a long period.A 2004 study led by Columbia University’s Joseph Graziano, PhD, suggests that children who consumed water with arsenic levels above 5 parts per billion (ppb) showed evidence of lowered IQ.[2]

What are the Current Laws in Place Concerning the Levels of Arsenic in Food and Drink?

 

There is surprisingly little regulation on the levels of arsenic allowed in food and drink.According to Michael Taylor, deputy commissioner of the FDA, 23 ppb is the “level of concern” for arsenic concentration in fruit juices but there is no legal limitInformation on the FDA site states, “[The] FDA is collecting all relevant information to evaluate and determine if setting guidance or other level for inorganic arsenic in apple juice is appropriate.”[3] The FDA and the EPA revised the federal limit for arsenic allowable in public water and bottled water to 10 ppb in 2006, noting that the safest level would be 0 ppb.[4] States have the authority to mandate limits below 10 ppb, and New Jersey has the strictest limits, with a maximum level of 5 ppb. State officials caution against consuming or cooking with water at any higher concentration.[5]

Do my Family Members Consume Arsenic?

In November 2011, Consumer Reports completed a study of 88 samples of apple and grape juice that found that 10% had arsenic levels surpassing the drinking-water standards.Of this, most of the arsenic found was inorganic.A sample Walgreen’s grape juice was found to have an arsenic concentration of 24.7 ppb—more than double than the legal limit for drinking water—and most of it (82.9%) was inorganic.Of the two harmful types of organic arsenic, MMA was found in higher concentrations in apple juice whereas DMA was more likely to be found in grape juice.Consumer Reports also found that 35% of children younger than 5 drink more juice than is recommended by pediatricians.[2]

On February 2012, another study, led by a research group from Dartmouth College, presented troubling new findings.In an effort to cut down on the use of high fructose corn syrup as a sweetener, some manufacturers have been making the transition to organic brown rice syrup (OBRS).Because arsenic-based pesticides were once used in rice production, and rice plants are extremely effective in taking in the leftover arsenic from the soil, using syrup made from organic brown rice has resulted in arsenic in infant formula and other commonly used products.[6]

Currently, the only formula brand using OBRS is Nature’s One, which produces Baby’s Only Organic Dairy Toddler Formula and Baby’s Only Organic Soy Toddler Formula.These products were tested against 15 formulas that did not contain OBRS, and it was found that Nature’s One’s products had more than 20 times as much arsenic as the other brands.In a statement published on its web site, the company says, “An independent, third party testing laboratory completed testing on organic brown rice syrup used in formulas produced in 2011. The testing proved there are no safety concerns using the organic brown rice syrup ingredient.”The company has not released test results to the public, “to protect against inaccurate interpretations.”[7]

Cereal bars and “energy shots” are other possible daily sources of arsenic. A little less than half of all cereal bars contain organic brown rice syrup, and when tested, those with OBRS listed in the top five ingredients had the highest concentration of arsenic. At least half of the arsenic tested was inorganic and any organic arsenic was classified as DMA, one of the two harmful forms of organic arsenic.[6]

The Bottom Line

The drinking water limit on arsenic was set at a low level because water is frequently consumed on a daily basis throughout one’s life.For that reason, higher arsenic levels in foods consumed less often are of less concern.Fortunately, arsenic is usually excreted within 2-3 days of consumption.Nevertheless, some experts believe that the arsenic level allowed in water may be too lax, and additional sources of arsenic can add to those risks, especially for children and pregnant women.We need more research to know whether or not it is safe to consume low-levels of arsenic every day.

Meanwhile, the two things you can do are:

  1. make sure your drinking water meets the federal limit of 10 ppb of arsenic, especially if you have a private well or live in a rural area, and
  2. protect your children, whose bodies are smaller and still developing, from unnecessary exposure to arsenic.

It is especially important to protect infants from arsenic exposure until further research is conducted, so avoid formulas and baby foods containing rice products as a main ingredient.Most pediatricians advise against giving your children juice regularly because even when it has no added sugar, it delivers a lot of calories with little nutrition.The presence of arsenic is another reason to ration the juice!

If you are worried about your water supply, call your local health department for a list of labs certified to test for arsenic.The cost of testing ranges from $20-$35[8] NSF International provides extensive information on how to treat your home water.

References:

  1. Congresswoman Rosa L DeLauro. US House of Representatives. Congressman Frank Pallone (D-NJ) and Congresswoman Rosa DeLauro (D-CT) Fight to Protect Children from Arsenic in Apple Juice.Congresswoman Rosa L DeLauro: Representing the Third District of Connecticut. 8 Feb. 2012. Web. 28 Feb. 2012.
  2. “Arsenic in Your Juice:How Much Is Too Much? Federal Limits Don’t Exist.”ConsumerReports.org. Consumers Union, Jan. 2012. Web. 28 Feb. 2012.
  3. “Questions & Answers: Apple Juice and Arsenic.” FDA: US Food and Drug Administration. US Department of Health and Human Services, 16 Dec. 2011. Web. 21 Feb. 2012. <http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271595.htm>.
  4. “Basic Information about Arsenic in Drinking Water.” EPA: US Environmental Protection Agency. EPA, 26 Jan. 2012. Web. 01 Mar. 2012. <http://water.epa.gov/drink/contaminants/basicinformation/arsenic.cfm>.
  5. Buchanan, Gary A. “NJDEP New Jersey Department of Environmental Protection.” The Official Web Site for The State of New Jersey. 1 Nov. 2010. Web. 01 Mar. 2012. <http://www.state.nj.us/dep/dsr/arsenic/guide.htm>.
  6. Jackson, Brian P., Vivien F. Taylor, Margaret R. Karagas, and Kathryn L. Cottingham. “Arsenic, Organic Foods, and Brown Rice Syrup.” Environmental Health Perspectives (2012). Web. 21 Feb. 20
  7. “ORGANIC BROWN RICE SYRUP CONCERNS.” Nature’s One . Nature’s One, Inc. Web. 21 Feb. 2012. <http://www.naturesone.com/brown-rice/>.
  8. “Arsenic in Private Drinking-Water Wells.” Division of Toxicology and Environmental Medicine. ATSDR, 6 Aug. 2008. Web. 01 Mar. 2012. <http://www.atsdr.cdc.gov/arsenic/>.

FDA posts list of potential problem drugs

By Ricardo Alonso-Zaldivar
Associated Press
2008

 

WASHINGTON – The government on Friday began posting a list of prescription drugs under investigation for potential safety problems in an effort to better inform doctors and patients.

The first list is a bare-bones compilation naming 20 medications and the potential issue for each. It provides no indication of how widespread or serious the problems might be, leading some consumer advocates to question its usefulness, and prompting industry worries that skittish patients might stop taking a useful medication if they see it listed.

Food and Drug Administration officials said they are trying to walk a fine line in being more open to the public while avoiding needless scares. Congress, in a drug safety bill passed last year, ordered the agency to post quarterly listings of medications under investigation.

“My message to patients is this: Don’t stop taking your medicine,” said Dr. Janet Woodcock, who heads the FDA’s Center for Drug Evaluation and Research. “If your doctor has prescribed a drug that appears on this list, you should continue taking it unless your doctor advises you differently.”

At least five of the drugs on the list had problems that already have been publicized. These included the blood thinner heparin, recalled earlier this year, and immune-suppressing medications being studied for a link to cancer in youngsters.

One emerging concern that previously got little attention involved Tysabri, a newer, widely used multiple sclerosis drug. The FDA said it is investigating a potential link to skin melanoma, a dangerous cancer. Doctors in Boston had reported two cases of melanoma in Tysabri patients in a letter to the New England Journal of Medicine in February. Tysabri suppresses the immune system, and it has also been linked to a rare kind of brain infection that is often fatal. Manufacturer Biogen Idec Inc. said it does not believe there is an increased risk of melanoma.

The FDA said drugs will be placed on the list based on reports it receives from hospitals, doctors and patients.

“What’s new here is that we are telling the public really at the earliest stage what we are working on,” said Dr. Gerald Dal Pan, head of the FDA’s drug safety office. “I think the public told us, ‘We want to know what you are working on.’ And we are responding to that.”

The list is not just a reflection of raw data, but more like what a police officer would call “probable cause.” Officials said a drug will only be listed if FDA safety reviewers determine that a reported problem deserves a closer look.

“Our hope is that this list will serve not only as a means of communication to the public, but that it will also serve to encourage (medical) providers to provide us with additional reports should they see similar kinds of adverse events with the drugs that are on the list,” said Dr. Paul Seligman, who is responsible for the FDA’s safety communications.

Consumer advocates called the listing a positive step, but said it needs to be fleshed out.

“It’s a good thing to get started but it needs to have much more detail if it’s to have significant safety value,” said Thomas J. Moore, a senior scientist with the Institute for Safe Medication Practices. “A table with just a few words of description is quite limited.”

“It’s just the most basic warning system,” said Diana Zuckerman, president of the National Research Center for Women and Families. “It’s not going to say how many reports there were. It’s not going to say how many died and how many were hospitalized.”

Nor is it clear how drugs suspected of a problem will be removed from the list if later exonerated.

The Pharmaceutical Research and Manufacturers of America, the main industry lobbying group, said it supports giving more safety information to doctors and patients, but worries that some will be needlessly alarmed.

“Our reservation is that patients will be abruptly stopping therapy,” said Alan Goldhammer, a vice president of the organization. “One can’t generalize with an emerging safety notice. It may affect half the patients, a quarter of the patients, or only a small subset of the patients.”