Category Archives: Diet, Habits, & Other Behaviors

Boosting Healthy Bacteria for a Healthy Pancreas

Jessica Cote and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

Pancreatic cancer is rare–less than 2% of Americans will develop it in their lifetimes. However, pancreatic cancer is the 4th most common cause of cancer-related deaths in the U.S. claiming more than 43,000 American lives in 2017.[1]  The good news is that  prevention is possible, since most pancreatic cancers are not cause by inherited genes. Smoking and alcohol use are the major known causes, and can double the lifetime risk to about 3%. Quitting smoking and cutting back on alcohol are good ways to prevent pancreatic cancer and so is a healthy mouth and gut. Scientists have recently discovered that the bacteria living in our bodies can help us stay healthy and ward off dangerous cancers.

What is the Microbiome?

Inside our bodies we have hundreds of type of living bacteria and other organisms; this community of microorganisms is called the microbiome. These organisms live in harmony with our body and can keep us from getting sick, so we call them “probiotic” or “good bacteria.” In 2012, Scientists from the National Institutes of Health started the Human Microbiome Project to study the role of the microbiome in human health and disease.

We can increase the amounts of good bacteria in our body by eating foods rich in natural probiotics or taking a probiotic supplement. Probiotic-rich foods include: yogurt, sourdough bread, sour pickles, soft cheeses, sauerkraut, tempeh (fermented soy and grains), and other foods. Check out this list — you’re bound to find something you like!

Oral Bacteria and Pancreatic Cancer

A 2017 review found that gum disease can increase the chances of developing pancreatic cancer in a lifetime to about 2.4% to 3.2%. When scientists studied the blood of patients before they got diagnosed with pancreatic cancer, they began to find patterns of “bad” vs. “good” bacteria.[3]

Since diagnosing cancer early is the key to effective treatment, scientists hope that it will soon be possible to have a simple screening test for pancreatic cancer by testing the saliva for certain bacteria. They believe that 9 times out of 10, if certain bacteria are present, the person is not likely to have pancreatic cancer.[4]

Although medical experts aren’t completely certain how to remove bad bacteria from the mouth and gums, they usually recommend flossing and brushing teeth regularly as well as rinsing with mouthwash as the best ways to get rid of them.

Gut Bacteria and Pancreatic Cancer

Like the mouth, certain bacteria in the gastrointestinal (GI) tract may have a role to play in the development of pancreatic cancer. The bacteria Helicobacter pylori, which causes stomach ulcers and stomach cancer, can increase the lifetime risk of pancreatic cancer to about 2.4%. These trends were more frequently seen in people living in Europe and East Asia rather than North America, which suggests that environment, diet (red meat or high temperature foods), and genetics may all help to increase or decrease the chances of developing pancreatic cancer.[5]

The Bottom Line

More research is needed to understand the link between bacteria and pancreatic cancer, and medical experts have not yet figured out how best to reduce the number of harmful bacteria in our bodies and increase the good kind. Until then, take good care of your mouth (brushing and flossing and regular visits to your dentist) and keep your gut healthy by eating fruits, vegetables, and foods rich in natural probiotics such as yogurt.

Footnotes:

  1. National Cancer Institute. Cancer Stat Facts: Pancreas Cancer. Accessed Dec. 18, 2017. Available online: https://seer.cancer.gov/statfacts/html/pancreas.html.
  2. National Cancer Institute. Pancreatic Cancer Treatment (PDQ®)–Patient Version. (Dec. 23, 2016). Available online: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/_162.
  3. Bracci PM. Oral Health and the Oral Microbiome in Pancreatic Cancer: An Overview of Epidemiological Studies.The Cancer Journal. 2017;23(6): 310–314. doi: 10.1097/PPO.0000000000000287
  4. Ertz-Archambault N, Keim P, Von Hoff D. Microbiome and pancreatic cancer: A comprehensive topic review of literature. World Journal of Gastroenterology. 2017;23(10):1899-1908. doi:10.3748/wjg.v23.i10.1899.
  5. Xiao M, Wang Y, Gao Y. Association between Helicobacter pylori Infection and Pancreatic Cancer Development: A Meta-Analysis. Miao X, ed. PLoS ONE. 2013;8(9):e75559. doi:10.1371/journal.pone.0075559.

Cancer Prevention Campaign

You can reduce your risk of cancer through small changes in your life, including what you eat!

See these links for tips on how to reduce your risk through eating healthy foods and losing weight, and click “Prevention” at the top of this site for all kinds of other ways to prevent cancer.

Tips for Healthier Eating

Ten Tips to Get Your Family Eating Healthy

How Do I Get My Child to Eat Healthier Foods?

MyPlate: A New Alternative to the Food Pyramid

Kids Talk About Healthy Eating

Eating Habits That Improve Health and Lower Body Mass Index


Nutrition, Obesity, Exercise, and Cancer

Weight and Cancer: What You Should Know

What’s a Woman to Eat?

The Cost of Obesity: A Higher Price for Women—and Not Just in Terms of Health

Obesity in America: Are You Part of the Problem?

Breastfeeding: The Finest Food for Your Infant Isn’t Sold in Any Store

Are Processed Meats More Dangerous Than Other Red Meats?  Yes and No!

Do Chemicals in Our Environment Cause Weight Gain?

Fast Food Facts: Calories and Fat

Will Acai Help Me Lose Weight?

Thanks to Walmart for sponsoring this campaign.  You can visit Walmart.com for an inexpensive source for fruits & vegetables.

Heart Disease and Breast Cancer

Diana Zuckerman PhD and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

In a first-of-its-kind scientific statement, the American Heart Association reminds women that heart disease is the #1 killer of women and that frequently used breast cancer treatments can increase a woman’s chances of developing heart disease.  These treatments include radiation, hormone therapy, chemotherapy, and targeted therapy.

Facts that will Help you Decide your Treatment Options

Fact:  Heart disease affects almost 50 million U.S. women, and 1 in 3 deaths in women in the U.S. are due to heart disease. Breast cancer affects about 3.3 million U.S. women, and 1 in 32 deaths in women are due to breast cancer.  That means that women are about 10 times more likely to die of heart disease than to die of breast cancer.

 Fact: Women with a history of breast cancer are more likely to die from heart disease than women without a history of breast cancer.  That is because some health habits cause both heart disease and breast cancer, and because some breast cancer treatments can also increase your chances of dying of heart disease.

Fact: There are many things you can do to decrease your risks of developing both breast cancer and heart disease:  not smoking, eating a healthy diet, losing weight (if you are overweight or obese) and being physically active

Which Breast Cancer Treatments Harm the Heart?

Radiation therapy:

Radiation therapy is often recommended for women who have a lumpectomy, so it is important to know that it can cause inflammation that can damage heart muscles and blood vessels. Studies on animals show that it can also cause clots to form in the coronary arteries. The risks are higher for radiation that is directed at the left side of the chest. The effects are not immediate, but radiation can increase the chances of heart disease at any time between 5-30 years after radiation therapy.

Hormonal therapy:

Tamoxifen is a hormone therapy that is often prescribed for breast cancers that are sensitive to the hormone estrogen. Studies show that tamoxifen lowers bad cholesterol, but there is no evidence this decreased their chances of developing heart disease or dying from it. Perhaps that is because tamoxifen also increases the chances of forming blood clots, which can be dangerous if they are in the lungs, heart, or brain.

Aromatase inhibitors are a type of hormone therapy that is often prescribed for postmenopausal women with breast cancers that are sensitive to the hormone estrogen. Aromatase inhibitors increased the chances of developing heart disease by less than 1%, but the risks may be higher (about 7%) in women who already have heart disease. The U.S. Food and Drug Administration issued a warning about this for one aromatase inhibitor, anastrazole (brand name arimidex).

Chemotherapy:

Doxorubicin, a type of anthracycline-based chemotherapy, can have harmful effects on the heart, which can be permanent and irreversible. Doxorubicin can damage heart cells and cause inflammation that can weaken the heart muscles, which can lead to heart failure. Heart failure means the heart isn’t pumping well, which can cause the body to become swollen and the lungs to fill with fluid.  This can cause you to feel short of breath, tired, or weak.

5-Fluorouracil (5-FU), is a type of antimetabolite chemotherapy used for metastatic breast cancer and other cancers. Some women who take 5-FU develop chest pain caused by a blood clot or tightening in the blood vessels that feed the heart (coronary arteries). In very rare cases, the heart does not get enough blood, which can cause a heart attack.

Targeted Drugs:

Trastuzumab or pertuzumab are targeted drugs that work against breast cancer cells that make the protein HER2. These medications can cause heart failure that is reversible. Because of the risks, women should only take these medications for 1 year.  Women who are over age 50 with diagnosed heart disease, high blood pressure, reduced heart function, or prior use of doxorubicin are most likely to be harmed by this drug.

Prevention

Studies show that there are things you can change to help prevent breast cancer and heart disease.

  1. Stop smoking
  • For heart health – Smoking increases the chances of having a heart attack or stroke.
  • For breast health – Women who start smoking at a younger age, and smoke for many years, are more likely to develop breast cancer. Smoking causes about 4 in 1000 breast cancers. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits. To read more, click here.
  1. Maintain a healthy weight
  • For heart health – Being overweight or obese (a BMI of 25 or above) increases the chances of developing heart disease.
  • For breast health – Every extra 10 pounds over “normal” weight (BMI below 25) increases the chance of developing breast cancer by about 10%.
  1. Be physically active
  • For heart health – Sitting, watching TV, lying in bed, or driving for 10 hours or more a day while you are awake instead of 5 hours or less per day increases the chances of developing heart disease by about 18%. The AHA recommends exercising for 30 minutes or more a day 5 days each week.
  • For breast health – Those same sedentary activities for 12 hours or more a day compared to 5.5 hours or less increase the chance of developing breast cancer by about 80%. To prevent breast cancer, exercise for 30 minutes or more a day 5 days each week.
  1. Eat a healthy diet
  • For heart health – Eating a diet rich in fresh vegetables, Fresh fruit, fish, poultry, and whole grains reduces your chance of dying from heart disease by about 28% compared to eating a typical U.S. diet with many fast foods, red meats/processed meats, and packaged or processed foods.
  • For breast health – The typical U.S. diet is associated with a greater chance of developing breast cancer, but the clearest evidence is for eating at least 15 oz of red meat or processed meat each week compared to less than 9 oz. of red meat or processed meat.

Heart Health for Breast Cancer Patients and Survivors

High blood pressure, diabetes and high cholesterol increase the chances of having a heart attack or dying from one. The AHA recommends controlling blood pressure, blood sugar, and blood cholesterol with diet, exercise, and medications when needed. Exercise is good for the heart and it also fights off cancer. Studies show that exercising 30 minutes a day for 5 days out of the week decrease the chances of breast cancer returning and from dying from breast cancer.

The Bottom Line

Heart disease is a major cause of deaths in women, and remains a number one cause of death in breast cancer survivors. Women who are at a higher risk of heart disease should talk with their doctors about the risks and benefits of commonly used cancer treatments.

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

References:

Laxmi S. Mehta. et al. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation. 2018, originally published February 1, 2018. https://doi.org/10.1161/CIR.0000000000000556

Jones ME. et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Research. 2017;19:118. https://doi.org/10.1186/s13058-017-0908-4

 

Alcohol and Cancer

Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

The link between and alcohol and cancer may surprise you. A 2017 statement by the American Society of Clinical Oncology (ASCO) reports that drinking alcohol increases the risk of cancer of the mouth and throat, vocal cords, esophagus, liver, breast, and colon. The risks are greatest in those with heavy and long-term alcohol use. Even so, moderate drinking can add up over a lifetime, which could be harmful.[1]

What is Moderate Drinking? Heavy Drinking?

According to the National institute of Alcohol Abuse and Alcoholism (NIAAA), “moderate” drinking is 1 drink per day for women and 2 drinks per day for men, but not all “drinks” are equal. A drink is defined as approximately 14g of alcohol, which equals: 1.5 ounces of distilled spirits (e.g., vodka, gin, tequila, etc), 5 ounces of wine, 12 ounces of beer, and 8 ounces of malt liquor.[1,2] (Click here to see the CDC’s fact sheet.)

Heavy drinking is defined as 8 or more drinks per week OR 3 or more drinks per day for women and 15 or more drinks per week OR 4 or more drink per day for men. Most adults who engage in high-risk drinking started as teens.[1] (Click here to see our article on teen drinking.)

Drinking Amount and Cancer Risk

According to the International Agency for Research on Cancer (IARC), a branch of the World Health Organization (WHO), alcohol is a “group 1 carcinogen.” That means it can cause cancer in humans. Group 1 carcinogens include cigarette smoke, UV solar radiation, radon, and asbestos, for example.[3] Alcohol is known to cause six types of cancer, including cancer of the mouth and throat, vocal cords, esophagus (squamous cell), liver, female breast, and colon/rectum. Alcohol may also be tied to cancer of the pancreas, stomach, and lung, but more research is needed to find out for certain.[4] (Click here to see the National Cancer Institute’s Fact Sheet.)

Some of these cancers, such as mouth and throat cancer, are rare (about 1% lifetime risk), while colon cancer and breast cancer are much more common. [7] Depending on the amount a person drinks, he or she can increase the risk for even rare cancers. For example, moderate drinkers can almost double their lifetime risk of mouth and throat cancer to almost 2%, while heavy drinkers have a 500% increased risk of having mouth or throat cancer, from 1% to 5%.

Scientists believe that when alcohol comes into direct contact with tissue through drinking and swallowing, it causes more damage. For example, in the heaviest drinkers, alcohol raises the lifetime risk of esophagus cancer from about 0.5% to about 2.5%.[1,7]

Women need to be more cautious when drinking any amount of alcohol. The World Cancer Research Fund estimates that for every additional average drink per day, breast cancer risk goes up by 5% pre-menopause and up by 9% after menopause. Alcohol affects the amounts of certain sex hormones circulating in the body. For women who have had hormone receptor-positive breast cancer, 7 or more weekly drinks increased the chances of having a new cancer diagnosed in the other breast from about 5% to about 10%.[1]

How Alcohol Causes Cancer

Scientists believe that alcohol causes cancer in several ways:[1, 4]

  • Alcohol (ethanol) is broken down into a toxic substance called acetaldehyde. Acetaldehyde is directly toxic to the body’s cells.
  • Alcohol causes damage to cells through a process called free-radical oxidation.
  • Alcohol causes the body to absorb less folate (an important B vitamin) and other nutrients (antioxidant vitamins A, C, and E), which naturally repair damage and fight off cancers.
  • Alcohol increases the body’s level of estrogen (a sex hormone associated with breast cancer).

Does Quitting Change Your Chances of Developing Cancer or Cancer Recurrence?

Yes, drinking less alcohol on a regular basis reduces cancer risk, even in people who were already diagnosed with cancer. Research has shown that heavy or moderate drinkers who substantially reduce their alcohol consumption will slowly reduce their risk of developing mouth, throat, vocal cord, and esophagus cancer, but it would take 20 years of abstention to reduce the chances of developing those cancers to the lower chances of someone who never drank so frequently.  It is not clear whether reducing or giving up drinking after years of moderate or heavy drinking will have much impact for other alcohol-related cancers.[1]

In those who survived an esophagus cancer, drinkers tripled their risk for a new primary cancer diagnosis. On average, the risk of a new cancer diagnosis after esophagus cancer is removed is 8 % to 27%, and continuing heavy drinking will triple that risk.[5]

Among all cancer survivors, heavy drinking caused an 8% increased risk in dying and a 17% increased risk of cancer recurrence. Patients with cancer who abuse alcohol do worse because alcohol causes poorer nutrition, a suppressed immune system, and a weaker heart.[1]

What You Can Do to Lower Cancer Risk for You and Your Family

  1. . If you drink alcohol, limit drinks to an average of 1 a day for women and 2 a day for men.
  2. Recognize heavy drinking in a loved one, because the more a person drinks, the greater his or her chances of developing cancer. The “CAGE” questionnaire can help spot heavy drinking. Has the person tried to Cut back? Has the person been Annoyed when asked about drinking? Has the person felt bad or Guilty? Has the person needed a drink first thing in the morning (Eye opener)? Each “yes” counts as 1 point. A score of 2 or more suggests problem drinking.[6]
  3. Talk with your doctor about your risk. Doctors can refer or offer counseling and treatment services to patients with risky drinking habits.
  4. Seek help early. Problem drinking can’t be wished away. There are many resources to access information and help. The Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services (HHS) has a toll free hot-line and website. Call 1-800-662-HELP (4357) or visit https://findtreatment.samhsa.gov/  today.
  5. Practice healthy habits. Eating a diet rich in cancer-fighting nutrients (i.e., fruits and vegetables), exercising, maintaining a healthy weight, reducing stress, and getting restful sleep can all help to lower cancer risk. Don’t smoke, and quit if you do. Drinking and smoking increases cancer risk more than either one alone.

The Bottom Line

To prevent cancer, try to limit your drinking by sticking to a maximum average of 1 a day if you’re a woman and 2 a day if you’re a man.

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

Footnotes:

  1. LoConte, NK. et al. Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. Journal of Clinical Oncology. published online before print November 7, 2017. DOI: 10.1200/JCO.2017.76.1155. Available online: http://ascopubs.org/doi/full/10.1200/JCO.2017.76.1155
  2. Centers for Disease Control and Prevention. Alcohol and Public Health. Fact Sheets- Moderate Drinking. Accessed November 16, 2017. Available online: https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm

 

Beginner’s Guide to Developing an Exercise Routine

Morgan Wharton and Caitlin Kennedy, Cancer Prevention and Treatment Fund

Exercise is one of NCHR’s seven recommended ways to maximize your health. If you want to exercise but aren’t sure where to begin, we can help! If you feel like your daily life doesn’t allow you to get fit (not enough time, no money for a gym membership, etc.), we have some “work-arounds” that may help.

Benefits of Exercise

Everyone knows that exercise helps keep you healthy by preventing weight gain, but did you know that it also lowers your risk of heart disease, stroke, high blood pressure, unhealthy cholesterol, type 2 diabetes, colon cancer, breast cancer, and depression? Exercising to improve muscle strength improves balance, and reduces the risk of falling, fractures, and arthritis. Overall, regular exercise improves your chances of living a longer, healthier life.[1] Even people who have been diagnosed with cancer can benefit from exercise. Click here to read more how exercise can help cancer patients.

How Much Should I Exercise?

The Centers for Disease Control and Prevention (CDC) recommend that adults should aim for 150 minutes of moderate-intensity exercise every week (such as walking quickly) or 75 minutes of high-intensity activity per week (such as running), plus two days of strength training (training with weights or resistance bands). If you haven’t been very active, start exercising at a low intensity, then slowly increase the amount and intensity of exercise each week.[2]

How Do I Create an Exercise Routine?

Regardless of your fitness goals, start small to avoid discouragement or burnout: if you set your initial goals too high and aim for perfection, you’ll be more likely to abandon your exercise plans before they improve your health. Follow these exercise routines from the CDC to create a balanced, varied routine.

To prevent injury, always start your workout with a good warm up-short aerobic activity followed by dynamic stretching. Dynamic stretching involves moving different muscle groups through a full range of motion and is the best form of stretching before exercise because it warms up groups of muscles rather than individual muscles. Static stretching, such as holding a muscle in a position of resistance for up to 30 seconds, is helpful for improving flexibility and muscle imbalance over time, but is not beneficial just before exercising.[3] Investing in good running shoes will also help with preventing injuries such as shin splints that can develop after running on hard surfaces with the wrong kind of footwear.

If you don’t feel up to completing a full workout or are too busy on a given day, even taking the stairs instead of an elevator or escalator, walking around while you make phone calls, or walking to work or during your break can make up your exercise for the day. Try to have some physical activity each day, and you’ll find that’s more likely if you get co-workers involved.[4] Form a walking group and walk to work with people who live near you, or walk together on your daily breaks. If you don’t have a group of people to exercise with at work, consider using social media to benefit from peer pressure. You can download the HealthyShare app on Facebook to get people from your social network involved and use Nike+ to track your workouts and upload your progress to sites like Facebook and Twitter.

Keeping track of your fitness goals and exercise can help you develop a routine so exercise becomes a habit. If you don’t want to use mobile technology to keep track of your exercising, click here to check out some tools designed by the U.S. Department of Health & Human services for other ways to track your fitness goals and routines.

In addition to running- and movement-based exercise, weight training is very valuable. If you enjoy weight lifting, joining a gym can add a financial incentive to working out: if you’ve already paid for a membership, you’ll have more reason to go and get your workout in! If you need more motivation to get to the gym, check out GymPact – you can get paid just for completing workouts at your gym! If you aren’t sure how to use the machines in the gym, check out these instructional videos and these tips for better technique.

Whether or not you go to a gym, there are plenty of ways to get a good workout at home! You can get a great workout with bodyweight exercises alone. Use this guide from the National Institutes of Health to begin resistance training and weight lifting at home. Investing in a jump rope, balance ball, medicine ball, resistance bands, and 5-pound dumbbells can give you more flexibility with your workouts. Variation is important to get the most benefits from exercise and prevent boredom from the same routines. The Nike Training Club app for smartphones has free workouts, sorted by difficulty, which can be done with these basic training tools. The app also tracks your progress and adds new workouts once you reach specific milestones based on the number of minutes you’ve exercised.

Signing up for a race is a great way to motivate you to begin an exercise routine. It gives you a deadline to work towards – the date of the race – and a concrete goal to train for – the length of the race.  A 5k is a great first race to train for because it’s only 3.14 miles.

Avoiding the Risks of Exercise

Dehydration

People who exercise outside and do not drink enough water put themselves at risk for heat stroke and exhaustion. Drink plenty of water beginning the day before you exercise, and drink 10 ounces of water for every 20 minutes of exercise (a can of soda is 12 ounces). Drink before you get thirsty, because thirst is the first sign of dehydration.[5] Finally, beware of the dangers of water bottles containing BPA. Be sure to select a stainless steel bottle or a plastic water bottle that is labeled “BPA free.” Read more about the harmful effects of BPA here.

Skin Cancer

While running and exercising outside, remember to apply sunscreen of SPF 30 or higher that offers full spectrum protection (protection against both UVA and UVB rays) and is water-resistant. Apply at least fifteen minutes before going outside to allow your skin to soak up the sunscreen. Reapply often-every two hours and after swimming and excessive sweating. You should also apply lip balm of at least SPF 30. This will reduce your risk of sunburn, skin cancer, and premature aging of the skin.[6] Read more about running and skin cancer here.

Overtraining

Overtraining can put too much stress on the immune system and keep it from doing its job, which is to keep you from getting sick! People who overtrain put themselves at risk of developing illnesses like colds and the flu because their immune systems are “run down.” You may feel fatigued all the time, or find yourself getting injured.  Some soreness and fatigue is a normal part of training, but if your discomfort becomes excessive, increase your rest/recovery time in between workouts.[7]

Regular endurance exercise may be risky, as well.  Running more than 30 miles per week may lessen or erase the health benefits, including a longer life, which moderate levels of running provide.  People who run a lot of marathons have been found to have higher levels of coronary plaque, a type of heart disease and a cause of heart attacks.[8] Therefore, moderate levels of regular exercise are recommended.

The Bottom Line

The potential benefits far outweigh the potential risks of regular exercise. Grab a friend, use social media, and register for a race to keep your motivation levels high until exercise becomes a part of your daily routine. Regular physical activity can improve your physical health, and also your mood and overall mental well-being. Maybe you’ve heard of a “runner’s high” – well, you don’t have to be a runner to experience the calming effects of exercise.  If you want to experience these health benefits and live a longer, healthier life, now is the time to begin a fitness routine!

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

References:

  1. Physical activity and health. Division of Nutrition, Physical Activity and Obesity 2011; Available from: http://www.cdc.gov/physicalactivity/everyone/health/index.html.
  2. Health, O.o.W.s. Physical activity (exercise) fact sheet. 2009.
  3. How much physical activity do adults need? 2011; Available from: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html.
  4. O’Donovan, G., Lee, I., Hamer, M., et al. (2017). Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns with Risk for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Intern Med. 177(3): 335-342. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2596007?utm_source=silverchair&utm_campaign=altmetric&utm_content=2017_year-end&cmp=1&utm_medium=email&redirect=true. Accessed on January 5, 2018.
  5. Parracino, L., A Simple Guide to Stretching, 2002, National Academy of Sports Medicine.
  6. Make Physical Activity Fun, in Overcoming Barriers to Physical Activity, W. Can!, Editor, U.S. Department of Health & Human Services.
  7. Healthy Hydration. 2012; Available from: http://www.acefitness.org/fitfacts/fitfacts_display.aspx?itemid=173.
  8. Sunscreens. 2012; Available from: http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens.
  9. Kellmann, M., Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scand J Med Sci Sports, 2010. 20 Suppl 2: p. 95-102.
  10. Mohlenkamp S, Lehmann N , Breuckmann F, Brocker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jockel K, & Erbel R. Running: The risk of coronary events. Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. European Heart Journal, 2008. 29(15): p. 1903-1910.

Are Processed Meats More Dangerous than Other Red Meats?

Megan Cole, Claire Karlsson, and Sage Wylie, Cancer Prevention & Treatment Fund

You have probably heard it many times already: don’t eat too much red meat or processed foods. But research shows processed red meats, like bacon, hot dogs, and salami are the biggest problem. Here’s why.

Red Meats vs. Processed Red Meats

In 2015, the International Agency for Research on Cancer (IARC) of the World Health Organization concluded that processed meats are a Group one carcinogen, which means it causes cancer.  Other Group one carcinogens include tobacco and asbestos. Based upon a review of over 800 studies, 22 scientists from ten countries determined that processed meats can cause colorectal cancer and probably stomach cancer. [1] Although people who eat more red meat are more likely to develop pancreatic and prostate cancer, nobody knows whether people who eat more red meat tend to have other poor health habits that are the real causes of these cancers, rather than the red meat itself.

Are processed meats more dangerous than other red meats? Yes!Bacon, hot dogs, bologna, and other processed meats are now blamed for causing cancer, and they also increase your chances of developing heart disease and diabetes. A 2010 study led by Dr. Renata Micha from the Harvard School of Public Health analyzed 20 previous studies and concluded that while eating more red meat didn’t predict whether a person developed heart disease or diabetes, eating processed meat did. [2]  A person who ate one portion (about one hot dog or two slices of deli meat) of processed meat every day was 42% more likely to develop coronary heart disease and 19% more likely to develop diabetes than if that person did not eat processed meat every day.  That risk was the same if the person ate 2 portions of processed meat every day instead of one, and doubled if the person ate 2 portions a day instead of none.  In other words, even if you like the taste or convenience of processed meat, eating less processed meat is always better for your health than eating more.

Why the Difference?

When comparing red meats with processed meats, there are some key nutritional differences. While levels of saturated fats and cholesterol are usually similar in processed and unprocessed meats, processed meats generally have four times the amount of sodium and 50% more preservatives than red meats.[3] Researchers suggest that these increased levels of sodium and preservatives may explain the increase in health risk. To determine if that is true, further research is needed. What is known, however, is that sodium increases blood pressure and preservatives have been shown to reduce tolerance to sugars. High blood pressure contributes to heart disease and reduced tolerance to sugars increases the risk of diabetes. Other studies have found that processed meats that have been cured, smoked and barbequed at high temperatures are more likely to cause colon cancer than other red meats.[4] Cured meats like salami may pose particular risks for cancers because the nitrate and nitrite salts used in the curing process can promote cancer cell growth. Yet much more research is needed to clarify how processed meats can lead to cancer.

In addition, a study found an increase in breast cancer for Hispanic women with the highest consumption of processed meat, although that was not found in non-Hispanic white women. [5]

…But Don’t Pick up That Steak so Fast.

Does this mean that you are now free to eat all the red meat you want as long as it isn’t processed? Well, no.  Studies have shown that red meat raises the level of “bad cholesterol,” because it is high in saturated fat. Chicken and fish are much lower in saturated fat.  While processed meat is labeled as a definite carcinogen, red meat is categorized as probably carcinogenic to humans (called Group 2A by IARC). Plus, eating less red meat may help reduce climate change, because cows emits harmful greenhouse gases.[6] Additionally, a study of 150,000 women, published in a major medical journal in 2016, found that eating red meat for protein instead of eating plants increases the chances of developing heart disease and dying at a younger age.[7]

What Meats Should I Eat and What Meats Should I Avoid?

As outlined by the US Department of Agriculture (USDA), consider the following when selecting meats for you or your family:
• Choose lean or low-fat meat and poultry. Avoid ground beef that is less than 80% lean (the leaner, the better), and choose skinless chicken.
• If you do buy processed meats, be sure to read the ingredients and Nutrition Facts label to avoid foods high in salt. Look for products labeled “low sodium,” “reduced sodium,” or “no salt added.” To be considered “healthy,” products must not have more than 600 mg of sodium per serving.
• Consider eating fish rich in omega-3 fatty acids, such as salmon, trout, and herring, or getting protein from other non-meat sources, such as beans, legumes, almonds, sunflower seeds, and egg whites.[8]

Is All Processed Meat Worse than Red Meat?

All processed meats are not necessarily worse than all other red meats, as the “healthiness” of a meat depends upon the number of calories per serving as well as its sodium and fat content. For instance, lean deli meat may be healthier than a fatty unprocessed hamburger or steak. However, in general, bacon, sausage, hot dogs, pastrami, and many other processed meats are fattier, saltier, higher in calories, and contain more additives than unprocessed red meats such as beef, pork, and lamb. Lean and low-sodium varieties of processed meat are less unhealthy, but still not as healthy as most non-processed meats.

The Bottom Line

Foods that are higher in calories, saturated fat, and sodium tend to increase weight, fat, and blood pressure, which in turn, may lead to the development of heart disease and/or diabetes. So? Eat a balanced diet with plenty of whole grains, fruits, vegetables, low-fat dairy, and lean proteins. Enjoy red meat in moderation and remember: if you have to choose between a hot dog or a hamburger, the unprocessed meat of the hamburger is the safer bet when it comes to avoiding cancer, coronary heart disease and diabetes. However, try to avoid topping your burger with high-salt processed condiments such as ketchup, salt, and pickles.

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

References

  1. Bouvard, Véronique; Loomis, Dana; Guyton, Kathryn Z; Grosse, Yann; El Ghissassi, Fatiha; Benbrahim-Tallaa, Lamia; Guha, Neela; Mattock, Heidi; Straif, Kurt. (October 2015). “Carcinogenicity of consumption of red and processed meat”. The Lancet. DOI: http://dx.doi.org/10.1016/S1470-2045(15)00444-1.
  2. Micha, R., Wallace, S.K., Mozaffarian, D. (June 2010).“Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes: A systematic review and meta-analysis”. Circulation. 121(21): 2271–2283. doi: 10.1161/CIRCULATIONAHA.109.924977.
  3. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, & Schatzkin A (2009 March 23) Meat intake and mortality: a prospective study over half a million people. Archives of Internal Medicine 169(6):562-571.
  4. Santarelli, R.L., Pierre, F., Corpet, D.E., (2008). “Processed meat and colorectal cancer: a review of epidemiologic and experimental evidence”. Nutrition and Cancer. 60(2):131-44. doi: 10.1080/01635580701684872.
  5. Kim, A.E., Lundgreen, A., Wolff, R.K., et al. (2016). “Red meat, poultry, and fish intake and breast cancer risk among Hispanic and Non-Hispanic white women: The Breast Cancer Health Disparities Study.” Cancer Causes Control.  doi: 10.1007/s10552-016-0727-4. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26898200. Accessed on November 13, 2017.
  6. Powell R (2008) Eat less meat to help the environment, UN climate expert says. Telegraph.
  7. Song M, Fung TT, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Internal Medicine; 2016.
  8. United States Department of Agriculture (USDA) (2010). Inside the Pyramid (Meat).

Should I Get the Flu Shot?

Lauren Goldbeck, Alex Pew, and Arista Jhanjee, Cancer Prevention & Treatment Fund

It’s that time of year again — time to get your flu shot! Everyone aged 6 months or over and without any restrictive health conditions is encouraged to get the vaccine every year.[1]

Flu season usually starts as early as October and can last all the way until May. The flu usually peaks between December and March. The Centers for Disease Control and Prevention (CDC) recommends getting vaccinated by the end of October. Even if you don’t get your vaccine by then, it’s good to get vaccinated anytime during the flu season.

Check if your office, school, or local government is giving free flu vaccines first. If not, don’t worry! Most (if not all) pharmacies and doctors’ offices have the vaccine available and it is free (no co-pay at all) under nearly every insurance plan. Just call first to make sure the vaccine is available.

Thanks to the Affordable Care Act (Obamacare), health insurance companies have to provide free preventive services like the flu shot.[2] However, insurance companies can require you to go to certain places to get the shot. You should check with your insurance company first before getting your shot.

What’s New This Year?

This year, the CDC does not recommend getting the nasal spray form of the flu vaccine, which contains live viruses. This is because the nasal spray has not been effective for the last few years.[3]   We agree that the nasal spray vaccine is ineffective, so you should not get it even if you (or your children) don’t like shots. Even before that warning came out, researchers knew that the live viruses in the spray were too dangerous for pregnant women, because they could harm the baby.

Scientists change the flu vaccine every year to try to make it as effective as possible against the new flu strains that are most common that year. Vaccines are made with either three or four viral strains. This year’s vaccines differ from last year’s vaccines by a single strain.

How Effective is the Flu Vaccine in 2017-2018?

The most common flu viruses change every year. Since the new seasonal vaccine requires about 6 months to make, scientists have to do their best to predict which strains will be most common months in advance. These predictions aren’t always accurate.[4] In a good year, the vaccine can reduce your risk of getting the flu by 60%.[5] The evidence shows that the 2017 vaccine will probably reduce your risk of getting the flu by 50% this year. Although it’s far from perfect, it’s definitely worth getting.[6]

Can the Flu Shot Give Me the Flu?

No, the flu shot can’t give you the flu. The flu shot is made of proteins that come from dead viruses, so you can’t get infected. However, the flu shot can cause soreness, redness, or swelling around the injection site. It can also cause a low-grade fever or body aches.[7]

Things to Remember for Young Children

  • Children aged 6 months to 8 years who have never received a flu vaccine should get two doses of the vaccine. The two doses should be separated by at least 4 weeks.
  • Children aged 6 months to 8 years who have previously received 2 or more vaccine doses only need one dose this year.[1]

If I’m over 65, Is There Anything Different for Me?

As we age, the flu can be more dangerous and vaccines are less effective because our immune systems are not as strong. You may have seen a “high-dose flu vaccine” advertised for people over the age of 65.  Should you consider it?

The high-dose vaccine has four times as many flu proteins than the usual flu shot, and so it is expected to be more effective. Studies comparing the high-dose and standard-dose vaccines found that those who received the high-dose version (IIV3-HD) were better protected against the flu during the 2012-2013 flu season[8,9]. Unfortunately, the CDC reported that the high-dose flu vaccine was not more effective during the 2013-2014 season. And, individuals receiving the high-dose version also had more of the common side-effects from the flu shot, like a low-grade fever and soreness. Since there is no clear evidence that the high-dose vaccine has benefits that outweigh the risks, the CDC doesn’t have a recommendation for getting one vaccine over the other. However, facilities that offer flu shots may administer the high-dose shot without asking patients what they prefer. If you are 65 or older and don’t want the high-dose shot, you should say so when requesting a shot.

What Should I Do If I Have an Egg Allergy?

Flu injection options are very similar for individuals with and without egg allergies.

  • If your only reaction to eating eggs is hives
    • You can receive any flu vaccine.
  • If you have a severe reaction to eggs, including nausea/vomiting, changes in blood pressure, respiratory issues, and/or any reaction requiring medication or emergency medical attention (ex. anaphylaxis)…
    • You can receive any flu vaccine.
    • You should receive the vaccine in a medical setting and under the supervision of a provider who is trained to address allergic reactions.[10]

Can I Still Get the Flu Even After Getting the Flu Shot?

 Yes, you can still get the flu after getting the flu shot. There are many strains of the flu that could possibly infect you, and the shot doesn’t protect you against all strains. And as we said, it works better on people with stronger immune systems. Even if you do get the flu, it might be less severe if you’ve had the vaccine.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2017–18 Influenza Season. MMWR Recomm Rep 2017;66(No. RR-2):1–20. DOI: http://dx.doi.org/10.15585/mmwr.rr6602a. Accessed on September 8, 2017.
  2. Will the Affordable Care Act cover my flu shot? U.S. Department of Health and Human Service. Retrieved from https://www.hhs.gov/answers/affordable-care-act/will-the-aca-cover-my-flu-shot/index.html.  Accessed on September 8, 2017.
  3. Centers for Disease Control and Prevention. (2016). ACIP votes down use of LAIV for 2016-2017 flu season. Retrieved from https://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html. Accessed on September 8, 2017.
  4. Selecting Viruses for the Seasonal Influenza Vaccine. (2016). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/about/season/vaccine-selection.htm.  Accessed on September 8, 2017.
  5. Vaccine Effectiveness – How Well Does the Flu Vaccine Work? (2017). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/about/qa/vaccineeffect.htm.  Accessed on September 8, 2017.
  6. Flannery B, Chung JR, Thaker SN, et al. Interim Estimates of 2016–17 Seasonal Influenza Vaccine Effectiveness — United States, February 2017. MMWR Morb Mortal Wkly Rep 2017;66:167–171. DOI: http://dx.doi.org/10.15585/mmwr.mm6606a3.  Accessed on September 8, 2017.
  7. Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention. (2017). Retrieved from https://www.cdc.gov/flu/protect/keyfacts.htm. Accessed on September 13, 2017.
  8. Diaz Granadanos, C. A. et al. (2014). Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014 Aug 14;371(7):635-45. doi: 10.1056/NEJMoa1315727. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25119609. Accessed on September 14, 2017.
  9. Shay, D., Chillarige, Y., Kelman, J., et al. (2017). Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012-2013 and 2013-2014. The Journal of Infectious Diseases; 215(4): 510-517. Retrieved from https://academic.oup.com/jid/article/3058746. Accessed on September 18, 2017.
  10. Flu Vaccine and People with Egg Allergies. (2016). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm.  Accessed on September 8, 2017.

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.

Are Women Who Work Night Shifts at a Higher Risk for Developing Breast Cancer?


Night shift work may seem like an odd thing to link to breast cancer. Nevertheless, scientists found that women who work night shifts for many years are more likely to get breast cancer than other women. This includes nurses and flight attendants who work overnight. The International Agency for Research on Cancer, which is a part of the World Health Organization, reported that shift work is a likely risk factor for certain cancers, just as diet can increase or decrease the risks. Researchers found that night shift work links to breast cancer because it can change a person’s sleep-wake cycle. This has a lot to do with artificial light.[1]

What does the research say about the link between night shift work and breast cancer?

Researchers have studied this question in different ways and have come to different conclusions. This can be confusing. One way researchers can help make sense of different conclusions is to combine multiple studies into a larger combination study. Six groups of researchers in the past decade have used these larger studies to ask if night shift work affects breast cancer risk. Five of these studies found that the risk of breast cancer increased by between 5% and 20%.

The number of years a woman has worked night shifts also seems to matter. One team found that a woman’s risk for breast cancer increased 3% for every 5 years that she worked night shifts and 13% for every 500 night shifts worked.[2] Johns Hopkins University researchers found that women who “regularly” worked night shifts increased their risk for developing breast cancer by 20% compared with women who did not.[3] A third group found that women who worked night shifts for fewer than 5 years had a 2% increase in  risk. However, those that worked night shifts for over 20 years had a 9% increase in risk.[4]

One of the larger studies, done in 2016 by a University of Oxford research team,  made the news because they did not find a link between night shift work and breast cancer risk.[5] However, experts on this topic quickly criticized this study for the way it was designed[6]  For example, the Oxford researchers used studies that only followed women for 2 to 4 years. This is much shorter than the previous studies that found a link between breast cancer and shift work. Following women for only 2 to 4 years is not enough time to see if women’s risk of breast cancer risk will change.

Another major problem with the Oxford study had to do with confusing survey responses measuring how often a woman worked night shifts. This was a significant flaw in the study.

What does this increased risk mean?

The average woman has a 1 in 8 chance, or 12.4% chance, of getting breast cancer at some point during her life.[7] In addition, a woman’s risk of developing breast cancer increases as she ages. Working night shifts for a long time increases risk by between 5% and 20% of a woman’s current risk.  So, for a woman working night shifts, her risk would increase to about 13%-14%. This is a small increase in risk for the average woman. However, any increased risk is of concern for women that have other risk factors for breast cancer, such as a family history of breast cancer or mutations of the BRCA1 or BRCA2 genes (often called the “breast cancer genes”).

Why is night shift work linked to breast cancer?

Night shift work can change a person’s regular sleep-wake cycle. Our sleep-wake cycle is a roughly 24-hour rhythm that tells us when we are alert or sleepy.[8] Humans are naturally active during the day and sleepy at night. However, women who work night shifts reverse this pattern. When a woman is working night shifts, she might use external signals, like artificial light or caffeine, to help tell her body to stay awake. The problem is that her body still sends internal signals that it is time for sleep. These different signals disrupt her natural sleep-wake cycle.

Hormones and other bodily activities do not change to match the woman’s work schedule either. Some of these hormones affect tumors, so this can allow tumors to grow.[9]  One example is the melatonin that our bodies make at night to help us sleep.[8] Melatonin helps to prevent tumor growth.[9] A woman who works in artificial light at night makes less melatonin. Another example is glucocorticoids, which our bodies make when we are stressed. People who work night shifts have higher levels of glucocorticoids that help tumors survive.

Why is this important?

Breast cancer is the most common form of cancer in women.[10] We know that 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. In this next year, 255,000 women in the U.S. will be diagnosed with invasive breast cancer. Another 63,410 will be diagnosed with ductal carcinoma in situ, a non-invasive condition when abnormal cells develop in the milk ducts in the breast).[11]  The number of people that work on night shifts full-time is increasing. In 2004, there were 15 million Americans.[12] This is concerning for women who work night shifts over a long period of time because they may be at an increased risk for developing breast cancer.

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

References

  1. International Agency for Research on Cancer (IARC). (2007). IARC monographs on the evaluation of carcinogenic risks to humans. Volume 98. Shift-work, painting and fire-fighting. Lyon: International Agency for Research on Cancer.
  2. Wang, F., Yeung, K. L., Chan, W. C., Kwok, C. C., Leung, S. L., Wu, C., Chan, E. Y. Y., Yu, I. T. S., Yang, X. R., & Tse, L. A. (2013). A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer. Annals of Oncology, 24(11), 2724-2732. doi:10.1093/annonc/mdt283.
  3. Kamdar, B. B., Tergas, A. I., Mateen, F. J., Bhayani, N. H., & Oh, J. (2013). Night-shift work and risk of breast cancer: a systematic review and meta-analysis. Breast Cancer Research and Treatment, 138(1), 291-301. doi:10.1007/s10549-013-2433-1.
  4. Lin, X., Chen, W., Wei, F., Ying, M., Wei, W., & Xie, X. (2015). Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies. Sleep Medicine, 16(11), 1381-1387. doi:10.1016/j.sleep.2015.02.543.
  5. Travis, R. C., Balkwill, A., Fensom, G. K., Appleby, P. N., Reeves, G. K., Wang, X., Roddam, A. W., Gathani, T., Peto, R., Green, J., Key, T. J., & Beral, V. (2016). Night Shift Work and Breast Cancer Incidence: Three Prospective Studies and Meta-analysis of Published Studies. Journal of the National Cancer Institute, 108(12). doi:10.1093/jnci/djw169.
  6. Hazards Magazine special online report. (2016, December). Cancer all-clear for night work based on ‘bad science’, warn scientists. Retrieved from http://www.hazards.org/cancer/graveyardshift.htm.
  7. National Cancer Institute at the National Institute for Health (NIH). (2012). Breast Cancer Risk in American Women. Retrieved from https://www.cancer.gov/types/breast/risk-fact-sheet.
  8. National Institute of General Medical Sciences at the National Institute of Health (NIH). Circadian Rhythms Fact Sheet. (2012, November). Retrieved from https://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx.
  9. Ball, L. J., Palesh, O., & Kriegsfeld, L. J. (2016). The Pathophysiologic Role of Disrupted Circadian and Neuroendocrine Rhythms in Breast Carcinogenesis. Endocrine Reviews, 37(5), 450-466.
  10. World Health Organization (WHO). (2017). Breast cancer: prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en/index1.html.
  11. org. (2017, January 10). U.S. Breast Cancer Statistics. Retrieved from http://www.breastcancer.org/symptoms/understand_bc/statistics.
  12. The National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC). (2016, June 21). Work Schedules: Shift Work and Long Hours. Retrieved from https://www.cdc.gov/niosh/topics/workschedules/.

The last 50 years of smoking: cigarettes and what we know about them has changed

Anna E. Mazzucco, Ph.D.

The U.S. Surgeon General just released an annual report on the negative health effects of smoking.  But this one marks the 50th anniversary of the very first report on smoking in 1964.  We’ve learned a lot about smoking in 50 years, and unfortunately most of the news is bad.

Many health problems in addition to Lung Cancer

While many people know that smoking comes with serious health risks, such as lung cancer and chronic obstructive pulmonary disease (COPD), the 50th anniversary report warns about less widely known risks. For example, smoking increases the risk of:

  • ectopic pregnancy (this type of pregnancy kills the fetus and the mother can also die or become infertile as a result)
  • birth defects
  • diabetes
  • heart disease
  • stroke
  • rheumatoid arthritis
  • difficulty getting or maintaining an erection (erectile dysfunction or ED).

Smoking also increases your chances of developing cancers. A United Kingdom study involving over 100, 000 women found a significant link between smoking and breast cancer. Over a 7-year period, about 2% of women who ever smoked developed cancer compared to about 1.6% of women who never smoked. This means that smoking causes about 4 in 1000 breast cancers. Even though that number seems small (less than half a percent), it is statistically significant. Starting smoking at a younger age, smoking 15 or more daily cigarettes, and smoking for at least 10 years increase the chances of developing breast cancer. If you smoke, you should talk to your doctor about ways to quit. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits. To read more, click here.

Whether you’re a cancer patient, cancer survivor, or have no known health conditions, smoking puts you at greater risk of dying. Exposure to tobacco smoke while in the womb and smoking in the teenage years have both been shown to cause long-term problems regarding brain development.

 20 Million people have died from smoking since 1964

Although smoking has decreased over the 50 years—from 52% to 25% of adult men, and from 35% to 19% of adult women—the decline has slowed over the last two decades. However, among adults who never completed high school or who have a GED diploma, almost 1 in 2 are smokers.[end Centers for Disease Control and PreventionCurrent Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report. 2012; 61(44):889–94 [accessed 2014 Feb 10]  The report estimates that half a million Americans die from smoking every year, and this number has not changed in a decade. Smoking costs the U.S. economy about $100 billion per year, including direct medical costs and the indirect cost of lost productivity from employee sick time due to smoking-related illness.

The Surgeon General cautions that current efforts to reduce smoking are not getting as much support as they need.  While many states have received substantial funds from settlements with tobacco companies which were intended for tobacco control programs, this funding is frequently been spent elsewhere.  In 2013, Alaska was the only state to fund their tobacco control programs at the level recommended by the Centers for Disease Control and Prevention (CDC).

 What more should be done to reduce smoking?

In 2009, the FDA was given much more authority to regulate tobacco products, and in 2010, it made it illegal to sell tobacco products to anyone under 18, banned free samples of cigarettes, and prohibited cigarette brands from sponsoring music and other cultural events. While making public spaces smoke-free and increasing the price of cigarettes and other tobacco products has helped, we need to do more.  Most experts agree that effective tobacco control programs require a combination approach: public health campaigns supplemented by laws that limit where you can smoke, make cigarettes harder to buy, and ensure that programs to help people quit smoking are covered by all health plans.  Under the Affordable Care Act, Medicare, Medicaid and employer-sponsored insurance plans are required to cover medications to help with quitting.  Unfortunately, it is still unclear exactly what will be covered through the state insurance exchanges, even though they are subsidized through the federal government.

Of course, the ideal strategy is to prevent a person from starting to smoke, since tobacco is very addictive.  The Surgeon General’s report says more advertising campaigns targeting young people with anti-smoking messages are needed, since 87% of adult smokers had their first cigarette by age 18.  A study published in 2014 revealed that the nicotine dose from cigarettes increased 15% between 1999 and 2011, making them more addictive without any warning to consumers.[end Land T et al.  Recent Increases in Efficiency in Cigarette Nicotine Delivery: Implications for Tobacco Control.  Nicotine and Tobacco Research. 2014.]  That is only one example of a long history of misleading information from tobacco companies, which is why anti-tobacco ads are so important.  For example, the Surgeon General’s report details how “low-tar” cigarettes, advertised by tobacco companies as safer, were later found to be just as harmful.   In addition, other changes in cigarette design and content have also had unexpected health effects, such as increasing rates of one of the two most common types of smoking-related lung cancer, adenocarcinoma.

Once a person starts to smoke, all doctors and health experts agree: quitting smoking is one of the best things you can do for your health and the health of your loved ones, no matter how long you’ve been smoking.  Studies show that the health benefits of quitting kick in soon after you stop.   Twenty minutes after your last cigarette your high blood pressure will drop; within 3 months your lung function will improve; one year later your risk of heart disease will fall to half of what it was when you were smoking; and five years after your last cigarette your risk of several cancers will drop by half as well.[end S. A. Kenfield, M. J. Stampfer, B. A. Rosner, G. A. Colditz. Smoking and Smoking Cessation in Relation to Mortality in Women. JAMA: The Journal of the American Medical Association, 2008; 299 (17): 2037-2047.],[end Centers for Disease Control and Prevention. 2010 Surgeon General’s Report—How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. 2010.]  For information on how to quit, see this article.  If you are considering taking medication to help with quitting, check out this article.  And if you are thinking of using e-cigarettes to cut back on regular cigarettes, you should know that there are many unanswered questions about the risks of e-cigarettes and almost no research to support their use in smoking cessation. For more on e-cigarettes, read here.  Many e-cigarette brands are owned by tobacco companies which have been caught lying to the American public about the risks of their products repeatedly.