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Thyroid Cancer: What Patients Need to Know About a Common but Often Overdiagnosed Disease

Other Cancers, Treatment & Management

Farmin Shahabuddin, MPH and Akashleena Mallick, MD, MPH, Cancer Prevention and Treatment Fund

A Small Gland with a Big Job

Your thyroid is a small, butterfly-shaped gland at the front of your neck. If you have a noticeable Adam’s apple, it is just below that. Your thyroid makes hormones that help control your metabolism, heart rate, blood pressure, and body temperature. Thyroid cancer happens when cells in this gland begin to grow out of control. Sometimes these cells form a lump called a nodule, but most nodules are not cancerous, and not every thyroid cancer shows up as a nodule. In fact, only about 5% of thyroid nodules are cancerous. Many early thyroid cancers cause no symptoms and are found by chance, when a doctor feels a lump during a routine checkup or notices something on imaging that was done for another reason.

Thyroid cancer can develop at any age, though it is usually found in adults. Fortunately, it is less dangerous than other cancers, and about 98% of people diagnosed with thyroid cancer are alive 5 years later.1 Survival rates vary by the type and stage of the cancer, but the outlook is very good for most patients.

The Four Main Types

It’s important to know that the different types of thyroid cancer behave differently:

  • Papillary thyroid cancer is by far the most common — about 80% of patients. It usually grows slowly and responds very well to treatment.2
  • Follicular thyroid cancer accounts for about 10% of cases. It also tends to grow slowly, but it can sometimes spread to the lungs or bones.2
  • Medullary thyroid cancer is only about 4% of patients, and it can run in families through a gene change called RET.3
  • Anaplastic thyroid cancer is only about 2% of cases and is the most aggressive and fastest growing.2

Radiation and Thyroid Cancer

One known cause of thyroid cancer is exposure to radiation, especially during childhood and adolescence, when the thyroid gland is most sensitive.4 The main causes are radiation therapy to the head or neck and radiation from nuclear accidents. The good news is that most medical imaging is not a major concern, since tests like dental X-rays expose the thyroid to very small amounts of radiation. However, repeated higher-dose scans, such as CT scans of the head, neck, or chest done many times over the years, can cause thyroid cancer.4 For a closer look at how different types of radiation can affect the thyroid, see our article on Radiation and Thyroid Cancer.

Why Thyroid Cancer Is Often Overdiagnosed

Overdiagnosis in thyroid cancer occurs when very small, slow-growing tumors are correctly diagnosed as cancer but are so unlikely to grow or spread that they would never have caused symptoms, harmed a person’s health, or shortened their life if they are not treated.5 This is not a wrong diagnosis, which would be if someone is told they have cancer when they actually do not. However, not all thyroid cancers grow slowly, so any thyroid nodule or cancer diagnosis needs to be carefully evaluated by a doctor.

About 44,000 people in the United States are expected to be diagnosed with thyroid cancer every year, and about 2,300 people will die from it each year. Diagnoses have increased over the past few decades, yet the number of people dying from thyroid cancer has remained relatively stable.6 About 75% of people diagnosed with thyroid cancer are women, particularly with small papillary thyroid cancer (2 cm or less).7 One reason for this sex difference is that women use health care more often than men, increasing the chances that thyroid nodules will be found.6 Biological reasons for the difference are still being studied.6 Men may be diagnosed later because thyroid cancer is lower on the list of conditions doctors think to check for in men.6

Higher dose imaging tests, such as CT scans of the head, neck, or chest, and repeated radiation exposure over time, have also resulted in an increase in thyroid cancer diagnoses.8 These scans can spot tiny nodules that doctors may not be able to feel during a physical exam. Many scans are ordered for completely unrelated reasons, such as neck pain, dental problems, car accident injuries, or checkups for heart and lung conditions, so small thyroid nodules can be found accidentally. Once a nodule is seen on a scan, it usually leads to more tests, such as a biopsy, and sometimes to surgery. This happens because doctors cannot always predict which nodules will become dangerous and which ones never will, so they often choose to treat it just to be safe.8

Signs to Watch For

Many thyroid cancers cause no symptoms at all, especially in the early stages. When symptoms do appear, they can include a lump or swelling in the neck, hoarseness or other voice changes, trouble swallowing, pain in the front of the neck, or a cough that does not go away.9 However, these same symptoms are rarely caused by cancer, and instead due to a cold or a benign nodule, but if any of them last more than a couple of weeks, it is a good idea to go to your doctor to check.

How Thyroid Cancer Is Treated

Treatment depends on the type and stage of the cancer, as well as the person’s age and overall health.10 For a long time, surgery to remove part or all of the thyroid gland was the standard treatment for almost everyone.¹¹ That is now changing. For people with very small, slow-growing papillary cancers, many doctors now recommend active surveillance instead. This means the cancer is carefully watched with regular ultrasounds, and treatment is started only if it begins to grow or change.14 Studies have shown that many of these small cancers grow very slowly, if at all, so surgery can often be safely delayed or avoided altogether.14

Surgery is usually recommended for larger tumors, cancers that have spread beyond the thyroid, or the more aggressive types, such as medullary or anaplastic thyroid cancer.10 When surgery is needed, it can cause harm. The nerves that control the vocal cords can sometimes be bruised or injured, leading to a weaker voice or, in rare cases, trouble breathing.¹¹ The parathyroid glands, four tiny glands on the back of the thyroid that control calcium levels, can also be accidentally damaged, leaving some people with muscle cramps or tingling in the hands and feet. When these glands are injured, the body can no longer keep calcium at a healthy level on its own, so some people will need to take calcium and vitamin D pills for the rest of their lives.¹¹ People who have their whole thyroid removed also need a daily hormone replacement pill for the rest of their lives, and determining the right dose can take months or even years.¹³ Too low a dose can cause tiredness, weight gain, and trouble concentrating, while too high a dose can cause a fast heartbeat, anxiety, trouble sleeping, and weaker bones over time.¹³

Surgery is not always the only treatment. Some patients also receive radioactive iodine therapy, which uses radioactive iodine to destroy any leftover thyroid cells, and this can cause side effects such as dry mouth, changes in taste, and a temporary drop in the body’s ability to fight infection.¹² For advanced or aggressive cancers, doctors may also recommend external beam radiation, targeted drug therapy, or, in rare cases, chemotherapy.15  On top of the physical effects, many survivors report lasting fatigue, anxiety, depression, and a sense of uncertainty about the future, even years after treatment ends.16

Some physicians still tend to recommend surgery even when active surveillance would be a reasonable option, often because they or their patients feel more at ease knowing the cancer has been removed.17  But peace of mind can come at a real cost when the treatment itself causes harm that the cancer never would have. That is why many thyroid cancer specialists now encourage a more cautious, individualized approach for small, slow-growing tumors.

Questions Worth Asking Your Doctor

If you or a loved one has been diagnosed with thyroid cancer, it is a good idea to come to appointments prepared.  We agree with the American Cancer Society’s recommended questions:18

  • Is my cancer the slow-growing kind, or is it more aggressive?
  • Do I need treatment right away, or could active surveillance be an option for me?
  • What are the risks and benefits of treating this cancer now versus monitoring it?
  • What are the possible short-term and long-term effects of each treatment?
  • How will treatment affect my daily life, my voice, and my energy? And what does recovery usually look like?

The Bottom Line

Thyroid cancer is common and is rarely life-threatening, so most patients do not need surgery. For many people, especially those with small, slow-growing papillary cancers, careful monitoring may enable you to live just as long as you would with surgery while avoiding the side effects described above. The best decisions come from honest conversations between patients, families, and doctors, based on the most up-to-date evidence and guided by what matters most to you.

References

  1. National Cancer Institute. (2024). SEER cancer stat facts: Thyroid cancer. Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/thyro.html
  2. American Cancer Society. (2024). Survival rates for thyroid cancer. https://www.cancer.org/cancer/types/thyroid-cancer/detection-diagnosis-staging/survival-rates.html
  3. Mathiesen, J. S., Effraimidis, G., Rossing, M., Rasmussen, Å. K., Hoejberg, L., Bastholt, L., Godballe, C., Oturai, P., & Feldt-Rasmussen, U. (2023). Multiple endocrine neoplasia type 2 and medullary thyroid carcinoma. The Journal of Clinical Endocrinology & Metabolism, 108(2), 271–282. https://academic.oup.com/jcem/article/108/2/271/6795262
  4. Smith-Bindman, R., Chu, P. W., Azman Firdaus, H., Stewart, C., Malekhedayat, M., Alber, S., Bolch, W. E., Mahendra, M., Berrington de González, A., & Miglioretti, D. L. (2025). Projected lifetime cancer risks from current computed tomography imaging. JAMA Internal Medicine, 185(6), 710–719. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2832778
  5. Papaleontiou, M., & Haymart, M. R. (2020). Too much of a good thing? A cautionary tale of thyroid cancer overdiagnosis and overtreatment. Thyroid, 30(5), 651–652. https://doi.org/10.1089/thy.2020.0080
  6. LeClair, K., Bell, K. J. L., Furuya-Kanamori, L., Doi, S. A., Francis, D. O., & Davies, L. (2021). Evaluation of gender inequity in thyroid cancer diagnosis: Differences by sex in US thyroid cancer incidence compared with a meta-analysis of subclinical thyroid cancer rates at autopsy. JAMA Internal Medicine, 181(10), 1351–1358. https://doi.org/10.1001/jamainternmed.2021.4804
  7. Chen, D. W., Lang, B. H. H., McLeod, D. S. A., Newbold, K., & Haymart, M. R. (2023). Thyroid cancer. The Lancet, 401(10387), 1531–1544. https://doi.org/10.1016/S0140-6736(23)00020-X
  8. Li, M., Dal Maso, L., Pizzato, M., & Vaccarella, S. (2024). Evolving epidemiological patterns of thyroid cancer and estimates of overdiagnosis in 2013–2017 in selected countries. JAMA Network Open, 7(8), e2429045. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2845450
  9. American Cancer Society. (2024). Signs and symptoms of thyroid cancer. https://www.cancer.org/cancer/types/thyroid-cancer/detection-diagnosis-staging/signs-symptoms.html
  10. American Cancer Society. (2024). Treatment of thyroid cancer, by type and stage. https://www.cancer.org/cancer/types/thyroid-cancer/treating/by-stage.html
  11. American Cancer Society. (2024). Surgery for thyroid cancer. https://www.cancer.org/cancer/types/thyroid-cancer/treating/surgery.html
  12. American Cancer Society. (2024). Radioactive iodine (radioiodine) therapy for thyroid cancer. https://www.cancer.org/cancer/types/thyroid-cancer/treating/radioactive-iodine.html
  13. American Cancer Society. (2024). Thyroid hormone therapy. https://www.cancer.org/cancer/types/thyroid-cancer/treating/thyroid-hormone-therapy.html
  14. Tuttle, R. M., Fagin, J. A., Minkowitz, G., Wong, R. J., Roman, B., Patel, S., Untch, B., Ganly, I., Shaha, A. R., Shah, J. P., Pace, M., Li, D., Bach, A., Lin, O., Whiting, A., Ghossein, R., Landa, I., Sabra, M., Boucai, L., … Sherman, E. (2022). Active surveillance of papillary thyroid cancer: Frequency and time course of the six most common tumor volume kinetic patterns. JAMA Oncology, 8(11), 1588–1596. https://jamanetwork.com/journals/jamaoncology/fullarticle/2796440
  15. American Cancer Society. (2024). Targeted drug therapy for thyroid cancer. https://www.cancer.org/cancer/types/thyroid-cancer/treating/targeted-therapy.html
  16. Applewhite, M. K., James, B. C., Kaplan, S. P., Angelos, P., Kaplan, E. L., Grogan, R. H., & Aschebrook-Kilfoy, B. (2016). Quality of life in thyroid cancer survivors: A systematic review. Thyroid, 26(11), 1533–1541. https://journals.sagepub.com/doi/10.1089/thy.2015.0098
  17. Haymart, M. R., Miller, D. C., & Hawley, S. T. (2021). Physician perspectives on the treatment of low-risk thyroid cancer. JAMA Network Open, 4(12), e2140841. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791285
  18. American Cancer Society. (2024). Questions to ask your doctor about thyroid cancer. https://www.cancer.org/cancer/types/thyroid-cancer/detection-diagnosis-staging/talking-with-doctor.html

 

Radiation and Thyroid Cancer: What Every Patient Should Know Before the Next Scan

Other Cancers, Prevention

Farmin Shahabuddin, MPH and Akashleena Mallick, MD, MPH, Cancer Prevention and Treatment Fund

Thyroid cancer diagnoses have increased dramatically in recent years, and experts are asking why. The good news is that doctors now use better imaging tests that can find very small thyroid tumors. The bad news is that some of these very small tumors might never cause health problems even if they are not treated.

Another possible reason for the increase in thyroid cancer could be because radiation was commonly used for minor childhood issues decades ago, such as swollen tonsils and acne. This resulted in a surge of thyroid cancer when those children became adults. More recently, experts have looked at whether repeated exposure to medical imaging tests that use radiation, such as CT scans, dental X-rays, and other scans, might also increase the chance of thyroid cancer over time. Fortunately, medical imaging today uses less radiation than it did in the past due to improved technology1, and the use of lead aprons and other protections has further reduced exposure.

In this article, we will let you know what the most recent research shows and what you can do to reduce any added chance of thyroid cancer caused by X-rays, CT scans, or other medical scans, or other radiation, while still getting the care you need.

The thyroid is a small, butterfly-shaped gland in the front of the neck. It is just below your Adam’s apple, although the latter may not be visible. The thyroid makes hormones that help regulate metabolism, heart rate, blood pressure, and body temperature. Since the thyroid sits close to the surface of the skin, it is sensitive to radiation.2 For more on the gland and how cancer develops there, see our thyroid cancer article here.

What Is Radiation in Medical Imaging?

Radiation can come from sunlight or from human-made sources like medical imaging. Thyroid cancer can develop from many sources of radiation, such as past cancer treatment to the head or neck, nuclear accidents, and workplaces that use radioactive materials. For more information, see Everything You Ever Wanted to Know About Radiation and Cancer but Were Afraid to Ask.

In medicine, X-rays are the most common form of radiation used to take pictures inside the body. Other tests using radiation that we will discuss in this article include X-rays of the head and neck, CT scans, dental X-rays, dental CT scans, and mammography. Each test uses a different amount of radiation, and some tests expose the thyroid to more radiation than others. When imaging is done close to the thyroid (as described later in this article), patients can ask for a ‘thyroid shield’ as described below, which is a lead cover placed over the neck to keep radiation from reaching the thyroid.

Radiation and Thyroid Cancer in Children and Women

In 2023, about 2.5 million CT scans were performed on children in the U.S. A study projected that the radiation from these scans would eventually lead to about 3,500 cases of thyroid cancer in those children.3 The thyroid is particularly sensitive to radiation during childhood and adolescence, when the gland is most active. Cells in the thyroid divide more rapidly in younger patients, and children have more years ahead in which a cancer could develop.1 For these reasons, parents and caregivers may want to ask their doctors whether a test without radiation could be used instead.

Women are also more sensitive to radiation from imaging, which may help explain why thyroid cancer is diagnosed three times more often in women than men.4 The reasons are not yet completely understood. For more on women and thyroid cancer, see our thyroid cancer article here.

X-rays

Regular X-rays of the head, neck, chest, or upper spine deliver a small amount of radiation to the thyroid, though usually much less than a CT scan. For most patients, a single X-ray carries a small added chance of thyroid cancer.1 Repeated X-rays of the same body part over many years can increase the chance of thyroid cancer over time.

Before an X-ray, it is reasonable to ask whether a recent image on file, or a test without radiation, could give the same information. For X-rays of areas close to the neck, a thyroid shield can be requested to help reduce exposure to the thyroid.1

CT scans

A CT scan takes many X-ray pictures from different angles to combine them into a detailed image. As a result, a CT scan delivers more radiation than a regular X-ray. CT scans of the head, neck, chest, and upper spine expose the thyroid to the most radiation since the thyroid gland is located close to those areas of the body.2

When a CT scan does not include the neck itself, a thyroid shield can be helpful in lowering exposure to the thyroid, and patients can ask their healthcare professional whether one can be used.1

Before a CT scan, it is reasonable to ask your healthcare professional:

  • Is the scan truly needed?
  • Could a test without radiation, such as an MRI or ultrasound, give the same or better information?
  • Can a thyroid shield be used to protect the thyroid when the scan does not include the neck?

Dental CT scans

Cone beam CT (CBCT), also known as a dental CT scan, is a newer scan that uses X-rays to take 3-D pictures of the teeth, jaw, and sinuses. Dentists may use it before braces, dental implants, or jaw surgery. CBCT delivers much less radiation than a medical CT scan, but more than a regular dental X-ray. Some of this radiation can reach the thyroid when the scan includes the lower jaw.5

In February 2024, the American Dental Association (ADA) updated its guidance to no longer recommend the routine use of thyroid shields during dental imaging, including CBCT, because the shield can block part of the image and lead to a repeat scan, which means more radiation overall.7 The ADA notes that modern equipment and restricting the size of the X-ray beam protect patients more effectively than a shield does. A patient who prefers a shield can still request one, and the dentist should consider whether using one would increase the chance of needing a repeat scan.7

Dental X-rays

Previous concerns about dental X-rays mostly came from studies of machines used before 1970, when the equipment delivered more radiation than today’s machines. Today, dental X-ray technology has improved, and many dental offices use digital sensors that lower radiation exposure even further. Due to these changes, a 2025 review found that current evidence does not clearly show that modern dental X-rays increase a person’s chance of developing thyroid cancer. ⁷ However, dental X-rays should still be used only when they are needed for diagnosis or treatment.

Mammograms

A mammogram is an X-ray of the breast.8 Since breasts are far from the thyroid gland, the chance of a 40-year-old woman developing thyroid cancer from one mammogram is about 6 in 1 billion. Even with yearly mammograms from age 40 to age 80 (which is more frequently than is recommended), the chance of developing thyroid cancer remains extremely low, about 1 in 18 million.9   That is why thyroid shields are not recommended during a mammogram.

The Bottom Line

CT scans expose the thyroid to more radiation than dental X-rays, dental CT scans, mammograms, and X-rays. However, the chance of thyroid cancer increases with the number of scans. Children, adolescents, and women are more sensitive to medical imaging radiation, so extra care is needed. For medical X-rays and CT scans of areas close to the neck, a thyroid shield can be requested. For dental X-rays, dental CT scans, and mammograms, current guidance does not recommend a thyroid shield for routine use, since it can interfere with the image and require a repeat scan. However, to reduce exposure to radiation, it makes sense to ask your doctor whether a scan is truly needed and weigh the benefits against the harms.

References

  1. American Cancer Society. (2026, April 23). Understanding radiation risk from imaging tests. https://www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/understanding-radiation-risk-from-imaging-tests.html
  2. Saenko, V., & Mitsutake, N. (2024). Radiation-related thyroid cancer. Endocrine Reviews, 45(1), 1–29. https://doi.org/10.1210/endrev/bnad022
  3. American Thyroid Association. (2025, September). Do CT scans increase the risk of thyroid cancer? Clinical Thyroidology for the Public, 18(9), 5. https://www.thyroid.org/patient-thyroid-information/ct-for-patients/september-2025/vol-18-issue-9-p-5/
  4. Cao, C.-F., Ma, K.-L., Shan, H., Liu, T.-F., Zhao, S.-Q., Wan, Y., Zhang, J., & Wang, H.-Q. (2022). CT scans and cancer risks: A systematic review and dose-response meta-analysis. BMC Cancer, 22, 1238. https://doi.org/10.1186/s12885-022-10310-2
  5. Lai, S. T. T., & Bauer, A. J. (2025). Approach to the pediatric patient with thyroid nodules. The Journal of Clinical Endocrinology & Metabolism, 110(8), 2339–2352. https://doi.org/10.1210/clinem/dgaf090
  6. Yeom, H. G., Kim, J. E., Huh, K. H., Yi, W. J., Heo, M. S., & Lee, S. S. (2022). Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 134(6), 801–812. https://doi.org/10.1016/j.oooo.2022.05.005
  7. Holmström, L., Tranæus, S., Hultin, M., Mejare, I., Kadesjö, N., & Shi, X.‑Q. (2025). Negative health effects of dental x‑rays: A systematic review. Acta Odontologica Scandinavica, 84, 328–340. https://doi.org/10.2340/aos.v84.43673
  8. Centers for Disease Control and Prevention. (n.d.). About mammograms. U.S. Department of Health and Human Services. Retrieved April 28, 2026, from https://www.cdc.gov/breast-cancer/about/mammograms.html
  9. Stempniak, M. (2022, February 10). Misinformation on mammography thyroid shielding goes viral, presenting opportunity for radiologist clarification. Radiology Business. https://radiologybusiness.com/topics/medical-practice-management/mammography-thyroid-shielding-radiologist

Exercise, Reducing Your Likelihood of Cancer, and Life After Treatment

Diet, Habits, & Other Behaviors, Quality Of LIfe, Treatment & Management

Farmin Shahabuddin, MPH, Cancer Prevention and Treatment Fund

Most people know that exercise is good for your heart and overall health. What many people do not know is that exercise may also reduce the likelihood of developing cancer and help cancer survivors live longer after treatment ends. Whether you have never had cancer or finished treatment and want to lower your chances of it coming back, physical activity is one of the most important things you can do.

Can Exercise Reduce Your Likelihood of Getting Cancer?

Research shows that people who are physically active are less likely to develop many types of cancer. A study of 1.4 million people found that those who exercised regularly were less likely to develop 13 types of cancer, including breast, colon, liver, kidney, stomach, and bladder cancer.1

A 2025 study tracked activity of more than 85,000 adults using wearable devices. The most active people were about 26% less likely to develop cancer than the least active.2 Even light activities such as errands and household chores made a difference. Taking more steps each day also helped. For example, people who took 9,000 steps a day were about 16% less likely to develop cancer than those who took 5,000.

Cancer usually is growing before it is diagnosed, and being active in the year before a diagnosis is also beneficial according to a 2025 study of more than 28,000 people with stage 1 cancers who had activity records for the year before their diagnosis.3 Those who exercised as little as 60 minutes per week were 27% less likely to have their cancer progress to a more advanced stage  and were 47% less likely to die, compared to those who were not active.3 Five years after diagnosis, about 91% of the most active people were still alive, compared to about 84% of those who had not been active.3

Why Does Exercise Lower the Likelihood of Cancer?

Exercise may lower the likelihood of cancer in several ways. It lowers hormones such as estrogen and insulin that can encourage cancer cells to grow.4,5,6 It helps the immune system spot and destroy abnormal cells.6 It also helps people maintain a healthy weight, which matters because being overweight contributes to an estimated 14% to 20% of cancer deaths in the U.S.6 Exercise also helps move food through the digestive system faster, which reduces the time that the lining of the intestines is exposed to potentially harmful substances.

Scientists are still learning more about why exercise can prevent cancer. A 2026 lab study found that even 10 minutes of exercise changed the blood in ways that helped colon cancer cells repair damaged DNA.7 While more research is needed, this adds to the evidence that exercise sends signals throughout the body that may help fight cancer.

How Much Exercise Do You Need?

The U.S Department of Health and Human Services physical activity guidelines recommend that all adults get 150 to 300 minutes per week of moderate activity such as brisk walking, or 75 to 150 minutes of vigorous activity such as running. Adults should also do muscle strengthening exercises at least 2 days per week.6 These guidelines are not specific to cancer prevention. Of course, any amount of physical activity is better than none. The key is to start where you are and gradually build up.

Exercise for Cancer Survivors After Treatment

Exercise does not just matter before a cancer diagnosis. It can also be helpful during cancer treatment (see this link for our article on that). Regular exercise after you have finished cancer treatment, can also help you live longer and feel better, with fewer side effects from treatment, including less fatigue.8,9 Survivors who exercise regularly are less likely to die from cancer and are more likely to live longer than those who do not exercise.[10-14] It does not matter if you were fit before you got diagnosed. What matters is that you start exercising now.

Since exercise improves the immune system, cancer survivors who exercise regularly lower their chances of the cancer returning. A large 2026 study followed more than 17,000 cancer survivors for an average of about 11 years. 15 The survivors had bladder, endometrial, lung, oral cavity, ovarian, or rectal cancer. The activities studied included brisk walking, cycling, and swimming.      The study compared survivors at different activity levels to those who did no physical activity at all. It found that even small amounts of exercise that were considerably less than the recommended physical activity guidelines, were linked to longer survival. Bladder cancer survivors who did relatively low levels of exercise were 33% less likely to die from their cancer, endometrial cancer survivors were 38% less likely, and lung cancer survivors were 44% less likely, compared to those who did no physical activity.

Survivors who met or exceeded the recommended guidelines saw even greater benefits. Endometrial cancer survivors who met the guidelines were 60% less likely to die from their cancer, and lung cancer survivors were 62% less likely, compared to those who did no exercise. Oral and rectal cancer survivors who doubled the recommended amount of activity were 61% less likely to die of oral cancer and 43% less likely to die of rectal cancer.

Sitting Less Matters Too

Along with exercising more, sitting less can also make a difference. A 2022 study followed over 1,500 cancer survivors ages 40 and over for an average of 4.5 years. Survivors who exercised at least 150 minutes per week were less likely to die than those who did not exercise. 16  Survivors who sat for more than 8 hours a day were also more likely to die than those who sat less than 4 hours per day. Those who both did not exercise and sat more than 8 hours per day had the worst outcomes of all.”

A 2020 study followed 8,000 adults aged 45 and older for about 5 years. People who sat the most were more likely to die from cancer than those who sat the least.17 Replacing just 30 minutes of sitting per day with moderate to vigorous activity was linked to a 31% lower chance of dying from cancer. Even replacing that sitting time with light activity like standing or gentle walking was linked to an 8% lower chance of dying.

What Kind of Exercise Should I Do?

Aerobic activity of light to moderate intensity was the most common type of exercise studied in cancer patients. Combining aerobic exercise with walking and resistance training, such as lifting weights or resistance bands, led to greater health benefits than aerobic activity alone.11,13 Lifting weights refers to any weights, even just a few pounds. Do not assume you need barbells and large muscles.

Walking is the easiest way to start. The greatest benefit comes from walking at an average speed, about a 20-minute mile, for 3 to 5 hours per week.8 Even walking just 1 hour per week showed improvements over no physical activity at all.

The most important thing is to make it a habit. Start small by taking the stairs instead of the elevator or walking after dinner each evening. It is better to start small and keep it up than to try to do too much and give up. Do not miss the chance to get at least some benefit from this easy, free way to fight cancer.

The Bottom Line

Exercise is a powerful, free tool. For people who have never had cancer, regular physical activity is linked to a lower likelihood of developing many types of cancer. For survivors who have finished treatment, exercise lowers the chances of cancer coming back and helps people live longer. Being active before a diagnosis also improves outcomes if cancer does occur. Even if you were not active before, starting to exercise afterward still helps. Try to walk 3 to 5 hours a week at an average pace, about 1 mile per 20 minutes. Try to sit less and move more throughout the day. Even a little exercise is better than none. It is never too late to begin.

To read about the benefits of exercise during cancer treatment, click here: https://stopcancerfund.org/pz-diet-habits-behaviors/exercise-cancer-treatment-benefits/

References

  1. Moore, S. C., Lee, I. M., Weiderpass, E., Campbell, P. T., Sampson, J. N., Kitahara, C. M., Keadle, S. K., Arem, H., Berrington de Gonzalez, A., Hartge, P., Adami, H. O., Blair, C. K., Borch, K. B., Boyd, E., Check, D. P., Fournier, A., Freedman, N. D., Gunter, M., Johansson, M., & Patel, A. V. (2016). Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Internal Medicine, 176(6), 816–825. https://doi.org/10.1001/jamainternmed.2016.1548
  2. National Cancer Institute. (2025, March 26). Cancer risk decreases with more physical activity [Press release]. https://www.cancer.gov/news-events/press-releases/2025/light-intensity-physical-activity-cancer-risk
  3. Patricios, J., Constantinou, D., Goff, P., Kolbe-Alexander, T., Capostagno, B., Gossage, S., & van Rensburg, D. C. J. (2025). Regular physical activity before cancer diagnosis may lower progression and death risks. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2024-108699
  4. Key, T., Appleby, P., Barnes, I., & Reeves, G. (2002). Endogenous sex hormones and breast cancer in postmenopausal women: Reanalysis of nine prospective studies. Journal of the National Cancer Institute, 94(8), 606–616. https://doi.org/10.1093/jnci/94.8.606
  5. McTiernan, A., Tworoger, S. S., Ulrich, C. M., Yasui, Y., Irwin, M. L., Rajan, K. B., Sorensen, B., Rudolph, R. E., Bowen, D., Stanczyk, F. Z., Potter, J. D., & Schwartz, R. S. (2004). Effect of exercise on serum estrogens in postmenopausal women: A 12-month randomized clinical trial. Cancer Research, 64(8), 2923–2928. https://doi.org/10.1158/0008-5472.CAN-03-3393
  6. National Cancer Institute. (n.d.). Physical activity and cancer fact sheet. U.S. Department of Health and Human Services. https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet
  7. Orange, S. T., Dodd, E., Nath, S., Bowden, H., Jordan, A. R., Tweddle, H., Hedley, A., Chukwuma, I., Hickson, I., & Sharma Saha, S. (2025). Exercise serum promotes DNA damage repair and remodels gene expression in colon cancer cells. International Journal of Cancer. https://doi.org/10.1002/ijc.70271
  8. Holmes, M. D., Chen, W. Y., Feskanich, D., Kroenke, C. H., & Colditz, G. A. (2005). Physical activity and survival after breast cancer diagnosis. JAMA, 293(20), 2479–2486. https://doi.org/10.1001/jama.293.20.2479
  9. McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175(1), 34–41. https://doi.org/10.1503/cmaj.051073
  10. Meyerhardt, J. A., Heseltine, D., Niedzwiecki, D., Hollis, D., Saltz, L. B., Mayer, R. J., Thomas, J., Nelson, H., Whittom, R., Hantel, A., Schilsky, R. L., & Fuchs, C. S. (2006). Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: Findings from CALGB 89803. Journal of Clinical Oncology, 24(22), 3535–3541. https://doi.org/10.1200/JCO.2006.06.0863
  11. Fong, D. Y. T., Ho, J. W. C., Hui, B. P. H., Lee, A. M., Macfarlane, D. J., Leung, S. S. K., Cerin, E., Chan, W. Y. Y., Leung, I. P. F., Lam, S. H. S., Taylor, A. J., & Cheng, K. K. (2012). Physical activity for cancer survivors: Meta-analysis of randomized controlled trials. BMJ, 344, e70. https://doi.org/10.1136/bmj.e70
  12. Meyerhardt, J. A., Giovannucci, E. L., Holmes, M. D., Chan, A. T., Chan, J. A., Colditz, G. A., & Fuchs, C. S. (2006). Physical activity and survival after colorectal cancer diagnosis. Journal of Clinical Oncology, 24(22), 3527–3534. https://doi.org/10.1200/JCO.2006.06.0855
  13. Spence, R. R., Heesch, K. C., & Brown, W. J. (2010). Exercise and cancer rehabilitation: A systematic review. Cancer Treatment Reviews, 36(2), 185–194. https://doi.org/10.1016/j.ctrv.2009.11.003
  14. Sternfeld, B., Weltzien, E., Quesenberry, C. P., Jr., Castillo, A. L., Kwan, M., Slattery, M. L., & Caan, B. J. (2009). Physical activity and risk of recurrence and mortality in breast cancer survivors: Findings from the LACE study. Cancer Epidemiology, Biomarkers & Prevention, 18(1), 87–95. https://doi.org/10.1158/1055-9965.EPI-08-0595
  15. Rees-Punia, E., Teras, L. R., Newton, C. C., Gapstur, S. M., Patel, A. V., Gaudet, M. M., Islami, F., Campbell, P. T., & McCullough, M. L. (2026). Leisure-time physical activity and cancer mortality among cancer survivors. JAMA Network Open, 9(2), e2556971. https://doi.org/10.1001/jamanetworkopen.2025.56971
  16. Cao, C., Friedenreich, C. M., & Yang, L. (2022). Association of daily sitting time and leisure-time physical activity with survival among US cancer survivors. JAMA Oncology, 8(3), 395–403. https://doi.org/10.1001/jamaoncol.2021.6590
  17. Gilchrist, S. C., Howard, V. J., Akinyemiju, T., Judd, S. E., Cushman, M., Hooker, S. P., & Diaz, K. M. (2020). Association of sedentary behavior with cancer mortality in middle-aged and older US adults. JAMA Oncology, 6(8), 1210–1217. https://doi.org/10.1001/jamaoncol.2020.2045

The Benefits of Exercise During Cancer Treatment

Diet, Habits, & Other Behaviors, Treatment & Management

Farmin Shahabuddin, MPH, Cancer Prevention and Treatment Fund

You may have heard that regular exercise can reduce your likelihood of developing cancer, but did you know it is also good for cancer patients who are going through treatment?

Is Exercise Good for Everyone with Cancer?

If you or someone you love is going through cancer treatment, you may wonder whether exercise is safe or even possible. The answer, according to a growing body of research, is yes. In 2022, the American Society of Clinical Oncology (ASCO) formally recommended that cancer doctors encourage their patients to do regular physical activity during treatment.1

Until recently, most of the research on exercise and cancer focused on patients with breast or colon cancer. However, newer studies have shown that exercise benefits people with many different types of cancer.2,3 A large 2025 review combined data from 151 studies involving nearly 1.5 million cancer patients with breast, prostate, lung, colorectal, and skin cancers. Across all these cancer types, patients who were physically active were less likely to die from their cancer than those who were not active.4

Of course, exercising during treatment can feel difficult. Cancer and its treatments can cause fatigue, pain, and other symptoms that make physical activity challenging. But exercise does not have to be intense to be helpful. Even gentle stretching, short walks, or light movement throughout the day can make a difference. A 2022 review of 15 clinical trials found that even patients with advanced cancers who participated in exercise programs at a low level of effort saw improvements in fatigue, independence, quality of life, and sleep.5

How Does Exercise Help Cancer Patients?

You may be wondering why exercise helps during cancer treatment. Researchers have found that it works in several ways. Exercise lowers levels of certain hormones, such as estrogen, that can fuel the growth of some cancers, and it reduces inflammation throughout the body, which is believed to play a role in how cancer develops and spreads.⁶ A 2026 clinical trial also found that patients who followed a simple home-based walking and resistance band program had a healthier immune response during chemotherapy, which may explain why they experienced fewer side effects like mental fatigue and difficulty thinking.⁷

Physical Benefits of Exercise During Treatment

The ASCO review found that exercise during cancer treatment led to improvements in heart and lung fitness, muscle strength, and energy levels.1 Other studies have found that cancer patients who exercise during treatment have lower body fat, lower blood pressure, and stronger bones, which means fewer fractures.8,9 Patients who exercised also reported less nausea and better sleep.8 The most commonly reported improvement was reduced fatigue, which is one of the most challenging side effects of cancer treatment.8,9

Beyond helping reduce side effects, exercise may also help cancer patients live longer. A 2025 review that followed nearly 1.5 million cancer patients for 6 months to several years after their diagnosis found that those who were physically active were less likely to die from their cancer than those who were not active. The benefit was seen across several types of cancer. Breast cancer patients who exercised were 31% less likely to die from their cancer, followed by colorectal cancer patients at 29%, prostate cancer patients at 27%, and lung cancer patients at 24%, compared to patients with those cancers who did not exercise.4 

Mental and Emotional Benefits

Cancer patients who exercised during treatment also reported improved mental and emotional well-being.2 They frequently reported a higher quality of life, less anxiety, and felt more motivated.8 Cancer patients over the age of 80 who exercised regularly during their weeks or months of treatment reported fewer memory problems.10 A review of studies that was published in 2025 noted that exercise during treatment can help improve emotional health, reduce symptoms of depression, and support overall psychological well-being across many cancer types.6

Exercise May Help Relieve “Chemo Brain”

“Chemo brain” (also known as chemo fog) is a common side effect of chemotherapy that affects many cancer patients receiving chemotherapy. Common symptoms include having trouble learning new tasks, remembering names, paying attention, and concentrating. Chemo brain can be upsetting and make everyday life much harder.

Fortunately, research suggests that exercise can help. A 2021 study found that patients who averaged  2.5 to 5 hours of moderate exercise (like brisk walking) per week or 1.5 to 2.5 hours of vigorous exercise (such as running) per week before, during, and after chemotherapy for breast cancer were less likely to report chemo brain symptoms than patients who did not exercise.11

A 2026 clinical trial tested a home-based exercise program in 687 cancer patients at 20 cancer centers across the United States.7 All patients were about to start chemotherapy. They were randomly assigned to either follow the exercise program or receive their usual care. The exercise program included daily walking and resistance band exercises at a light to moderate level of effort for 6 weeks. Before starting chemotherapy, patients in both groups were walking about 4,000 to 5,000 steps a day from their normal daily activities. After 6 weeks, patients who did not follow the exercise program were walking about half as many steps, while patients on the exercise program kept up their usual amount of walking.7 

Among patients receiving chemotherapy in 2-week cycles, those on the exercise program reported less overall cognitive impairment and less mental fatigue compared to those who did not exercise.7 In the exercise group, 92% of patients said they had a more positive view of exercise after the study, and 97% said they would recommend the program to other patients receiving chemotherapy.⁷

What Kind of Exercise Should I Do?

Light to moderate physical activity was the most common type of exercise studied in cancer patients.1,2 Combining activities that get your heart rate up, like walking or swimming, with activities that build muscle strength, like using light weights or resistance bands, led to greater health benefits than either type alone.2,9 The 2026 clinical trial described above found that a simple program of daily walking plus resistance band exercises, done at home without a gym or special equipment, was enough to make a meaningful difference during chemotherapy.7 Walking is the easiest way to start. Studies show that walking 3 to 5 hours per week provides the greatest benefit, but even 1 hour of walking per week showed improvements over no activity at all.3

The most important thing is to make exercise a habit. Start small by taking the stairs instead of the elevator or taking a walk during the day if you can. It is better to start small and keep it up than to try to do too much and give up. Do not miss the chance to get at least some benefit from this easy, free way to fight cancer.

The Bottom Line

Cancer patients who engage in even light or moderate physical activity regularly during treatment can expect fewer side effects, including less fatigue, fewer problems with concentration and memory, and better overall fitness and health. A home-based program of walking and resistance band exercises has been shown to reduce chemo brain and mental fatigue during chemotherapy. Exercise benefits people with all types of cancer, including those with advanced disease. Even a little exercise is better than none, and it is never too late to begin.

References

  1. Ligibel, J. A., Bohlke, K., May, A. M., Clinton, S. K., Demark-Wahnefried, W., Gilchrist, S. C., Irwin, M. L., Late, M., Mansfield, S., Marshall, T. F., Meyerhardt, J. A., Thomson, C. A., Wood, W. A., & Alfano, C. M. (2022). Exercise, diet, and weight management during cancer treatment: ASCO guideline. Journal of Clinical Oncology, 40(22), 2491–2507. https://doi.org/10.1200/JCO.22.00687
  2. Fong, D. Y. T., Ho, J. W. C., Hui, B. P. H., Lee, A. M., Macfarlane, D. J., Leung, S. S. K., Cerin, E., Chan, W. Y. Y., Leung, I. P. F., Lam, S. H. S., Taylor, A. J., & Cheng, K.-K. (2012). Physical activity for cancer survivors: Meta-analysis of randomised controlled trials. BMJ, 344, e70. https://doi.org/10.1136/bmj.e70
  3. Holmes, M. D., Chen, W. Y., Feskanich, D., Kroenke, C. H., & Colditz, G. A. (2005). Physical activity and survival after breast cancer diagnosis. JAMA, 293(20), 2479–2486. https://doi.org/10.1001/jama.293.20.2479
  4. Ungvari, Z., Fekete, M., Varga, P., Munkácsy, G., Fekete, J. T., Lehoczki, A., Buda, A., Kiss, C., Ungvari, A., & Győrffy, B. (2025). Exercise and survival benefit in cancer patients: Evidence from a comprehensive meta-analysis. GeroScience, 47(3), 5235–5255. https://doi.org/10.1007/s11357-025-01647-0
  5. Rodríguez-Cañamero, S., Cobo-Cuenca, A. I., Carmona-Torres, J. M., Pozuelo-Carrascosa, D. P., Santacruz-Salas, E., Rabanales-Sotos, J. A., Cuesta-Mateos, T., & Laredo-Aguilera, J. A. (2022). Impact of physical exercise in advanced-stage cancer patients: Systematic review and meta-analysis. Cancer Medicine, 11(19), 3714–3727. https://doi.org/10.1002/cam4.4746
  6. Albini, A., La Vecchia, C., Magnoni, F., Garrone, O., Morelli, D., Janssens, J. Ph., Maskens, A., Rennert, G., Galimberti, V., & Corso, G. (2025). Physical activity and exercise health benefits: Cancer prevention, interception, and survival. European Journal of Cancer Prevention, 34(1), 24–39. https://doi.org/10.1097/CEJ.0000000000000898
  7. Mustian, K. M., Lin, P.-J., Chakrabarti, A., Mattick, L. J., Samuel, S., Gada, U., Altman, B. J., Vertino, P. M., Kleckner, A. S., Kleckner, I. R., Guido, J. J., Li, C.-S., Peppone, L. J., Kamen, C. S., Loh, K. P., Rousey, S. R., Onitilo, A. A., Melnik, M., Mohile, S. G., & Janelsins, M. C. (2026). Effects of exercise on cognitive impairment in patients receiving chemotherapy: A multicenter phase III randomized controlled trial. Journal of the National Comprehensive Cancer Network, 24(3), 91–99. https://doi.org/10.6004/jnccn.2025.7118
  8. Knols, R., Aaronson, N. K., Uebelhart, D., Fransen, J., & Aufdemkampe, G. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 23(16), 3830–3842. https://doi.org/10.1200/JCO.2005.02.148
  9. Spence, R. R., Heesch, K. C., & Brown, W. J. (2010). Exercise and cancer rehabilitation: A systematic review. Cancer Treatment Reviews, 36(2), 185–194. https://doi.org/10.1016/j.ctrv.2009.11.003
  10. Sprod, L. K., Mohile, S. G., Demark-Wahnefried, W., Janelsins, M. C., Peppone, L. J., Morrow, G. R., Lord, R., Gross, H., & Mustian, K. M. (2012). Exercise and cancer treatment symptoms in 408 newly diagnosed older cancer patients. Journal of Geriatric Oncology, 3(2), 90–97. https://doi.org/10.1016/j.jgo.2012.01.002
  11. Salerno, E. A., Culakova, E., Kleckner, A. S., Heckler, C. E., Lin, P.-J., Matthews, C. E., Conlin, A., Weiselberg, L., Mitchell, J., Mustian, K. M., & Janelsins, M. C. (2021). Physical activity patterns and relationships with cognitive function in patients with breast cancer before, during, and after chemotherapy in a prospective, nationwide study. Journal of Clinical Oncology, 39(29), 3283–3292. https://doi.org/10.1200/JCO.20.03514

Two AstraZeneca Drugs To Be Scrutinized in First FDA Cancer Advisory Panel in 9 Months

In the News, News Stories & Editorials, We're In the News

Tristan Manalac, BioSpace, March 9, 2026

The FDA’s cancer advisors will discuss AstraZeneca’s application for the oral SERD camizestrant in breast cancer and the AKT inhibitor Truqap in prostate cancer.

The FDA’s Oncologic Drugs Advisory Committee will meet at the end of April to discuss two of AstraZeneca’s cancer drug applications—one seeking approval in breast cancer and another requesting a label expansion in prostate cancer.

The panel of outside experts is scheduled to convene on April 30, according to a Federal Registry posting, breaking what will be more than nine months of silence for the Committee. The ODAC, as the board is more commonly known, last met in July 2025.

The April meeting will be a whole-day affair, according to the registry notice. The morning session will focus on AstraZeneca’s new drug application for the oral SERD drug camizestrant, in combination with a CDK4/6 blocker such as Pfizer’s Ibrance or Novartis’ Kisqali, for HR-positive, HER2-negative breast cancer in the first-line setting.

[….]

Despite acing its target outcomes, analysts at Leerink Partners expressed concerns about how SERENA-6 was designed. “Importantly, the trial does not answer if intervening earlier, leveraging serial diagnostics to detect the early emergence of [ESR1 mutations], provides a longer-term benefit to patients rather than front-loading a benefit that could have eventually occurred in a later line,” they wrote in a note to investors on Friday.

In addition, while oral SERDs have become the standard of care for second-line therapy in ESR1m breast cancer patients, SERENA-6 “did not have an oral SERD widely used in the 2L and crossover to [camizestrant] was not permitted.”

[….]

During the afternoon session on April 30, the FDA’s cancer committee will discuss AstraZeneca’s bid to expand its AKT inhibitor Truqap to treat metastatic hormone-sensitive prostate cancer. Data from the Phase 3 CAPItello-281 trial showed that the drug plus abiraterone significantly improved radiographic progression-free survival versus placebo plus abiraterone.

The Phase 3 CAPItello-280 study of Truqap was halted in April 2025, however, as an independent data monitoring committee concluded that a combination regimen of the drug with docetaxel and androgen-deprivation therapy would miss its primary endpoints of overall survival and progression-free survival in patients with metastatic castration-resistant prostate cancer.

The ODAC meeting in April comes amid mounting criticism of FDA panels, which according to experts, have grown increasingly unbalanced and devoid of nuance.

In a September 2025 interview with BioSpace, for instance, Diana Zuckerman, president of the nonprofit National Center for Health Research, blasted a July 2025 expert panel on the use of selective serotonin reuptake inhibitors in pregnancy, which she said put too much emphasis on the potential harms of these drugs and not enough on their benefits.

“They didn’t want any nuance. It seemed they didn’t want any real difference of opinion,” she said.

To read the entire article, click here Two AstraZeneca Drugs To Be Scrutinized in First FDA Cancer Advisory Panel in 9 Months – BioSpace

Prasad Out At FDA, Turning Critics’ Focus Back To Makary

In the News, News Stories & Editorials, We're In the News
Jessica Karins and Maaisha Osman, Inside Health Policy, March 06, 2026

FDA’s polarizing and high-profile biologics chief Vinay Prasad is leaving the agency for the second time since his tenure began a year ago, and this time his departure may be permanent, after yet another controversy over rare disease approvals spilled into public view and cast new doubts on Prasad and Commissioner Marty Makary’s leadership. Makary’s next pick to run the biologics center is viewed as a make-or-break decision for his commissionership.

A House Energy & Commerce Committee Democrat who is vocal on FDA issues told Inside Health Policy the next goal for the agency’s critics could be ousting the commissioner. “Prasad is Makary’s man and Makary’s failure. Makary’s seat is hot and now we need a hearing to make it hotter,” Rep. Jake Auchincloss (MA) said.

In a social media post, Makary spun the departure as a planned return to Prasad’s family and academic committees after a one-year leave of absence from the University of California San Francisco, saying he has accomplished lasting reforms at the agency. Prasad had not previously mentioned plans to spend only a year at FDA.

The latest controversy for the Center for Biologics Evaluation and Research was its decision not to approve a Huntington’s disease gene therapy from UniQure, followed by anonymous statements from FDA officials to the media that left industry fuming. But that was one in a string of rare disease decisions under Prasad that angered industry and other FDA stakeholders. He also made several decisions on vaccines that were unpopular with regulated industry and public health stakeholders, including refusing to review Moderna’s mRNA influenza vaccine. He made headlines for claiming FDA had linked COVID-19 vaccines to multiple pediatric deaths, then never publicized promised data.

[….]

Many members of Congress have already criticized the agency under Makary’s leadership for what they see as inconsistent or inappropriate demands placed on rare disease drugmakers. Auchincloss said at an event earlier this week that Makary and Prasad should both be fired.

The dispute with UniQure centers around FDA asking the company to do a follow-up trial of its gene therapy that would require placebo surgery. FDA officials say the surgery isn’t risky or invasive; but UniQure and many Huntington’s disease patient advocates say it is. The anonymous FDA official said on the call with press UniQure’s original trial offered a “distorted or manipulated comparison,” and an HHS spokesperson told the Washington Post UniQure “lied” about what FDA wants from a second trial.

[….]

The dispute was viewed as not boding well for Prasad’s leadership at the biologics center. He had already left FDA for a short period once, amid controversy over a different gene therapy, before rejoining the agency. Another Makary appointee, George Tidmarsh, was accused of using his position to pursue a “bizarre personal vendetta” against a regulated company and left the agency permanently.

The backlash to the UniQure situation from rare disease stakeholders also isn’t a good sign for buy-in to FDA’s plausible mechanism pathway, which Makary has touted as evidence of a flexible regulatory flexibility but appears to offer more flexibility in theory than the agency is offering in practice.

Diana Zuckerman, president of the National Center for Health Research, told IHP Prasad’s departure from CBER represents a setback for efforts to strengthen scientific rigor in the agency’s regulatory decisions. She said Prasad brought a focus on scientific evidence that many researchers and policy experts have long argued has been missing at senior levels of FDA.

Zuckerman said that across several administrations, the agency has increasingly emphasized “customer service,” with industry too often treated as the primary customer rather than patients and public health. While she acknowledged that Prasad’s decisions and outspoken criticism of the agency drew opposition from industry groups, some rare disease advocates and even FDA staff, she said independent researchers have repeatedly raised concerns that FDA has approved costly medical products that are ineffective or unsafe.

In her view, the agency’s reliance on more “flexible” approval standards for products that lack clear evidence of benefit is contributing to rising health care costs and straining federal programs such as Medicare and Medicaid. “I think Dr. Prasad leaving is a loss for the FDA, for patients, and for Medicare and Medicaid,” Zuckerman said. 

To read the entire article, click here: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/prasad-out-fda-turning-critics-focus-back-makary

Divisive F.D.A. Vaccine Regulator Is Resigning

In the News, News Stories & Editorials, We're In the News

Christina Jewett, The New York Times (and syndicated at many other media outlets), March 6, 2026

Dr. Vinay Prasad, a polarizing figure at the Food and Drug Administration who oversaw vaccines, is leaving the agency at the end of April, according to a Health and Human Services spokesman.

As the agency’s chief science and medical officer, Dr. Prasad had wide-ranging authority over vaccines, drugs and gene therapies. He issued several controversial decisions, including overruling career scientists on some vaccine approvals and cracking down on a biotech company linked to two teenagers’s deaths.

In one of the most highly publicized moves, Dr. Prasad refused to accept Moderna’s application for a new mRNA flu vaccine, causing an uproar among companies and some experts who complained he was too often moving the goal posts on studies that had been OK’d by the agency. Within days, Dr. Marty Makary, the agency’s commissioner, reversed the decision after the company agreed to conduct another study.

And in recent months, he had issued a series of rejections for treatments of rare diseases, increasingly upsetting patients who have few options and biotech companies invested in developing cures.

Many of those decisions were made with little warning. He shied way from public advisory panel meetings on drugs under review, rebuffing calls for greater transparency. Dr. Prasad has criticized those forums, saying that the drug industry manipulated public opinion.

[….]

“[His]reforms represented a tremendous body of work achieved in a remarkably short period of time,” Dr. Makary wrote. “They are substantive, durable changes that will shape the agency’s approach for years to come and stand as part of Vinay’s lasting legacy here.”

Leaders in the biotech and investor communities had long pressed the White House for his ouster.

However, Diana Zuckerman, a close observer of the F.D.A. and president of the nonprofit National Center for Health Research, said Dr. Prasad’s decision to leave was a loss to independent researchers who had “hoped he would help strengthen the public health mission of the F.D.A.”

“F.D.A.’s ‘flexible’ standards for approving products that are not proven to work are resulting in an unsustainable health care system,” she said, noting the cost of failed therapies to Medicare and to patients.

Before joining the agency, Dr. Prasad was an academic at the University of California, San Francisco. He was known for criticizing the F.D.A., saying its drug review officials were too permissive in issuing approvals.

He has also been described as a Covid contrarian after complaining on podcasts and on his YouTube channel about public health measures that he deemed ill-informed by medical evidence.

But he and Dr. Makary broke with Mr. Kennedy on whether pregnant women should get the vaccine, including pregnancy as a condition warranting vaccination, in an article in The New England Journal of Medicine.

[….]

Last summer, after a second teenager died from liver-related complications from a therapy for Duchenne muscular dystrophy, Dr. Prasad demanded that the manufacturer, Sarepta, stop distributing the drug. The company pushed back, and the agency settled on keeping the drug from older children who were more likely to be harmed by it.

[….]

The Department of Health and Human Services held a background briefing on Thursday about the latest controversial decision, against a treatment for Huntington’s disease.

[….]

In a social media post Friday evening, Dr. Makary said that Dr. Prasad would be resuming his work in California and that a successor would be announced before he leaves.

To read the entire article, click https://www.nytimes.com/2026/03/06/health/fda-prasad-resigns.html?nl=breaking-news&segment_id=216275

Are Prostate Cancer Screenings Necessary? The Pros and Cons

Prostate Cancer

Farmin Shahabuddin, MPH, Shahmir H. Ali, ABD, Brandel France de Bravo, MPH, and Nicholas J. Jury, PhD

Prostate cancer is the second leading cause of cancer deaths for men in the United States, after lung cancer. One in every eight men will be diagnosed with prostate cancer in his lifetime.1 Most cases are in men 65 and older, and most deaths occur in men 75 and older.2 Annual screenings would seem to be an important way to prevent prostate cancer. However, it may surprise you that many experts, including the U.S. Preventive Services Task Force (USPTF), do not recommend men over 70 to get screened for prostate cancer.3 For men ages 55 to 69, it doesn’t recommend for or against screening, but instead recommends talking to their doctor about whether screening is right for them.

In fact, even if screening leads to a diagnosis of prostate cancer, it often does not require any treatment. That is why there is a hot debate within the medical community: Are prostate cancer screenings a good idea, and if so, for which men? This article discusses the available tests and the benefits and harms of getting tested for prostate cancer. It also describes a study published in 2026 that may help guide PSA screenings.

Are Prostate Cancer Screenings Accurate?

Prostate cancer occurs when small tumors develop in the prostate gland, which is an important part of the male reproductive system. Screening can be performed quickly and easily in a physician’s office using either of two tests: a blood test, called prostate-specific-antigen (PSA) test, and the digital rectal exam (DRE), a manual exam of the prostate area.

Unfortunately, prostate tests are often inaccurate. Both the PSA and DRE result in many false positives (when the test shows a man has prostate cancer who does not have prostate cancer) and false negatives (when a test shows a man does not have prostate cancer but he actually does have prostate cancer). Using both screening methods together will miss fewer cancers but also increase the number of false positives, which then results in more testing, such as biopsies that involve inserting a needle through the rectum.  Biopsies can possibly result in medical complications.

Researchers are also trying to determine if other types of testing might be more accurate in detecting prostate cancer.  One study of more than 5,500 men examined whether the rate of change in PSA levels when a man has multiple tests over time (also called “PSA velocity”) could improve cancer detection compared to standard (single blood test) PSA and DRE screening tests.4 They found that high PSA velocity often resulted in biopsies that did not improve cancer detection.

A New Way to Consider PSA Test Results

A study published in 2026 may help men and their physicians decide to rely on one PSA test in their 50’s to decide whether or not to have PSA tests after that. The researchers reported that one-tenth of 1% (0.1%) developed cancer within 5 years, just over half a percent (0.6%) within 10 years, and 3.3% within 20 years.  This clearly suggests these men can safely avoid PSA tests for many years.  Prostate cancer rates were also low for the 958 men with intermediate PSA levels (1.00-3.00 ng/mL): 1.4% at 5 years, 5.0% at 10 years, and 11.8% at 20 years.  In contrast, the 211 men with PSA levels greater than 3.00 ng/mL were much more likely to be diagnosed within 5 years (14.5%), 10 years (28.3%) and 20 years (34.8%).16

Do Prostate Cancer Screenings Save Lives?

Given these results, most men would feel comfortable waiting at least 5 years for another PSA test if the initial test was below 3.00 ng/,=mL). But as those test scores increase, you might think screening every few years would lead to earlier detection, earlier treatment, and a lower chance of death, since prostate cancer is usually curable (90% or better) if detected early. Surgery or radiation aim to remove or kill all cancerous cells in the prostate. If not detected and treated early, the cancer may spread beyond the prostate and can be fatal.

However, research has shown conflicting conclusions.  We examined the best research and found that whether prostate cancer screening saves lives depends on how exactly “screening” is defined, as well as how survival is measured. For example, a study of 76,000 American men aged 55-74 found that men who screened for prostate cancer every year were not any less likely to die of prostate cancer during the 7 years of the study than those receiving “usual care” (defined for most as at least one screening during those years).5,6

In contrast, a different study of 182,000 European men aged 50-75 found that men who received “regular screening” (every 2-4 years, depending on the European country) were less likely to die of prostate cancer during the 13 years of the study than those who did not have any screening.7,8  And yet, the men who were regularly screened did not live longer than those who didn’t, because they died of other causes.  That’s important to know, because the goal of screening is to live longer, not to prevent death from just one particular disease.

Newer research provides additional important information. In a study published in The New England Journal of Medicine in 2025, researchers in Europe followed more than 160,000 men for 23 years to see whether PSA screening saves lives. The study found that 14% of men who underwent an average of 2 PSA tests were diagnosed with prostate cancer, compared to 12% who did not have any screening PSA tests. Only 1.6% of the men who did not have PSA screening died of prostate cancer, compared to 1.4% who had PSA screening. 9

The researchers pointed out that deaths from other causes were much higher: about 49% of men in both groups died of other causes, showing that many men who develop prostate cancer may ultimately die from something else. This is why experts point out that prostate cancer is rarely fatal, and many men who develop prostate cancer will die from something else. That raises the question of whether screening does more harm than good.

Why don’t PSA Screening Programs save more lives?

As the 2026 study of one PSA screening of men between 45-70 (median age of 54) shows that most men will not benefit from frequent PSA screenings. A compromise could be for men to have one PSA test around age 45-70 and decide whether to continue PSA screenings for the next 10-20 years depending on the results of that test.

Prostate cancer usually grows so slowly that it is often equally safe to screen only when there are symptoms, rather than screening based on PSA or DRE results.  Symptoms of prostate cancer can include urinary problems, difficulty having an erection, or blood in the urine or semen. If a man has prostate cancer without any symptoms, he may not need to be treated. In fact, experts estimate that half the men who are diagnosed with prostate cancer would not have any symptoms in their lifetime, and 80-85% would not die of the disease within 15 years of diagnosis, even if they were not treated.10 

The New England Journal of Medicine study researchers point out that the complications of prostate cancer treatment, which include erectile dysfunction and incontinence, continue to be a concern, given the relatively small chances that PSA screening will save a man’s life.  The study also found that for every 1,000 men who were screened, about 27 more were diagnosed with prostate cancer that may never have caused symptoms or shortened their lives. The numbers probably would have been higher if the men had undergone more frequent PSA tests, since most of the men in the study only underwent two. More frequent PSAs would be expected to result in more unnecessary biopsies and treatments that carry their own risks, as noted above.

That’s exactly why experts do not agree that screening with a PSA or DRE test saves lives. For men who were diagnosed with prostate cancer, the chances of dying from the prostate cancer within 10 years of diagnosis were about 3 in 10,000 (that’s less than half of one percent), whether the men had a PSA screening or not.11 This means that although a PSA test will detect prostate cancers before any symptoms appear, often those cancers would never have become harmful. Experts say the findings show that PSA screening can save more lives but should be used carefully, focusing on men who are most likely to benefit while avoiding unnecessary testing in those at low risk.  Having one PSA test in one’s 50’s can help determine who is most likely to benefit from frequent PSA screenings and those who will not.

Can Prostate Cancer Screenings Do Harm?

Aside from not providing a significant benefit to many men, prostate cancer screening may be harmful. These harms can include 1) inaccurate results leading to unnecessary biopsies and complications, 2) complications and high costs associated with unnecessary treatment, and 3) serious side effects from treatments (such as urinary incontinence and impotence).12 In fact, a 2018 study based on data from 721,718 men across 5 clinical trials estimated that for every 1000 men screened for prostate cancer, screening-related complications will result in 1 person being hospitalized for sepsis, 3 requiring pads for urinary incontinence, and 25 reporting erectile dysfunction.13

These serious side effects from prostate cancer treatment are the reason why many men with prostate cancer choose “active monitoring” instead of treatment.  Active monitoring usually involves visiting a doctor for a PSA test every 6 months and a DRE at least once a year. However, even being asked to actively check on your symptoms during the years after being diagnosed with prostate cancer can have a detrimental psychological impact.  Men who were diagnosed with low-risk prostate cancer who were asked to monitor their symptoms reported significantly higher anxiety than those without cancer or those currently in treatment.14

It is also important to acknowledge that the harms of prostate cancer screening are disproportionately impacting some communities more than others. A 2018 study revealed that Black men were more likely to receive a false-positive PSA test and undergo a biopsy than white men.15 For more information on racial differences in prostate cancer, read our article linked here.

The Bottom Line

Based on the current evidence, U.S. experts continue to conclude that prostate cancer screenings often provide very little benefit and can be harmful.  Doctors and scientists are searching for better tests, such as using family history of prostate cancer to influence the time and frequency of recommended PSA screenings. However, the impact of such efforts on reducing deaths from prostate cancer remains unknown, and so do the likely harms. Therefore, the best thing to do is talk with your doctor about whether getting a prostate cancer screening is truly right for you.

References

  1. Key Statistics for Prostate Cancer | Prostate Cancer Facts. Accessed June 29, 2022. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html
  2. Cancer of the Prostate – Cancer Stat Facts. SEER. Accessed June 29, 2022. https://seer.cancer.gov/statfacts/html/prost.html
  3. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901. doi:10.1001/jama.2018.3710
  4. Vickers AJ, Till C, Tangen CM, Lilja H, Thompson IM. An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection. J Natl Cancer Inst. 2011;103(6):462-469. doi:10.1093/jnci/djr028
  5. Andriole GL, Crawford ED, Grubb RL, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310-1319. doi:10.1056/NEJMoa0810696
  6. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Division of Cancer Prevention. Published July 1, 2014. Accessed July 19, 2022. https://prevention.cancer.gov/major-programs/prostate-lung-colorectal-and-ovarian-cancer-screening-trial
  7. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. The Lancet. 2014;384(9959):2027-2035. doi:10.1016/S0140-6736(14)60525-0
  8. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320-1328. doi:10.1056/NEJMoa0810084
  9. Bassett, M. (2025, October 29). PSA screening reduces prostate cancer deaths, long-term data show. MedpageToday. https://www.medpagetoday.com/hematologyoncology/prostatecancer/118218
  10. Mulhem E, Fulbright N, Duncan N. Prostate Cancer Screening. afp. 2015;92(8):683-688.
  11. Ilic D, Djulbegovic M, Jung JH, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362:k3519. doi:10.1136/bmj.k3519
  12. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250-1261. doi:10.1056/NEJMoa074311
  13. Ruane-McAteer E, Porter S, O’Sullivan J, Dempster M, Prue G. Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable-risk prostate cancer patients: A 9-month longitudinal study. Psychooncology. 2019;28(8):1743-1752. doi:10.1002/pon.5161
  14. Miller EA, Pinsky PF, Black A, Andriole GL, Pierre-Victor D. Secondary prostate cancer screening outcomes by race in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial. The Prostate. 2018;78(11):830-838. doi:10.1002/pros.23540
  15. Miller, E. A., Pinsky, P. F., Black, A., Andriole, G. L., & Pierre-Victor, D. (2018). Secondary prostate cancer screening outcomes by race in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial. The Prostate, 78(11), 830–838. https://doi.org/10.1002/pros.23540

  16. Lindholz M, Bülow R, Schoots IG, et al. Clinical and Liquid Biomarkers of 20-Year Prostate Cancer Risk in Men Aged 45 to 70 Years. JAMA Netw Open. 2026;9(2):e2556732. doi:10.1001/jamanetworkopen.2025.56732

Sleep Better Tonight: A Guide for Cancer Patients and Survivors

Diet, Habits, & Other Behaviors, Quality Of LIfe

Farmin Shahabuddin, MPH, National Center for Health Research

Many cancer patients (and their loved ones) experience insomnia, which is defined as having trouble falling and/or staying asleep.1 If this is a problem for you, you are not alone. Lack of sleep can make us tired, make it difficult to concentrate, and make it difficult to deal with any issues that arise, and can increase our chances of developing other health problems.2 Most cancer patients with insomnia are prescribed sleep-aid medications, which can have unpleasant side effects, such as memory problems and other health risks.1 Before reaching for the medicine cabinet, there are natural strategies that can help you get the rest you need. This guide combines the latest research and expert recommendations to help cancer patients and survivors sleep without the need for pills.

Your Plate Is Your Sleep Aid: How Diet Affects Rest

One of the simplest and most overlooked ways to improve sleep is already in your kitchen. Research shows that foods and dietary patterns that improve sleep tend to be lower in sugar and saturated fat and higher in fiber.3

The Sleep-Friendly Menu

A Mediterranean-style diet, which is rich in fruits and vegetables, lean meat, olive oil, vegetable fats, and whole grains, has shown promising results for sleep. A 2020 study followed more than 400 women based on a sleep questionnaire that measured overall sleep quality and found that those who followed this eating pattern most closely had 30% fewer sleep problems as measured by a sleep questionnaire than those who did not.3

Foods that promote better sleep:3,4

  • Fruits and vegetables (promote relaxation)
  • Beans and lentils (the more servings, the better the sleep quality)
  • Whole grains
  • Nuts, seeds, and leafy greens
  • Lean meat, olive oil, and vegetable fats

Your gut and your brain work as a team. When you eat more fruits, vegetables, nuts, and other plant-based foods that are high in fiber, the good bacteria in your gut stay balanced and healthy. This helps your body relax and know when it is time to sleep, which may help you sleep better.3

Sleep Disruptors: What to Skip

Research found that eating more sugar, refined carbs, and saturated fat made people take longer to fall asleep and spend less time in deep, restorative sleep.4

Foods and drinks that disrupt sleep:3,4

  • Sugary snacks and drinks
  • Highly processed packaged foods
  • Chocolate (contains caffeine)
  • Alcohol (it makes you drowsy initially but disrupts sleep later)
  • Acidic foods like citrus, which can cause heartburn
  • Spicy foods

A study of almost 500 women found that those who took more than an hour to fall asleep consumed over 400 calories more per day and consumed more sugar, more saturated fat, and less fiber compared to those who fell asleep within 15 minutes.3

Creating the Perfect Sleep Environment

Cool, Dark, and Quiet

Your bedroom directly affects your sleep quality. Ideally, you want a quiet, dark, cool environment, all of which help you fall asleep more quickly.4 Temperatures between 65-70 are usually ideal, but keep in mind that biological differences mean that men tend to like cooler temperatures than women.

Wear Socks To Bed?

This may seem like a strange idea, but it works. As our body makes more melatonin near the end of the day to prepare us for sleep, our body temperature starts to drop. Wearing socks can help a natural process that increases the flow of blood to your hands and feet, warming them. The nonprofit Sleep Foundation points out that socks can help you fall asleep more quickly and even help you stay asleep.5 Of course, your socks should not be tight (you don’t want to cut off circulation!), and to prevent sweating feet, we recommend sleeping in cotton socks (100% cotton if possible) that are relatively lightweight.

The Light Fight: Winning the Battle Against Blue Glow

Melatonin is a hormone that is naturally released in the brain a few hours before we feel a sense of sleepiness. Light from phones, laptops, and TVs prevents melatonin from being released, making it hard to fall asleep.4 If you use your computer, smartphone, or tablet before bedtime, the blue and green light from these devices can neutralize melatonin’s effects. If you watch television, be sure you are at least six feet away from the screen.6 Even going to the bathroom in the middle of the night can make it harder to go back to sleep, so try using a flashlight to reduce the impact of the light. Unfortunately, if you wake up for a bathroom break, it is completely normal to take up to 30 minutes to drift back to sleep.6

Clock Work: Timing Your Way to Better Sleep

Harness the Power of Daylight

You can help program your body to produce melatonin for sleep at the right time of day by getting exposure to daylight during the morning and afternoon. Take a walk outside or sit beside a sunny window.4 Morning activity that exposes you to bright daylight will help your natural circadian rhythm.6

The Goldilocks Rule for Eating

Going to sleep hungry can keep you awake, but so can eating before bedtime. Avoid eating a big meal within two to three hours of bedtime. If you are hungry right before bed, eat a small, healthy snack (such as an apple with a slice of cheese or a few whole-wheat crackers) to satisfy you until breakfast.4

Rituals That Rock You to Sleep

When you were a child, and your mother read you a story and tucked you into bed every night, this comforting ritual helped lull you to sleep. Even in adulthood, a set of bedtime rituals can have a similar effect. Rituals help signal to the body and mind that it is time for sleep. Drink a glass of warm milk. Take a bath. Or listen to calming music to unwind before bed.4

Move It to Snooze It: Exercise and Sleep

Physical activity, even gentle movement like a short walk, can help you sleep better at night. Exercise boosts the effect of natural sleep hormones such as melatonin.4 However, timing matters: aerobic exercise releases endorphins, which are chemicals that keep people awake. If you are having trouble sleeping, try to avoid vigorous activity within two hours of bedtime.6 Of course, check with your doctor about what level of physical activity is right for you during treatment or recovery.

Breaking the Sleep Anxiety Cycle

One of the most effective ways to overcome sleep problems is cognitive behavioral therapy for insomnia. This type of therapy helps people understand how their thoughts, habits, and routines affect their sleep.7 It focuses on changing behaviors that interfere with sleep, such as spending too much time in bed awake with unhelpful thoughts, whether worrying about your health or the health of a loved one, or even worrying that not getting enough sleep will make you feel worse the next day.

A review of studies found that cognitive behavior therapy is effective for reducing insomnia in cancer survivors.8 In addition, a 2019 study from Memorial Sloan Kettering Cancer Center found that the therapy helped reduce insomnia in cancer survivors, and also helped patients reduce their use of sleep aids even 20 weeks after finishing treatment. About 25% of patients were using at least one prescription sleep aid at the beginning of the study, but only 17% used the medication 20 weeks after treatment.9 Twenty weeks after completing the therapy, participants fell asleep an average of 24 minutes faster. That may not seem like much, but it is comparable to the small benefit of sleeping pills.9

The study also evaluated acupuncture for insomnia and found it to be less effective than cognitive therapy at falling asleep but more effective at staying asleep. almost as effective as cognitive behavioral therapy. Acupuncture is a traditional Chinese treatment where a trained acupuncturist places special needles into the skin at specific points on the body, which are associated with different aspects of health, such as pain or insomnia. Those who received acupuncture fell asleep an average of 11 minutes faster than before treatment. Right after completing treatment, participants who had acupuncture slept for an average of 62 more minutes a night, which was 27 more minutes than those treated with cognitive behavioral therapy. That is much more additional sleep than is typical of sleeping pills.9

Most cognitive behavioral therapy programs for insomnia last about six to eight weeks. If it is difficult to find a trained CBT-I therapist where you live, online therapy options are becoming more available. Acupuncture is a good alternative, especially for those who also experience pain, since acupuncture can also provide short-term pain relief.9,10

For more information about cognitive behavioral therapy or acupuncture for cancer patients with insomnia, see link.

Quiet the Mind: Tackling Stress Before Bed

When you are dealing with cancer, it is natural for worries to bubble to the surface at night, concerns about your health, upcoming appointments, treatment side effects, costs, or what the future holds. Stress activates the fight-or-flight hormones that make it hard to sleep.4

Give yourself time to wind down before bed. To relax, try deep breathing exercises: The simple one is to inhale slowly and deeply, and then exhale. Or try the 4-7-8 breathing exercise, which, in addition to a breathing technique, helps you concentrate on something other than whatever is worrying you.11

In addition to relaxation techniques, small changes to your sleep environment can also help. A sleep mask can block out light from streetlights, electronics, or early morning sun, helping your body stay in sleep mode. White noise, such as a fan, sound machine, or app, creates a steady background sound that covers up sudden noises that can disrupt your sleep. This can help your brain relax and make it less likely that you will wake up during the night.

If you are curious about which sleep masks, white noise machines, and other sleep products work best, Consumer Reports has tested and reviewed many of them. You can check out their recommendations.12 In addition, there are free cell phone apps that provide a choice of soothing repetitive sounds, such as waves, babbling streams, and rain, such as the Soothing Sleep Sounds for iPhones.

The Melatonin Question: What You Need to Know

If you try melatonin supplements, experts recommend buying the same brand consistently since supplements are not tested by any unbiased government agencies, and dosages vary between manufacturers. For most people, it is safe to take melatonin nightly for one to two months. After that, you should stop and see how your sleep is.6

Important caution: Talk to your oncologist or health care provider before taking melatonin or any supplement, as it may interact with your cancer treatment. Do not use melatonin if you are pregnant or breastfeeding or have an autoimmune disorder, a seizure disorder, or depression. Also, talk to your provider if you have diabetes or high blood pressure.6

Red Flags: When to Talk to Your Doctor

Pain or discomfort, an urge to move your legs, snoring, and a burning pain in your stomach, chest, or throat are symptoms of common sleep disrupters, including restless legs syndrome, sleep apnea, and gastroesophageal reflux disease (GERD). If these symptoms are keeping you up at night or making you sleepy during the day, talk to your doctor.4 Many cancer patients experience sleep problems related to their treatment or medications, so do not hesitate to bring up sleep concerns with your care team.

The “Magic Food” Myth

You may have heard that specific foods like tart cherries or kiwifruit can ease you into slumber. While some small studies suggest benefits, there is no single “miracle” food that works for everyone.3

The Bottom Line

Better sleep does not come from any single trick; it comes from building healthy habits throughout your day. Start with one or two changes that feel manageable. Eat more fruits and vegetables, get some gentle movement when you can, dim the lights in the evening, find ways to quiet your mind through breathing exercises or therapy, and permit yourself to rest.

If sleep problems persist, talk to your care team about cognitive behavioral therapy or acupuncture; both have been shown to help cancer survivors sleep better without the side effects of sleeping pills. Small improvements add up over time, and better sleep can help you feel better each day.

References

  1. Savard, J., Ivers, H., Villa, J., Caplette-Gingras, A., & Morin, C. M. (2011). Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. Journal of Clinical Oncology, 29(26), 3580–3586.
  2. Harvard Health Publishing. (2023, November 20). 8 secrets to a good night’s sleep. Harvard Health. https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
  3. Wadyka, S. (2025, January 10). Foods to eat for better sleep. Consumer Reports. https://www.consumerreports.org/health/nutrition-healthy-eating/foods-to-eat-for-better-sleep-a7781483547/
  4. Johns Hopkins Medicine. (n.d.). Natural sleep aids: Home remedies to help you sleep. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/natural-sleep-aids-home-remedies-to-help-you-sleep
  5. Sleep Foundation. (n.d.). Sleeping with socks on. Sleep Foundation. https://www.sleepfoundation.org/sleep-hygiene/sleeping-with-socks-on
  6. Harvard Health Publishing. (2023, November 20). 8 secrets to a good night’s sleep. Harvard Health. https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
  7. Tagle, A. (2026, January 15). 4 ways to beat the anxiety of insomnia—and get back to sleep. NPR Life Kit. https://www.npr.org/2026/01/15/nx-s1-5611117/beat-anxiety-insomnia-get-back-to-sleep
  8. Johnson, J. A., Rash, J. A., Campbell, T. S., Savard, J., Gehrman, P. R., Perlis, M., Carlson, L. E., & Garland, S. N. (2016). A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Medicine Reviews, 27, 20–28.
  9. Garland, S. N., Xie, S. X., DuHamel, K., Bao, T., Li, Q., Barg, F. K., Song, S., Kantoff, P., Gehrman, P., & Mao, J. J. (2019). Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: A randomized clinical trial. Journal of the National Cancer Institute, 111(12), 1323–1331.
  10. Yin, X., Gou, M., Xu, J., Dong, B., Yin, P., Masquelin, F., Wu, J., Lao, L., & Xu, S. (2017). Efficacy and safety of acupuncture treatment on primary insomnia: A randomized controlled trial. Sleep Medicine, 37, 193–200.
  11. Young, M. (2022, September 6). How to do the 4-7-8 breathing exercise. Cleveland Clinic. https://health.clevelandclinic.org/4-7-8-breathing
  12. Consumer Reports. (2026, January 9). 12 products that help us get a good night’s sleep. Consumer Reports. https://www.consumerreports.org/health/sleeping/products-that-help-us-get-a-good-nights-sleep-a8894453489/

NCHR Written Comment to FDA on Modified Risk Tobacco Product (MRTP) Applications for ZYN Nicotine Pouch Products

Testimony & Briefings

January 21, 2026

Re: Docket number FDA-2025-N-0835
Modified Risk Tobacco Product Applications for ZYN Nicotine Pouch Products Submitted by Swedish Match U.S.A., Inc.

The National Center for Health Research (NCHR) appreciates the opportunity to submit this public comment regarding the Modified Risk Tobacco Product (MRTP) applications submitted by Swedish Match U.S.A., Inc. for ZYN nicotine pouch products.

NCHR is a nonprofit research organization that bridges the gap between scientific evidence and public policy to ensure that medical products and consumer health technologies are evaluated through rigorous, independent analysis. Our staff have medical, scientific, statistical, public health, and FDA policy expertise and we carefully reviewed the relevant research on ZYN.

We explain below why our scientific analysis concludes that the available evidence does not support granting Modified Risk Tobacco Product authorization for ZYN nicotine pouches. The application lacks the long-term evidence required to demonstrate reduced risks of oral cancer or serious cardiovascular and cerebrovascular concerns. In addition, the smoking habits of many adults, adolescents and children who are also using tobacco pouches, the rising popularity of ZYN among children, teens, and young adults and the documented harm shown in the Poison Control Centers data provides additional evidence that the statutory population-health standard has not been met.

Our analysis below focuses on population-level impact, youth use patterns, limitations of the clinical and epidemiologic evidence, evidence of oral and cardiovascular health risks, documented pediatric exposures, and the evidentiary standards for reduced-risk authorization.

  1. Under Section 911 of the Tobacco Control Act, Modified Risk Tobacco Product (MRTP) authorization requires evidence that a product will benefit the health of the population as a whole, not simply reduce exposure to selected toxicants in individual users. That population standard has not been met in the data provided to the FDA. 

ZYN use by children and adults is rising rapidly. According to the 2024 National Youth Tobacco Survey, approximately 480,000 middle and high school students reported current nicotine pouch use. This is often not experimental or occasional use: over 22% reported daily use, and nearly 30% used pouches on 20 or more days in the past month (NYTS 2024). A study published last year reported increasing middle and high school students’ use and frequent co-use with e-cigarettes and/or cigarettes, rather than substitution for cigarettes, directly undermining the population benefit required for MRTP claims (JAMA Network Open, 2025).

In prior MRTP reviews, the U.S. Food and Drug Administration has cautioned that epidemiologic trends observed in Sweden cannot be directly extrapolated to the U.S. context because of differences in social, cultural, and market conditions. This is a particular problem because the data was of a different product and there are substantial differences between General Snus and ZYN.  In addition,  the Swedish studies were focused on adults and in the U.S. ZYN is especially popular with children and teenagers. For all these reasons, reliance on the Swedish epidemiologic research results is not appropriate for evaluating ZYN’s population-level impact.

  1. The proposed claims of lower risks of serious diseases are unsubstantiated and inappropriate because of the lack of long-term data in Sweden and the lack of long-term U.S. health outcomes data. Swedish Match seeks to claim reduced risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis, but these diseases are associated with decades of exposure, not with the short-term use of a product that was not nationally available in the U.S. until 2019. It is well established that most adult smokers started smoking in their teens or early adulthood, and yet they rarely are diagnosed with lung cancer, COPD, cardiovascular diseases, or other serious diseases until they are middle aged or older. It is therefore inappropriate to base claims of lower risks on Swedish data of 20 years or less of a different product and the available evidence is short-term on U.S. nicotine pouch users and limited to  toxicant comparisons, biomarkers, perceptions, and brief observational follow-up,  which cannot support reduced-risk claims for diseases that typically develop decades after exposure.

Oral health is of particular concern. Published studies of Swedish nicotine pouch users have reported a higher prevalence of oral mucosal lesions, evidence of local inflammation with elevated inflammatory biomarkers, and findings consistent with microbial dysbiosis and periodontal effects. In contrast,  some industry-cited findings claim safety by focusing on the absence of plaque acidogenesis, which does not measure oral cancer risk and cannot support claims of reduced malignancy. These findings represent short-term biologic signals of tissue irritation and altered oral ecology, which are incompatible with claims of safety and do not constitute clinical or epidemiologic evidence of reduced risk for long-latency outcomes such as oral cancer or other serious diseases. In addition, most are not based on ZYN users. Taken together, the available evidence, which is relatively short-term and based on surrogate endpoints, does not demonstrate that ZYN nicotine pouches, as actually used, reduce the risk of oral cancer or other serious disease outcomes.

  1. Being “tobacco-free” does not mean harmless, and this is particularly important for cardiovascular and cerebrovascular risk. Both the European Society of Cardiology and the American Heart Association have emphasized that nicotine itself is toxic to the heart and blood vessels, regardless of delivery form. In addition, the American Heart Association and other experts warn that modern oral nicotine products remain addictive, may adversely affect cardiovascular risk pathways, and lack long-term outcome data, while noting that nicotine can raise blood pressure, increase heart rate, and impair vascular function-mechanisms directly relevant to myocardial infarction and stroke.

Moreover, independent chemical analyses of nicotine pouches have identified dozens of non-nicotine constituents per product, including compounds with known toxicologic concern, underscoring that reduced combustion does not equate to safety. In the absence of long-term statistically significant evidence demonstrating reduced cardiovascular or cerebrovascular events among nicotine pouch users, allowing claims of reduced risk of heart disease or stroke misleads consumers and fails to meet the MRTP population health standard.

  1. In addition to concern about the popularity of ZYN among children and teens that potentially results in a life-threatening nicotine addiction, there are short-term, real-world harms for children of all ages. FDA safety communications and national poison center surveillance show sharp increases in nicotine pouch exposures, with approximately 70 percent occurring in children under five years of age, most commonly through unintentional ingestion (FDA consumer update, 2025; Pediatrics, 2025). Young children are uniquely vulnerable to nicotine toxicity because of their low body weight and immature physiology, and even small amounts of nicotine can cause vomiting, seizures, cardiovascular instability, and other serious adverse effects. These exposures are not theoretical; they are occurring in real-world household settings as flavored nicotine pouches become more widely available. These pediatric harms occur whether or not an adult smoker in the house switches from cigarettes and therefore must be included in FDA’s population-level MRTP assessment. Authorizing reduced-risk claims will inevitably increase household exposures as well as parents’ perceived safety of these products for their children.
  1. ZYN’s marketing practices and product design are inconsistent with Section 911’s public health standard. Under Section 911 of the Tobacco Control Act, Modified Risk Tobacco Product authorization requires evidence that marketing a product with reduced-risk claims will advance public health, including by reducing nicotine addiction and supporting cessation among current tobacco users without increasing uptake or dependence among non-users.

Rather than promoting nicotine de-escalation or cessation, ZYN’s rewards programs (described on zyn.com and in social media) and 2 different nicotine strengths appear designed to maximize continued use and dependence. The shift from lower-dose to higher-dose products, combined with loyalty and rewards incentives, is fundamentally inconsistent with the public health intent of harm reduction and undermines any claim that these products advance public health.

These concerns are reinforced by market data demonstrating that ZYN’s growth reflects rapid commercial expansion rather than smoking cessation or complete switching. A peer-reviewed analysis published in JAMA Network Open found that overall U.S. nicotine pouch sales increased 10-fold from 126.06 million units during the 5 months between August and December 2019 to 808.14 million units in the first three months of 2022. During those years, ZYN accounted for 58.8% of total unit share, far exceeding competing brands.

Taken together, ZYN’s program rewarding more purchases (which is especially popular with students), offering both a lower and higher dose of  nicotine, and dominant market growth pattern indicate it is increasing and sustaining nicotine exposure. Importantly, the applicant has not demonstrated that this rapid growth corresponds with reductions in cigarette smoking, increased cessation, or decreased overall nicotine dependence at the population level. These real-world use patterns are incompatible with the statutory requirement that MRTP authorization advance public health. The evidence does not support granting reduced-risk claims for ZYN nicotine pouch products. Compared to current use, which has increased dramatically in recent years, advertising claims of lower risk that is allowed with MRTP authorization is expected to increase ZYN use and nicotine addiction, especially among children and teens, since research clearly shows that the label encourages a misperception of safety.

In conclusion, the evidence submitted in support of the MRTP applications for ZYN nicotine pouch products does not meet the statutory standard under Section 911 of the Tobacco Control Act. ZYN’s growing popularity among middle school and high school students is similar to the early stages of the vaping epidemic among children and teens that occurred prior to the COVID pandemic restrictions that reduced such use.  There are no long-term data supporting the claims that these products are safer than combustible cigarettes in terms of cancer, cardiovascular disease, stroke, or other serious health outcomes among U.S. users. At the same time, data suggesting likely risks of oral cancer, the cardiovascular and cerebrovascular toxicity of nicotine regardless of delivery form, and preventable harms to young children through accidental exposure represent population-level risks independent of any potential individual benefit among adult smokers. We therefore strongly urge that the FDA help reduce nicotine-addiction among children, teens and adults by not granting Modified Risk Tobacco Product authorization for ZYN nicotine pouch products.

Respectfully submitted,
National Center for Health Research
Washington, D.C.

 

References:

  1. S. Food and Drug Administration. (n.d.). Modified risk tobacco products (MRTP).
    https://www.fda.gov/tobacco-products/advertising-and-promotion/modified-risk-tobacco-products
  2. Gentzke, A. S., Cornelius, M., Jamal, A., et al. (2024). E-cigarette and nicotine pouch use among middle and high school students—United States, 2024. MMWR Morbidity and Mortality Weekly Report, 73(35). https://www.cdc.gov/mmwr/volumes/73/wr/mm7335a3.htm
  3. Han, D. H., Lee, S., & Seo, D. C. (2025). Trends in nicotine pouch use and co-use with e-cigarettes among U.S. adolescents, 2023–2024. JAMA Network Open, 8(1), e2333311.
  4. S. Food and Drug Administration. (2026). Modified risk applications for ZYN nicotine pouches now under FDA scientific review. https://www.fda.gov/tobacco-products/ctp-newsroom/modified-risk-applications-zyn-nicotine-pouches-now-under-fda-scientific-review
  5. S. Food and Drug Administration. (2016). Technical project lead review and decision summary: Modified risk tobacco product application for General Snus. https://www.fda.gov/tobacco-products/ctp-newsroom/modified-risk-applications-zyn-nicotine-pouches-now-under-fda-scientific-review
  6. Barrington-Trimis, J. L., Liu, F., Unger, J. B., et al. (2025). Oral nicotine product use and vaping progression among adolescents. Pediatrics, 155(6), e2024070312.
  7. Rungraungrayabkul, D., Gaewkhiew, P., Vichayanrat, T., Shrestha, B., & Buajeeb, W. (2024). What is the impact of nicotine pouches on oral health: A systematic review, vol. 24. BMC Oral Health. BioMed Central Ltd.
  8. European Society of Cardiology. (2025). Vapes, pouches, heated tobacco, shisha, cigarettes: Nicotine in all forms is toxic. https://www.escardio.org/The-ESC/Press-Office/Press-releases/vapes-pouches-heated-tobacco-shisha-cigarettes-nicotine-in-all-forms-is-tox
  9. Stokes, A., Auer, R., Goodman, M., et al. (2025). Smokeless oral nicotine products: A scientific statement from the American Heart Association. Circulation.
  10. American Heart Association. (2025). Triple threat: E-cigarettes, oral nicotine pouches, and heat-not-burn products. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/triple-threat-e-cigarettes-oral-nicotine-pouches-and-heat-not-burn-products
  11. S. Food and Drug Administration. (2025). Store nicotine pouches safely to prevent accidental exposure to children and pets. https://www.fda.gov/consumers/consumer-updates/properly-store-nicotine-pouches-prevent-accidental-exposure-children-and-pets
  12. S. Food and Drug Administration. (2025). FDA authorizes marketing of 20 ZYN nicotine pouch products after extensive scientific review. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-20-zyn-nicotine-pouch-products-after-extensive-scientific-review
  13. Lyu, J. C., Ozga, J. E., Stanton, C. A., Hrywna, M., Ganz, O., Ross, J. C., … & Ling, P. M. (2025). Advertising the leading US nicotine pouch brand: a content analysis of ZYN advertisements from 2019 to 2023. Tobacco Control.
  14. Majmundar, A., Okitondo, C., Xue, A., Asare, S., Bandi, P., & Nargis, N. (2022). Nicotine pouch sales trends in the US by volume and nicotine concentration levels from 2019 to 2022. JAMA Network Open, 5(11), e2242235-e2242235.
  15. La Capria, K., Hamilton-Moseley, K. R., Phan, L., Jewett, B., Hacker, K., Choi, K., & Chen-Sankey, J. (2024). Perceptions of FDA-authorized e-cigarettes and use interest among young adults who do not use tobacco. Tobacco prevention & cessation, 10, 10-18332.
  16. Wackowski, O. A., Rashid, M., Greene, K. L., Lewis, M. J., & O’connor, R. J. (2020). Smokers’ and young adult non-smokers’ perceptions and perceived impact of snus and e-cigarette modified risk messages. International journal of environmental research and public health, 17(18), 6807.

 

Click here to read our oral testimony to the FDA on the Modified Risk Tobacco Product applications for ZYN nicotine pouch products.