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NCHR Letter to CDC Director Supporting Review of Biopsy Before Hysterectomy or Myomectomy

Policy

May 9, 2018

Robert R. Redfield, MD
Director, Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329-4027

Dear Dr. Redfield:

I am writing to you on behalf of the National Center for Health Research to strongly urge the Centers for Disease Control and Prevention (CDC) to conduct a review to determine the potential benefits of requiring pre-surgical biopsies for women scheduled for hysterectomy or myomectomy (removal of fibroids).

The review is urgent because a recent article that was published in the medical journal Obstetrics & Gynecology reports that the rate of unsuspected cancer is dangerously high in women undergoing these procedures.  When women with undetected cancer undergo those surgeries, especially but not only when the surgery involves a medical device called a power morcellator, the cancer can spread inside the woman’s abdomen, resulting in an early-stage cancer being upstaged to a much more dangerous stage 4 cancer.  Until recently, experts assumed that the risk of these patients having an undetected cancer was less than 1 in 1,000, which was later revised to 1 in 352.  However, the new study indicates that the risks are much higher, and the risk of an undiagnosed uterine cancer is close to 10% for women ages 55 and older.

Researchers from Yale Medical School and the Columbia University College of Physicians and Surgeons studied more than 26,000 women who underwent hysterectomy or fibroid removal. Their finding that undetected cancers were much higher than previously estimated demonstrates that thousands of women are at risk every year.  A review by the CDC would provide important information that could be used to develop new guidelines.  It seems likely that including a biopsy as the standard of care for women undergoing these gynecological procedures could save thousands of women’s lives.

We thank you for your interest and attention to this matter. We strongly urge you to move forward with a review as soon as possible with the goal of developing guidelines pertaining to tissue biopsy methods that will identify women with gynecological cancer before undergoing a surgical procedure to remove the uterus or fibroid.

The National Center for Health Research is a nonprofit research center that conducts and scrutinizes research that can be used to improve public health through better healthcare services, programs, and policies.  We have no financial ties to the products or procedures that we evaluate.

Sincerely,

Diana Zuckerman, Ph.D.
President

 

See our related statement here.

Talcum Powder and Ovarian Cancer

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

A growing body of evidence suggests that using talcum powder (also called talc) in the genital area can increase a woman’s chances of developing ovarian cancer. The more years she uses talc, the more likely she is to develop ovarian cancer.[1] Talc is an ingredient in many baby powders. If you have ever used talcum powder or baby powder, or if you are still using it on yourself or your baby, here’s what you need to know.

About 1.3% of women in the United States will be diagnosed with ovarian cancer in her lifetime.[2] Although this is much lower than the lifetime risk for developing breast cancer,[3] there is no recommended test to screen for ovarian cancer, so unlike breast cancer, ovarian cancer is rarely diagnosed early. When ovarian cancer is found early, a woman has nearly a 93% chance of surviving at least 5 years after she is diagnosed. Those chances drop off significantly to about 30% if the cancer is found after it has spread to other parts of her body.[4] According to the American Cancer Society, over 21,000 women are estimated to receive a new diagnosis of ovarian cancer in 2021, and almost 14,000 women are estimated to die from it.[5] 

Based on many research studies involving thousands of women, those who have used talcum powder are about 30% more likely to be diagnosed with ovarian cancer than women who have not.[6,7] This means that over her lifetime, a woman who uses talcum powder increases her chances of developing ovarian cancer from 1.3% to 1.7%. That is still a low risk for any individual woman, but if 1 million women use talcum powder, approximately 4,000 more of those women will develop ovarian cancer, compared to the number that would have developed ovarian cancer if they hadn’t used talcum powder.

How Good Is the Evidence?

Most of the evidence comes from a type of study known as a case-control study.  For these studies, researchers recruit two groups of women – women with ovarian cancer (called “cases”) and women without ovarian cancer (called “controls”). All of the women are asked to recall whether they used talcum powder in the past, and if so, how often and how it was used. These studies cannot tell us for sure that using talcum powder causes ovarian cancer, but they can tell us if women who report using the powder in the genital area are more likely to develop ovarian cancer.

It is possible that there is a bias in women’s responses. Women with ovarian cancer might inaccurately recall having used more talc in the genital area than they actually did, leading to a false association between genital use of talc and ovarian cancer. However, it does not seem likely that these results are due to biased answers or faulty memory. While there is never a guarantee that memories are 100% accurate, many women are very sure about whether or not they regularly used talcum powder in the genital area. The International Agency for Research on Cancer (IARC), a well-respected agency within the World Health Organization (WHO), concluded that there was an “unusually consistent” increased chance of developing ovarian cancer among women who reported using talcum powder in the genital area.[8] In addition, the results are consistent for one particular type of epithelial ovarian cancer, called serous carcinoma. If the association between genital talc use and developing ovarian cancer were due to faulty memory or biased responses, we would see an association between it and all forms of ovarian cancer. The fact that it is consistently associated with one type of ovarian cancer means it is more likely that these findings are accurate.[9]

Important Studies

Some of the most convincing evidence comes from two case-control studies published in 2016: the African American Cancer Epidemiology Study (AACES) and the New England study.[10,1]

The AACES study compared 584 African American women who had been diagnosed with ovarian cancer to 745 African American women who did not have ovarian cancer. The women in the study came from 11 different geographic regions of the United States, and women with ovarian cancer were compared to women of the same ages and from the same geographic regions.[10] In this study, talc use was common – about 63% of women with ovarian cancer and 53% of the healthy women said they had used talc.  

The study found that the women who had only used talc in the genital area, as well as women who used talc only in non-genital areas, or who used it in both, were significantly more likely to have been diagnosed with epithelial ovarian cancer than women who did not use talc. Those who used talc in the genital area had a more than 40% increased risk of cancer, whereas those who used talc only in non-genital areas had an increased risk of over 30%. Instead of having a 1.3% lifetime risk, the women who used talc in the genital area would have over a 1.8% risk. Johnson & Johnson has been shown to target African American women in their marketing of talc, and African American women are more likely to use the product than other women,[11] so it is important to understand the risks for this population. 

In that study of African American women, the women who had a respiratory condition (such as asthma) were slightly more likely to develop ovarian cancer if they used talc, compared to women who did not have a respiratory condition.[10] The researchers believe that talcum powder causes the body to develop inflammation, which is known to potentially cause the growth of cancer cells. Women who are more likely to develop inflammation, such as those who have an underlying respiratory condition, may be at a slightly higher risk of developing ovarian cancer from talc.

The New England ovarian cancer study also suggests that the body develops cancer as a result of inflammation caused by talcum powder.[1] The researchers compared approximately 2,041 women living in Massachusetts and New Hampshire who had been diagnosed with ovarian cancer with 1,578 women of the same age and geographic location who did not have cancer. They reported that the women who used talc in the genital area, whether or not they used it elsewhere in their bodies, were significantly more likely to be diagnosed with epithelial ovarian cancer. Most reported using Johnson & Johnson Baby Powder or Shower to Shower brand powder. Many body powders are now made with cornstarch instead of talc, but women who used powders made with cornstarch were not considered talc users in the study.

Overall, the women using talc were about 33% more likely to develop ovarian cancer. Instead of having a 1.3% lifetime risk, a woman who used talc increased their lifetime risk to about 1.7%. However, some women were more at risk than others. Women who used talc and were sterilized prior to menopause (underwent a tubal ligation or hysterectomy) or who took hormone therapy for menopausal symptoms were even more likely to develop ovarian cancer compared to other talc users. The researchers believe that the hormone estrogen may make women less vulnerable to the risk of talc.[1] 

One study published in 2020 reports that there are no consistent findings of a relationship between talc exposure and developing ovarian cancer.[12] However, it is important to note that the study was funded by the Cosmetics Alliance Canada and Industrial Minerals Association-North America. Since the researchers were funded by companies that profit off of talc use, that could have biased their results. Another study published in 2020 also found no statistically significant association between genital application of talc and ovarian cancer across 4 studies.[13] However, the researchers warn that their study may have been underpowered and could have missed a small increase in risk due to talc use. This is especially likely because there are some shortcomings in the research, such as inconsistency with how talc use was measured and no information about the amount of talc in the powders women reported using.

How Could Talc Cause Ovarian Cancer? 

Talc is often found in the same places in the earth as asbestos, so asbestos may be contaminating talc when it is mined.[14]  Asbestos is known to cause cancer in humans. In 2019, the U.S. Food and Drug Administration (FDA) found that a bottle of Johnson & Johnson baby powder tested positive for asbestos.[15] The FDA gathered a team of experts from 8 different federal agencies, and these experts developed recommendations for standardizing testing talc products for asbestos.[15,16]

However, this team of experts said that it is “irrelevant” whether the products contain asbestos because both asbestos and similar minerals (such as talc) are suspected of causing “similar pathological outcomes.”[16] In fact, microscopic photos of talc show that it can look very similar to asbestos, regardless of whether it is contaminated with asbestos. The team of experts asserted that talc, even without any asbestos present, is suspected to cause health problems. One reason that researchers believe genital application of talc can cause ovarian cancer is that talc can enter the ovaries and cause inflammation, and inflammation can cause cancer.[17,18] 

Lawsuits Over Talc and Cancer 

Since 2014, Johnson & Johnson has defended its talcum powder in lawsuits brought by families of women who had used their talcum powder products and died from ovarian cancer. In February 2016, the courts ruled in favor of the family of a woman who died of ovarian cancer at 62 years old. Particles of talc were found in her ovaries, which were removed after her cancer diagnosis. The courts overturned the ruling just a few months later based on jurisdictional issues that were not related to the science.[19] In another matter, a California woman with ovarian cancer won a $70 million dollar against Johnson & Johnson. She continues to fight for fair warning labels on the products it sells. A powder sold by the brand Assured already carries such a warning: “Frequent application of talcum powder in the female genital area may increase the risk of ovarian cancer.”[20]

There is some evidence that men may also be harmed by talc. For example, the courts ruled in favor of a New Jersey man because the powder had caused an asbestos-related lung cancer known as mesothelioma. In this case, the talcum powder was likely contaminated with asbestos. Despite the jury’s decision, Johnson & Johnson continues to deny claims that their product contains asbestos or that it causes cancer. However, the court held that exposure to asbestos from another source was not a likely cause of his cancer.[21] 

A 2018 investigation by Reuters examined Johnson & Johnson’s internal reports, company memos, and confidential documents from 1971 to the early 2000s.[22] According to the documents, as early as 1971, researchers from Mount Sinai Medical Center had told Johnson & Johnson that they had found traces of asbestos in the company’s baby powder made with talc. The documents suggest that Johnson & Johnson claimed that the tiny amount of asbestos found in some samples of its powders was too small to cause health problems, and the company lobbied the Food and Drug Administration to agree with that assessment. 

Currently, Johnson & Johnson is facing over 15,000 lawsuits from people who believe that their cancers were caused by talc products sold by the company.[16] In one lawsuit, a group of 22 women who developed ovarian cancer sued the company and were awarded $2 billion. The company tried to appeal the case before the Supreme Court, but in June 2021, the Supreme Court rejected the appeal, which means that the $2 billion award still stands.[23]

In May 2020, Johnson & Johnson announced that they would stop selling talc-based baby powders in the U.S. and Canada.[24] Nevertheless, the company denies any claims that their product is associated with cancer. Instead, they claim that they are no longer selling the talc-based powder due to low demand and “misinformation around the safety of the product and a constant barrage of litigation advertising.” The company will still sell baby powders that are cornstarch-based, rather than talc-based. 

The Bottom Line

While the scientific evidence has shown a consistent link between talcum powder and ovarian cancer and possibly other health risks, many questions remain. The bottom line question is: why take the risk?

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

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

References

  1.     Cramer DW, Vitonis AF, Terry KL, et al. The association between talc use and ovarian cancer: A retrospective case–control study in two US states. Epidemiology. 2016;27(3): 334-346.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/
  2.     Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, Gaudet MM, Jemal A, Siegel RL. Ovarian cancer statistics, 2018. CA: A Cancer Journal for Clinicians. 2018 Jul;68(4):284-96.
  3.     National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. Seer.cancer.gov. https://seer.cancer.gov/statfacts/html/breast.html. 2020. 
  4.     U.S. Preventive Services Task Force. Final Recommendation Statement: Ovarian Cancer: Screening. Rockville, MD:U.S. Preventive Services Task Force. 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/ovarian-cancer-screening1\
  5.     American Cancer Society. Key Statistics for Ovarian Cancer. Cancer.org. https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html. Updated 2021. 
  6.     Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention. 2018; 27(3):248-57.
  7.     Terry KL, Karageorgi S, Shvetsov YB, Merritt MA, Lurie G, Thompson PJ, Carney ME, Weber RP, Akushevich L, Lo-Ciganic WH, Cushing-Haugen K. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer Prevention Research. 2013; 6(8):811-21.
  8.     International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 93 Carbon Black, Titanium Dioxide, and Talc; 2010. http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8F.pdf
  9.     Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention. 2018; 27(3):248-57.
  10. Schildkraut JM, Abbott SE, Alberg AJ, et al. Association between body powder use and ovarian cancer: The African American Cancer Epidemiology Study (AACES). Cancer Epidemiology, Biomarkers & Prevention. 2016;25(10):1411-1417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050086/
  11. Cohen R.  Talc linked to ovarian cancer risk in African-American women. Reuters Health News. June 6, 2016. https://www.reuters.com/article/us-health-talc-ovarian-cancer/talc-linked-to-ovarian-cancer-risk-in-african-american-women-idUSKCN0YO2T7
  12. Goodman JE, Kerper LE, Prueitt RL, Marsh CM. A critical review of talc and ovarian cancer. Journal of Toxicology and Environmental Health, Part B. 2020; 15:1-31.
  13. O’Brien KM, Tworoger SS, Harris HR, Anderson GL, Weinberg CR, Trabert B, Kaunitz AM, D’Aloisio AA, Sandler DP, Wentzensen N. Association of powder use in the genital area with risk of ovarian cancer. JAMA. 2020; 323(1):49-59.
  14. U.S. Food and Drug Administration. Talc. Fda.gov. https://www.fda.gov/cosmetics/cosmetic-ingredients/talc. Updated March 2020. 
  15. The Mesothelioma Center. FDA Panel Recommends Standardized Talc Testing for Asbestos. Asbestos.com. https://www.asbestos.com/news/2020/01/21/standardized-talc-testing-asbestos/. January 2020. 
  16. Reuters. Government experts urge new talc testing standards amid asbestos worries. Reuters.com. https://www.reuters.com/article/us-usa-fda-talc-testing/government-experts-urge-new-talc-testing-standards-amid-asbestos-worries-idUSKBN1Z92I4. January 2020. 
  17. Trabert B. Body powder and ovarian cancer risk–what is the role of recall bias?. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016; 25(10):1369.
  18. Penninkilampi R, Eslick GD. Perineal Talc Use and Ovarian Cancer: A Systematic Review and Meta-Analysis. Epidemiology. 2018; 29(1):41‐49. doi:10.1097/EDE.0000000000000745
  19. Taylor J. Missourinet. Johnson & Johnson case from St. Louis gets heard in Missouri Supreme Court. Missourinet. March 5, 2018. https://www.missourinet.com/2018/03/05/johnson-johnson-case-from-st-louis-gets-heard-in-missouri-supreme-court/
  20. DailyMed. LABEL: ASSURED MEDICATED BODY POWDER- menthol powder. Dailymed.nlm.nih.gov. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c8dad6e4-748f-41c1-98d6-1afa836967ce. Updated November 2017. 
  21. Bellon T.  J&J, Imerys unit must pay $117 million in N.J. asbestos cancer case. Reuters. April 11, 2018. https://www.reuters.com/article/us-johnson-johnson-cancer-lawsuit/jj-imerys-unit-must-pay-117-million-in-n-j-asbestos-cancer-case-idUSKBN1HI2ZD
  22. Girion L, Wood M. Johnson & Johnson knew for decades that asbestos lurked in its Baby Powder. Reuters. December 14th 2018, https://www.reuters.com/investigates/special-report/johnsonandjohnson-cancer/#johnson-research-sidebar
  23. National Public Radio. Supreme Court Says A $2 Billion Verdict In A Baby Powder Cancer Case Should Remain. Npr.org. https://www.npr.org/2021/06/01/1002149828/supreme-court-johnson-johnson-talc-verdict-ovarian-cancer. June 2021.
  24. National Public Radio. Johnson & Johnson Stops Selling Talc-Based Baby Powder In U.S. And Canada. Npr.org. https://www.npr.org/2020/05/19/859182015/johnson-johnson-stops-selling-talc-based-baby-powder-in-u-s-and-canada. May 2020.

Boosting Healthy Bacteria for a Healthy Pancreas

Diet, Habits, & Other Behaviors, Pancreatic Cancer, Prevention
Jessica Cote and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

Pancreatic cancer is rare–less than 2% of Americans will develop it in their lifetimes. However, pancreatic cancer is the 4th most common cause of cancer-related deaths in the U.S. claiming more than 43,000 American lives in 2017.1  The good news is that  prevention is possible, since most pancreatic cancers are not cause by inherited genes. Smoking and alcohol use are the major known causes, and can double the lifetime risk to about 3%.2 Quitting smoking and cutting back on alcohol are good ways to prevent pancreatic cancer and so is a healthy mouth and gut. Scientists have recently discovered that the bacteria living in our bodies can help us stay healthy and ward off dangerous cancers.

What is the Microbiome?

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

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

Oral Bacteria and Pancreatic Cancer

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

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

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

Gut Bacteria and Pancreatic Cancer

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

The Bottom Line

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

Footnotes:

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

Children and Athletes at Play on Toxic Turf and Playgrounds

Environmental Exposures

Nyedra W. Booker PharmD MPH and Stephanie Fox-Rawlings PhD, National Center for Health Research.

Is your child playing on rubber instead of grass at the playground? The use of human-made surfaces on playgrounds has increased dramatically over the years. First developed during the 1960s primarily for athletic fields, these artificial surfaces were also part of a strategy to provide children with more opportunities for outdoor physical activity, particularly in the inner city where outdoor playgrounds were scarce.[1] The first artificial turf (marketed as “Chemgrass”) was made of plastic, yet looked a lot like natural grass.  Since then, these artificial surfaces have expanded and many look like colorful rubber surfaces.  But regardless of what they look like, all are made with materials that can be dangerous to children and adults.

As its use for various sports activities increased significantly over the years, so did the concerns. Athletes began to complain that the surface was much harder than natural grass, as some studies also began to show that the use of artificial turf could increase the risk for football and other sports-related injuries. This prompted a ban on the use of artificial turf by the English Football Association in 1988, while many ballparks and professional sports stadiums in the United States began converting back to using natural grass during the 1990s. Over time, material such as rubber was added to keep the blades of “grass” in place and provide more cushioning.[1] Artificial turf containing rubber and other cushioning materials was also assumed to reduce sports-related injuries, but study results have not always supported that assumption.[2] Even with modern fields, many professional athletes dislike playing on artificial turf. It increases the severity of abrasions due to sliding, puts additional stress on joints, and heats up much more than grass does in the sun – and can become dangerously hot.[3][4] Following their failure to force soccer’s international governing body (FIFA) to use sod instead of artificial turf for the 2015 Women’s World Cup, an international group of women players are suing the FIFA.[5]

Some of the benefits of artificial turf are that it’s a long-lasting “all-weather” material that does not require a lot of maintenance in the short-term or potentially dangerous pesticides. Artificial turf is currently used on more than 12,000 athletic fields in the U.S.[6]    Unfortunately, these surfaces often don’t last as long as expected.

From the Tire Swings to Play Surfaces made from Tires or New Rubber

Do you remember when children used to play on tire swings in the backyard or at the park? Those same tires are now being put to a new and possibly hazardous use! Recycled rubber tires have become one of the top choice materials for surfacing children’s playgrounds. [7] In 2013, approximately 233 million scrap tires were generated, of which 8% (approximately 17.5 million tires) was processed for playground surface cover and 4% (almost 10 million tires) for sports surfaces. [8] Logically, tire scraps seemed like a surface that would be less likely to harm children if they fell. Recycling tires for use in playgrounds also keeps them out of landfills where they take up space, harbor rodents and other animals, and trap standing water that serve as breeding grounds for mosquitoes and other disease-bearing insects. But just as tires that have been thrown away can catch fire and release many different harmful chemicals into the air and ground water, tire materials and other synthetic rubber can release chemicals into the air we breathe.[9]    Those chemicals can also get on our skin and even in our mouths.  This is an example where what seemed like helpful recycling can instead be harmful.

The tire material and other rubber used on playgrounds can include the following:

  •    Loose tire shred (rubber mulch) or “crumb” on a surface that can be raked.
  •    Tire shreds that are combined with a binder and then poured onto a permanent surface
  •    Tiles made from tire shreds and binder that have been factory-molded, then glued to a playground surface.[7]
  •    Colorful rubber that is “poured in place” (PIP) that is not necessarily made from tires but contains many of the same dangerous materials.

Are Playground Surfaces Made With Rubber or Tire Crumb Safe?

There has been increasing evidence that raises concerns about the safety of tire waste as well as new rubber and other synthetic materials used on playground surfaces. While rubber includes some natural rubber (called latex) from rubber trees, it also contains phthalates (chemicals that affect hormones, see Phthalates and Children’s Products), polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs) and other chemicals known or suspected to cause adverse health effects.[10] PAHs, for example, are natural or human-made chemicals that are made when oil, gas, coal or garbage is burned.[11] According to the EPA, breathing air contaminated with PAHs may increase a person’s chance of developing cancer, and the Agency for Toxic Substances and Disease Registry (ATSDR) states that PAHs may increase the risk for cancer and also increase the chances of birth defects.[11] [12]

What the Scientific Studies Say

The California Office of Environmental Health Hazard Assessment (OEHHA) conducted three laboratory studies in 2007 to investigate the potential health risks to children from playground surfaces made from tire waste. One study evaluated the level of chemicals released that could cause harm to children after they have had contact with loose tire shreds, either by eating them or by touching them and then touching their mouth. The other two studies looked at the risk of injury from falls on playground surfaces made from tire waste compared to wood chips, and whether tire shreds could contaminate air or water.[7]

It would not be ethical to ask children to eat tire shreds, so the researchers created chemical solution that mimicked the conditions of a child’s stomach and placed 10 grams of tire shreds in it for 21 hours at a temperature of 37°C. Researchers then measured the level of released chemicals in the solution and compared them to levels EPA considered risky. The study also mimicked a child touching the tire shreds and then touching her mouth by wiping recycled tire playground surfaces and measuring chemical levels on the wipes. To evaluate skin contact alone, the researchers tested guinea pigs to see if rubber tire playground samples caused any health problems. This study assumed that children would be using the playground from the ages of 1 through 12. Results of the OEHHA studies showed that a single incident of eating or touching tire shreds would probably not harm a child’s health, but repeated or long-term exposure might. Five chemicals, including four PAHs, were found on wipe samples. One of the PAHs, “chrysene,” was higher than the risk level established by the OEHHA, and therefore, could possibly increase the chances of a child developing cancer.[7]

Out of the 32 playgrounds surfaced in recycled tires that the researchers in California looked at, only 10 met that state’s 2007 standard for “head impact safety” to reduce brain injury and other serious harm in children who fall while playing. In contrast, all five surfaces made of wood chips met the safety standard.[7]

A 2012 study analyzing rubber mulch taken from children’s playgrounds in Spain found harmful chemicals in all, often at high levels.[10] Twenty-one samples were collected from 9 playgrounds in urban locations. The results showed that all samples contained at least one hazardous chemical, and most contained high concentrations of several PAHs. Several of the identified PAHs can be released into the air by heat, and when that happens children are likely to inhale them. While the heat needed to do this was very high in some cases (140 degrees Fahrenheit/ 60 ºC), many of the chemicals also became airborne at a much lower temperature of 77 ºF (25 ºC). The authors concluded that the use of rubber tire waste on playgrounds “should be restricted or even prohibited in some cases.”[10]

A 2015 report by Yale scientists analyzed the chemicals found in 5 samples of tire crumbs from 5 different companies that install school athletic fields, and 9 different samples taken from 9 different unopened bags of playground rubber mulch. The researchers detected 96 chemicals in the samples. A little under a half have never been studied for their health effects, so their risks are unknown, and the other chemicals have been tested for health effects, but those tests were not thorough. Based on the studies that were done, 20% of the chemicals that had been tested are considered to probably can cause cancer, and 40% are irritants that can cause breathing problems such as asthma, and/or can irritate skin or eyes. [13]

What The EPA has Done

The EPA created a working group that collected and analyzed data from playgrounds and artificial turf fields that used tire material. Samples were collected at six turf fields and two playgrounds in four study sites (Maryland, North Carolina, Georgia and Ohio). In a report released in 2009, the agency concluded that the level of chemicals monitored in the study and detected in the samples were “below levels of concern.” There were limitations to this study, however. The study did not measure the concentration of organic chemicals that are known to vaporize during summer heat (called SVOCs). SVOCs include PAH.

A meeting was then convened by the EPA in 2010, bringing together various state and federal agencies to discuss safe levels of chemical exposure on playgrounds made from tire rubber, and opportunities for additional research. [14] When announcing the results of the study, EPA joined other organizations in recommending that as a precaution, young children wash their hands frequently after playing outside.[14]

In the case of PAHs, the EPA has concluded that while there are currently no human studies available to determine their effects at various levels, based on laboratory findings, “breathing PAHs and skin contact seem to be associated with cancer in humans.” [11]

In February 2016, the U.S. government announced a new action plan to better understand the likely health risks of tire crumb and similar artificial surfaces. This initiative involves 4 U.S. government agencies: the EPA, Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease Registry (ATSDR) and Consumer Product and Safety Commission (CPSC). In December 2016, they released a status report. [15]

What is the Impact on Our Environment?

Although this article focuses on the impact of artificial turf on health, it is worth noting that artificial turf also has a negative impact on the environment.  Sarah-Jeanne Royer, PhD, a postdoctoral fellow at the University of Hawaii who has published research on the impact of degrading plastic on greenhouse gasses, explained to National Center for Health Research staff that artificial turf fields are made of polyethylene and sometimes nylon so they produce greenhouse gasses.[16] The “outgassing” from the plastic is higher during the day but continues at lower levels at night.  Because the artificial turf fields have millions of fragments, they have a very high surface area that produces much more greenhouse gas than a flat carpet would.

How to Protect your Children

So how can you protect your child at the playground? Remember that children are much more likely to be harmed by exposure to chemicals in their environment than adults because they are smaller (so the exposure is greater) and because their bodies are still developing. This is why it’s important to significantly reduce (or try to eliminate) any contact your child may have with substances that are known or suspected to be harmful. If you have more than one playground in your area, choose the one that doesn’t have a recycled rubber play surface or other types of rubber or synthetic surface.

Parents can actively persuade local officials that playgrounds should use wood chips rather than rubber or other substances that are less safe when children fall, and more dangerous in terms of chemicals that they breathe or get on their hands.

The CDC, Consumer Product Safety Commission (CPSC) and EPA all recommend that you teach your child the importance of frequent hand washing, especially after playing outside and before eating.[14] The President’s Cancer Panel  advised to “minimize children’s exposure to toxics” and “both mothers and fathers should avoid exposure to endocrine-disrupting chemicals and known or suspected carcinogens prior to a child’s conception and throughout pregnancy and early life, when risk of damage is greatest.”[17]

The Consumer Product Safety Commission recommends the following precautions:

  1. Avoid mouth contact with playground surfacing materials, including mouthing, chewing, or swallowing playground rubber. This may pose a choking hazard, regardless of chemical exposure.
  2. Avoid eating food or drinking beverages while directly on playground surfaces, and wash hands before handling food.
  3. Limit the time at a playground on extremely hot days.
  4. Clean hands and other areas of exposed skin after visiting the playground, and consider changing clothes if evidence of tire materials (e.g., black marks or dust) is visible on fabrics.
  5. Clean any toys that were used on a playground after the visit. [18]

To learn more about artificial turf and concerns about cancer risks for kids and young adults, watch this ESPN news video here.

Related Articles

NCHR Letter to the DC City Council on Artificial Turf
Risks of Head Injuries on Artificial Turf Fields in Washington, DC
Nearly a Dozen Artificial Turf Fields in DC Failed Last Round of Safety Tests

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

  1. Claudio L. Synthetic Turf-Health Debate Takes Root. Environmental Health Perspectives, 2008; 116(3):A117-22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265067/.
  2.  New York State Department of Health. Fact Sheet: Crumb-Rubber Infilled Synthetic Turf Athletic Fields. August 2012 (last revised). http://www.health.ny.gov/environmental/outdoors/synthetic_turf/crumb-rubber_infilled/fact_sheet.htm Accessed May 2016.
  3. Dubois L. Artificial Turf Controversy a Constant in Backdrop of Women’s World Cup. Sports Illustrated. June 24, 2015. http://www.si.com/planet-futbol/2015/06/23/womens-world-cup-artificial-turf-canada.
  4. Goff S. Women’s World Cup will be played on lush, green artificial turf. Washington Post. June 5, 2015. https://www.washingtonpost.com/sports/womens-world-cup-will-be-played-on-lush-green-artificial-turf/2015/06/05/a786a0ac-0b8d-11e5-951e-8e15090d64ae_story.html Accessed May 2016.
  5. Dockterman E U.S. Women’s Soccer Team Refuses to Play on Turf. Time. Dec 8, 2015. http://time.com/4140786/womens-soccer-team-turf/ Accessed May 2016.
  6. Synthetic Turf Council. About Synthetic Turf. https://syntheticturfcouncil.site-ym.com/page/Public. Accessed May 2016.
  7. State of California-Office of Environmental Health Hazard Assessment (OEHHA), Contractor’s Report to the Board. Evaluation of Health Effects of Recycled Waste Tires in Playground and Track Products. January 2007. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C62206013.pdf Accessed May 2016.
  8. Rubber Manufacturers Association. US Scrap Tire Markets 2013. Nov 2014. https://rma.org/sites/default/files/US_STMarket2013.pdf Accessed May 2016.
  9. US Environmental Protection Agency (EPA). Wastes-Resource Conversation-Common Wastes & Materials – Scrap Tires (Frequent Questions). http://www.homepages.ed.ac.uk/shs/Hurricanes/Frequent%20Questions%20%20%20Scrap%20Tires%20%20%20US%20EPA.html Accessed May 2016.
  10. Llompart M, Sanchez-Prado L, Lamas JP, Garcia-Jares C, et al. Hazardous Organic Chemicals in Rubber Recycled Tire Playgrounds and Pavers. Chemosphere. 2013;90(2):423-431. http://www.sciencedirect.com/science/article/pii/S0045653512009848
  11. US Environmental Protection Agency (EPA). Polycyclic Aromatic Hydrocarbons (PAHs)-Fact Sheet. November 2009. https://www.epa.gov/north-birmingham-project/polycyclic-aromatic-hydrocarbons-pahs-fact-sheet Accessed May 2016.
  12. Agency for Toxic Substances and Disease Registry (ATSDR). Polycyclic Aromatic Hydrocarbons. September 1996. http://www.atsdr.cdc.gov/toxfaqs/tfacts69.pdf Accessed May 2016.
  13. Benoit G, Demars S. Evaluation of Organic and Inorganic Compounds Extractable by Multiple Methods From Commercially Available Crumb Rubber Mulch. Water Air Soil Pollut 2018. 229(3): 64. https://doi.org/10.1007/s11270-018-3711-7
  14. US Environmental Protection Agency (EPA). Fact Sheet – The Use of Recycled Tire Materials on Playgrounds & Artificial Turf Fields. http://www.emcmolding.com/uploads/files/file130102132640.pdf
  15. EPA. Federal Research on Recycled Tire Crumbs Used on Playing Fields. December, 2016. https://www.epa.gov/sites/production/files/2016-12/documents/federal_research_action_plan_on_recycled_tire_crumb_used_on_playing_fields_and_playgrounds_status_report.pdf. Accessed August, 2017.
  16. Astroturf. https://www.astroturf.com/synthetic-turf-products/sports-grass-infill/
  17. Reuben, S. (2010). Reducing Environmental Cancer Risk What We Can Do Now. Annual Report President’s Cancer Panel. U.S. Department of Health and Human Services. https://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf. Accessed 6 Jun. 2018.
  18. CPSC. Crumb Rubber Information Center. https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/Crumb-Rubber-Safety-Information-Center

Cancer Prevention Campaign

Diet, Habits, & Other Behaviors, Prevention

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

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

Tips for Healthier Eating

Ten Tips to Get Your Family Eating Healthy

How Do I Get My Child to Eat Healthier Foods?

MyPlate: A New Alternative to the Food Pyramid

Kids Talk About Healthy Eating

Eating Habits That Improve Health and Lower Body Mass Index


Nutrition, Obesity, Exercise, and Cancer

Weight and Cancer: What You Should Know

What’s a Woman to Eat?

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

Obesity in America: Are You Part of the Problem?

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

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

Do Chemicals in Our Environment Cause Weight Gain?

Fast Food Facts: Calories and Fat

Will Acai Help Me Lose Weight?

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

Heart Disease and Breast Cancer

Breast Cancer, Diet, Habits, & Other Behaviors, news-you-can-use, Prevention
Diana Zuckerman PhD, Cancer Prevention and Treatment Fund

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

Facts that will Help you Decide your Treatment Options

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

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

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

Which Breast Cancer Treatments Harm the Heart?

Radiation therapy:

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

Hormonal therapy:

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

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

Chemotherapy:

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

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

Targeted Drugs:

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

Prevention

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

  1. Stop smoking
  • For heart health – Smoking increases the chances of having a heart attack or stroke.
  • For breast health – Women who start smoking at a younger age, and smoke for many years, are more likely to develop breast cancer. Smoking causes about 4 in 1000 breast cancers. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits.2
  1. Maintain a healthy weight
  • For heart health – Being overweight or obese (a BMI of 25 or above) increases the chances of developing heart disease.
  • For breast health – Every extra 10 pounds over “normal” weight (BMI below 25) increases the chance of developing breast cancer by about 10%.
  1. Be physically active
  • For heart health – Sitting, watching TV, lying in bed, or driving for 10 hours or more a day while you are awake instead of 5 hours or less per day increases the chances of developing heart disease by about 18%. The AHA recommends exercising for 30 minutes or more a day 5 days each week.
  • For breast health – Those same sedentary activities for 12 hours or more a day compared to 5.5 hours or less increase the chance of developing breast cancer by about 80%. To prevent breast cancer, exercise for 30 minutes or more a day 5 days each week.
  1. Eat a healthy diet
  • For heart health – Eating a diet rich in fresh vegetables, Fresh fruit, fish, poultry, and whole grains reduces your chance of dying from heart disease by about 28% compared to eating a typical U.S. diet with many fast foods, red meats/processed meats, and packaged or processed foods.
  • For breast health – The typical U.S. diet is associated with a greater chance of developing breast cancer, but the clearest evidence is for eating at least 15 oz of red meat or processed meat each week compared to less than 9 oz. of red meat or processed meat.

Heart Health for Breast Cancer Patients and Survivors

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

The Bottom Line

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

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

References:

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

2Jones ME. et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Research. 2017;19:118. https://doi.org/10.1186/s13058-017-0908-4

Alcohol and Cancer

Breast Cancer, Colon Cancer, Diet, Habits, & Other Behaviors, Lung Cancer, news-you-can-use, Pancreatic Cancer, Prevention

Ealena Callender, MD, MPH, & Meg Seymour, PhD, Cancer Prevention and Treatment Fund

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

What is Moderate Drinking? Heavy Drinking?

The 2020-2025 Dietary Guidelines for Americans recommends that Americans can reduce their risk of alcohol-related health problems by drinking in moderation, which means 1 drink per day or less for women and 2 drinks per day or less for men.2 However, not all “drinks” are equal. A drink is defined as approximately 0.6 fluid ounces of alcohol, which equals: 1.5 ounces of distilled spirits (e.g., vodka, gin, tequila, etc), 5 ounces of wine, 12 ounces of beer, and 8 ounces of malt liquor.3 (Click here to see the CDC’s fact sheet.) The guidelines define moderate drinking as two drinks or less per day for men and one drink or less per day for women.

The CDC describes heavy drinking as having more than eight drinks per week for women and more than 15 drinks per week for men. Binge drinking refers to consuming multiple drinks on a single occasion – four or more drinks for women and five or more drinks for men.

Drinking and Cancer

In January 2023, the Canadian Centre on Substance Use and Addiction (CCSA) published updated guidelines that recommend limiting alcohol use to two or fewer drinks per week to reduce the risk of harm from alcohol.4 At that level, they say risk of harm from alcohol is low. Risk is moderate for those who drink three to six servings of alcohol per week and “increasingly high” for those who drink seven or more. The report warns that drinking three to six alcoholic beverages per week is associated with increased risk of several types of cancer.

These guidelines may surprise many people, especially those who assumed moderate drinking was not anything to be concerned about.  But research indicating the risk of cancer from drinking even small amounts of alcohol has been published for years.  For example, Alcohol is known to cause at least six types of cancer: mouth and throat cancer, larynx (voice box) cancer, esophageal cancer, colon and rectal cancer, liver cancer, and breast cancer in women.5 A 2021 study found that 4% of all new cancer cases diagnosed throughout the world in 2020 were attributable to alcohol consumption, and the researchers say that may be a low estimate.6

Depending on the amount a person drinks, they can increase their chances for developing even rare cancers. For example, moderate drinkers can almost double their lifetime risk of mouth and throat cancer to almost 2%, while heavy drinkers increase their risk of having mouth or throat cancer, from 1% to 5%.1 A 2020 study from Australia found that the heaviest drinkers (drinking more than 14 drinks per week) had an overall higher likelihood of developing cancer, compared with those who drank the least (1 or 0 drinks per week). The men who drank the most had a 4.4% higher overall likelihood of developing cancer than the men who drank the least, and the women who drank the most had a 5.4% higher overall chance of developing cancer.7

Women need to be more cautious about drinking any amount of alcohol because the alcohol is even more likely to cause cancer in women than in men. Research has shown that women who drink even 1 drink per day have a 5-9% higher chance of developing breast cancer, compared with women who do not drink.8 The risk is even higher for women who drink more. One reason may be that alcohol affects the amounts of certain sex hormones circulating in the body. For women who have had hormone receptor-positive breast cancer, seven or more weekly drinks increased the chances of having a new cancer diagnosed in the other breast from about 5% to about 10%.1

Heavy drinking is also risky for those who currently have or have had other types of cancer. Among all cancer survivors, heavy drinking caused an 8% increased risk in dying and a 17% increased risk of cancer recurrence. Patients with cancer who abuse alcohol do worse because alcohol causes poorer nutrition, a suppressed immune system, and a weaker heart.1

In 2020, an estimated 100,000 cases of cancer globally were caused by light to moderate drinking (fewer than two alcoholic beverages per day).6 A study of alcohol use in the European Union found that a drinking level of less than one drink per day was linked to 40% of alcohol-related cancers in women and 32% in men.9

Individuals who increase their alcohol use may also increase their chance of getting cancer, according to a large 2022 study.10 Compared with men and women who maintained the same level of drinking over about six years, the study found that those who increased their alcohol consumption were more likely to get cancer. While those who increased their alcohol consumption most dramatically saw a more significant increase in their risk of cancer, even those who only increased their consumption by a small amount had a higher risk of cancer than those who did not change their level of drinking.

How Alcohol Causes Cancer

Scientists believe that alcohol causes cancer in several ways:1

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

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

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

The Bottom Line

To decrease your chances of cancer and other serious health problems, try to limit your drinking.  If you drink alcohol, try to drink less often and aim for a maximum average of 1 a day if you’re a woman and 2 a day if you’re a man.

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

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

 

References

1. LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: a statement of the American Society of Clinical Oncology. Journal of Clinical Oncology. 2018;36(1):83-93.

2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov

3. Centers for Disease Control and Prevention. Dietary Guidelines for Alcohol. Cdc.gov. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm. Updated December 2020.

4. https://www.ccsa.ca/canadas-guidance-alcohol-and-health

5. Centers for Disease Control and Prevention. Alcohol and Cancer. Cdc.gov. https://www.cdc.gov/cancer/alcohol/index.htm. Updated July 2019.

6. Rumgay H, Shield K, Charvat H, Ferrari P, Sornpaisarn B, Obot I, Islami F, Lemmens VE, Rehm J, Soerjomataram I. Global burden of cancer in 2020 attributable to alcohol consumption: A population-based study. The Lancet Oncology. 2021;22(8):1071-80.

7. Sarich P, Canfell K, Egger S, Banks E, Joshy G, Grogan P, Weber MF. Alcohol consumption, drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over. British Journal of Cancer. 2021;124(2):513-23.

8. National Institute on Alcohol Abuse and Alcoholism. Women and Alcohol. Niaaa.nih.gov. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/women-and-alcohol. Updated April 2021.

9. Rovira, P., & Rehm, J. (2021). Estimation of cancers caused by light to moderate alcohol consumption in the European Union. European journal of public health, 31(3), 591–596. https://doi.org/10.1093/eurpub/ckaa236

10. Yoo, J. E., Han, K., Shin, D. W., Kim, D., Kim, B. S., Chun, S., Jeon, K. H., Jung, W., Park, J., Park, J. H., Choi, K. S., & Kim, J. S. (2022). Association Between Changes in Alcohol Consumption and Cancer Risk. JAMA network open, 5(8), e2228544. https://doi.org/10.1001/jamanetworkopen.2022.28544

 

Hormonal Therapy for Ductal Carcinoma In Situ (DCIS)

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

In recent years, ductal carcinoma in situ (DCIS) has become one of the most commonly diagnosed breast conditions. It is often referred to as “stage zero breast cancer” or a “pre-cancer.” It is a non-invasive breast condition that is usually diagnosed on a mammogram when it is so small that it has not formed a lump. In DCIS, some of the cells lining the ducts (the parts of the breast that secrete milk) have developed abnormally, but the abnormality has not spread to other breast cells.

DCIS is not painful or dangerous, but it sometimes develops into breast cancer in the future if it is not treated. If it develops into breast cancer, it can spread, at which point it is called invasive. The goal of treating invasive cancer is to prevent it from spreading to the lungs, bones, brain, or other parts of the body, where it can be fatal. Since DCIS is not an invasive cancer, it is even less of a threat than Stage 1 or Stage 2 breast cancer, which are the earliest types of invasive cancer.[1]  For more information, see our free DCIS booklet, and our other articles on DCIS.

Most women with DCIS will never develop invasive cancer whether they are treated or not, but it is impossible to predict which women with DCIS will develop cancer and which ones won’t. That’s why treatment is recommended. A woman with DCIS does not need all the same treatments as a woman diagnosed with invasive breast cancer, but surgery is almost always recommended. Most DCIS patients will choose a lumpectomy (which removes the DCIS but does not remove the entire breast), and radiation therapy is usually recommended for those women to destroy any stray abnormal cells in the same breast.[1]

Some women also try hormone therapy such as tamoxifen or aromatase inhibitors. That is the focus of this article.

DCIS does not need to be treated immediately. A woman can spend a few weeks after her diagnosis to talk with her doctors, learn the facts about her treatment choices, and think about what is important to her before she chooses which kind of treatment to have.

Hormonal Therapy

Hormonal therapy is recommended for some women with DCIS to help prevent breast cancer from developing and to prevent DCIS from returning after it has been surgically removed.  It is only effective for women whose DCIS is “estrogen receptor positive”, which DCIS usually is.

Hormonal therapy is taken as a pill every day for at least 5 years. Side effects include increased risk of endometrial cancer, severe circulatory problems, or stroke. In addition, hot flashes, vaginal dryness, abnormal vaginal bleeding, and a possibility of premature menopause are common for women who were not yet menopausal when they started treatment.[1]

What is the benefit of hormone therapy for women also undergoing radiation therapy?

Tamoxifen blocks the effects of estrogen on breast cells, which can stop the growth of cancer cells that are sensitive to estrogen. A study of more than 1,800 pre-menopausal and post-menopausal women with DCIS evaluated the benefits of tamoxifen for women who had lumpectomy and radiation treatment. These women were randomly assigned to take tamoxifen for 5 years or a placebo (sugar pill). The study found that after 5 years, women who took tamoxifen were about 5% less likely to develop either DCIS or cancer in the same breast, cancer in the opposite breast, or distant cancer spread (8.2% in women taking tamoxifen vs. 13.4% in placebo). However, the vast majority of women survived and they did not live any longer whether they took tamoxifen or not.[1]

For postmenopausal women, aromatase inhibitors may be used instead of tamoxifen. Aromatase inhibitors block the body’s ability to make estrogen. A study of more than 3,000 post-menopausal women with DCIS evaluated the benefits of hormone treatment for women who had lumpectomy and radiation treatment. These women were randomly assigned to take tamoxifen or anastrozole for 5 years. The study found that after 5 years, compared to women taking tamoxifen, the women taking anastrozole were 2% less likely to develop either DCIS or cancer in the same breast, cancer in the opposite breast, or distant cancer spread (from about 8% of women taking tamoxifen compared to 6% taking anastrozole).  As in the previous study, the vast majority of women survived and those taking anastrozole did not live any longer than women taking tamoxifen.[2]

That was a very small benefit for anastrozole compared to tamoxifen, and another study of post-menopausal women with DCIS found no difference between the two hormone treatments.[3]

What is the benefit of hormone therapy for lumpectomy patients who do not undergo radiation therapy?

Although radiation therapy is usually recommended for lumpectomy patients, it is inconvenient and many women prefer to avoid it.  In addition, radiation is only beneficial for preventing cancer in the one breast, while hormone therapy helps prevent cancer in both breasts. A study of more than 1,700 women with DCIS who underwent a lumpectomy evaluated radiation and/or tamoxifen.  The women were randomly assigned either to radiation, tamoxifen, radiation plus tamoxifen, or no treatment after surgery. For women who did not have radiation therapy, tamoxifen reduced the chances of developing DCIS within 10 years in the same breast by about 3% and the chances of developing DCIS in the other breast by about 1%. Interestingly, tamoxifen did not significantly decrease the chances of developing invasive breast cancer in the same breast, and only reduced the chances of developing invasive cancer in the opposite breast by about 1%.[4]

In women treated with radiation, about 10% developed DCIS or breast cancer within the next 10 years after surgery, and it made no difference whether these women took tamoxifen or not. And while the vast majority of women were alive 10 years later, their chances of survival were no different whether they were treated with radiation, tamoxifen, both, or neither.[4]

Side Effects

While there are benefits to using hormonal therapy, tamoxifen and aromatase inhibitors carry risks of serious harms. Because estrogen plays an important role in maintaining strong bones and healthy cholesterol, blocking estrogen can put healthy women at greater risk for heart disease and osteoporosis.

Tamoxifen:

  • endometrial (uterine) cancer- for every 1,000 women, 2 more will develop uterine cancer
  • blood clots- for every 1,000 women, 3 more will develop potentially dangerous blood clots
  • strokes-  for every 100 women, 1 will develop a stroke
  • cataracts
  • hot flashes
  • vaginal discharge
  • vaginal bleeding

source: Medscape

Aromatase Inhibitors:

  • uterine cancer-  for every 1000 women, 20 more will develop uterine cancer
  • blood clots- for every 1,000 women, 20 more will develop a blood clot
  • strokes- for every 100 women, 2 more will develop a stroke
  • Joint pain for every 1000 women, 20 to 100 more will develop joint pains
  • hot flashes
  • vaginal bleeding
  • vaginal discharge

source: Medscape

The Bottom Line

In women diagnosed with DCIS, hormonal therapy can help prevent DCIS from recurring.  If a woman doesn’t undergo radiation therapy, hormonal therapy can reduce her chances of  invasive cancer in the opposite breast, but not invasive cancer in the same breast. And, hormonal therapy used in addition to radiation treatment apparently has no benefit, but does have added risks.

Perhaps most important, women who take hormonal therapies do not live any longer than women who don’t.

Too often, women with DCIS are encouraged to undergo radiation as well as hormonal therapy, but as you can see, the benefits of doing both are not greater than the benefits of choosing one or the other. And, the benefits of either radiation or hormonal therapy are primarily for reducing the chances of recurrence, but there is no benefit in terms of living longer.  Fortunately, almost all women with DCIS will live regardless of which of these treatments they have.

Talk to your doctor about which treatment options may be right for you.

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

Footnotes:

  1. National Cancer Institute. Breast Cancer Treatment PDQ. (Feb. 2018). Available online: https://www.cancer.gov/types/breast/hp/breast-treatment-pdq#link/_1576_toc
  2. Margolese, Richard G et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial.The Lancet. 2016;387(10021): 849 – 856.
  3. Forbes, John F et al. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. The Lancet.2016;387(10021): 866 – 873.
  4. Cuzick, Jack et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. The Lancet Oncology. 2011; 12(1): 21 – 29
  5. Medscape. Drugs & Diseases. Available online: https://reference.medscape.com/drug/soltamox-tamoxifen-342183#4 and https://reference.medscape.com/drug/arimidex-anastrozole-342208#4

Beginner’s Guide to Developing an Exercise Routine

Breast Cancer, Colon Cancer, Diet, Habits, & Other Behaviors
Morgan Wharton and Caitlin Kennedy, Cancer Prevention and Treatment Fund

Exercise is one of our seven recommended ways to maximize your health. It will reduce your chances of developing cancer and of living longer after your diagnosis.[1]  If you want to exercise but aren’t sure where to begin, we can help! If you feel like your daily life doesn’t allow you to get fit (not enough time, no money for a gym membership, etc.), we have some “work-arounds” that may help.

Benefits of Exercise

Everyone knows that exercise helps keep you healthy by preventing weight gain, but did you know that it also lowers your risk of heart disease, stroke, high blood pressure, unhealthy cholesterol, type 2 diabetes, and depression?[2,3] In addition, a study published in 2020 reported that a physically active lifestyle is even associated with less likelihood of developing cancer, or of dying of cancer.[4] Exercising to improve muscle strength also improves balance, and reduces the risk of falling, fractures, and arthritis. Overall, regular exercise improves your chances of living longer and helps you have a higher quality of life.[2]   

Even people who have been diagnosed with cancer can benefit from exercise. Click here to read more how exercise can help cancer patients.

How Much Should I Exercise?

The Centers for Disease Control and Prevention (CDC) recommend that adults should aim for 150 minutes of moderate-intensity exercise every week (such as walking quickly) or 75 minutes of high-intensity activity per week (such as running), plus two days of strength training (training with weights or resistance bands). If you haven’t been very active, start exercising at a low intensity, then slowly increase the amount and intensity of exercise each week.[5]

A 2017 study found that any amount of physical activity can reduce the chances of dying from cardiovascular disease or cancer. This means that if you regularly exercise, are a “weekend warrior,” or are less active than the CDC recommends, that will still help you live longer than not exercising at all.[6]

How Do I Create an Exercise Routine?

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

To prevent injury, always start your workout with a good warm up-short aerobic activity followed by dynamic stretching. Dynamic stretching involves moving different muscle groups through a full range of motion and is the best form of stretching before exercise because it warms up groups of muscles rather than individual muscles. Static stretching, such as holding a muscle in a position of resistance for up to 30 seconds, is helpful for improving flexibility and muscle imbalance over time, but is not beneficial just before exercising.[7] Investing in good running shoes will also help with preventing injuries such as shin splints that can develop after running on hard surfaces with the wrong kind of footwear.

If you don’t feel up to completing a full workout or are too busy on a given day, even taking the stairs instead of an elevator or escalator, walking around while you make phone calls, or walking to work or during your break can make up your exercise for the day. Even if it’s a shorter, less intense workout, it’s always best to get some activity each day, and you might be more likely to continue if you get others involved. Form a walking group and walk to work with people who live near you, or walk together on your daily breaks. If you don’t have a group of people to exercise with at work, consider using social media to benefit from peer pressure. Also upload your progress and fitness goals on sites like Facebook and Twitter.

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

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

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

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

Avoiding the Risks of Exercise

DEHYDRATION

People who exercise outside and do not drink enough water put themselves at risk for heat stroke and exhaustion. Drink plenty of water beginning the day before you exercise, and drink 10 ounces of water for every 20 minutes of exercise. Drink before you get thirsty, because thirst is the first sign of dehydration.[8] Finally, beware of the dangers of water bottles containing BPA. Be sure to select a stainless steel bottle or a plastic water bottle that is labeled “BPA free.” Read more about the harmful effects of BPA here.

SKIN CANCER

While running and exercising outside, remember to apply sunscreen of SPF 30 or higher that offers full spectrum protection (protection against both UVA and UVB rays) and is water-resistant. Apply at least fifteen minutes before going outside to allow your skin to soak up the sunscreen. Reapply often-every two hours and after swimming and excessive sweating. You should also apply lip balm of at least SPF 30. This will reduce your risk of sunburn, skin cancer, and premature aging of the skin.[9] Read more about running and skin cancer here.

OVERTRAINING

Overtraining can put too much stress on the immune system and keep it from doing its job, which is to keep you from getting sick! People who overtrain put themselves at risk of developing illnesses like colds and the flu because their immune systems are “run down.” You may feel fatigued all the time, or find yourself getting injured.  Some soreness and fatigue is a normal part of training, but if your discomfort becomes excessive, increase your rest/recovery time in between workouts.[10]

Regular endurance exercise may be risky, as well.  Running more than 30 miles per week may lessen or erase the health benefits, including a longer life, which moderate levels of running provide.  People who run a lot of marathons have been found to have higher levels of coronary plaque, a type of heart disease and a cause of heart attacks.[10] Therefore, moderate levels of regular exercise are recommended.

The Bottom Line

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

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

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

  1. Chen et, al. Association of physical activity with risk of mortality among breast cancer survivors. JAMA Netw Open.2022;5(11):e2242660. doi:10.1001/jamanetworkopen.2022.42660
  2. Centers for Disease Control and Prevention. Benefits of Physical Activity. http://www.cdc.gov/physicalactivity/everyone/health/index.html. Updated August 2020. 
  3. World Health Organization. Physical activity. https://www.who.int/news-room/fact-sheets/detail/physical-activity. Updated 2018.
  4. Gilchrist SC, Howard VJ, Akinyemiju T, Judd SE, Cushman M, Hooker SP, Diaz KM. Association of Sedentary Behavior With Cancer Mortality in Middle-aged and Older US Adults. JAMA Oncology. 2020;6(8):1210–1217.
  5. Centers for Disease Control and Prevention. How much physical activity do adults need?. http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html. Updated May 2020. 
  6. O’Donovan G, Lee IM, Hamer M, Stamatakis E. Association of “weekend warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality. JAMA Internal Medicine. 2017; 177(3):335-42.
  7. Parracino, L. A Simple Guide to Stretching. https://www.creightonprep.creighton.edu/uploaded/Athletics_Page/Weight_Room/Stretching/A_Simple_Guide_to_Stretching.pdf. 2002.
  8. American Council on Exercise. Healthy Hydration. https://www.acefitness.org/education-and-resources/lifestyle/blog/6675/healthy-hydration/. 2012. 
  9. American Academy of Dermatology. SUNSCREEN FAQS. https://www.aad.org/media/stats-sunscreen. 
  10. Kellmann M. Preventing overtraining in athletes in high‐intensity sports and stress/recovery monitoring. Scandinavian Journal of Medicine & Science in Sports. 2010; 20:95-102.
  11. Mohlenkamp S, Lehmann N , Breuckmann F, Brocker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jockel K, & Erbel R. Running: The risk of coronary events. Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. European Heart Journal, 2008. 29(15): p. 1903-1910.

The Unknown Health Risks of Air Pollution

Lung Cancer
Hannah Kalvin and Alex Pew, Cancer Prevention & Treatment Fund

Air pollution is a hot topic in the media. Here is what you need to know about the causes of air pollution and how it can increase the risk of cancer and other serious diseases in adults and children.

Types of Air Pollution and the Impact on Your Health

The Environmental Protection Agency (EPA) has classified six air pollutants that are the most common and the most dangerous. They are:[1]Air pollution

  • Ozone
  • Particulate Matter
  • Carbon Monoxide
  • Nitrogen Oxides
  • Sulfur Dioxides
  • Lead

Each of these can cause breathing problems and can increase asthma symptoms. Children, the elderly, and people with asthma are the most likely to be harmed by air pollutants.

Ozone is commonly known as the layer of gas that protects the Earth from UV rays. However, only ozone in the atmosphere has this protective effect. Ozone located on the ground level is a health hazard. Ground level ozone is the result of industrial plants, electric utilities, motor vehicle exhaust, gasoline vapors, and chemical solvents. Each of these causes the release of invisible molecules that react with each other and create ozone on the ground level when it is warm and sunny outside.[2] Inhaling ozone can cause chest pain, coughing, throat irritation, and congestion. If someone has bronchitis, emphysema, or asthma, ground level ozone makes it even more difficult to breathe. Eventually, repeated exposure to ground level ozone can scar the lungs.[3]

Particulate Matter is made up of very small particles and liquid droplets. They can be acids, organic chemicals, metals, soil, or dust particles. Particulate matter forms when gasses from power plants, industries, and/or automobiles react in the air. This form of air pollution is found near roads, in smoke, in haze, and in forest fires. When these particles are 10 micrometers or less in diameter, they are small enough to go through the nose or throat, resulting in major health problems.[4] When inhaled, particulate matter can cause serious lung damage, since the particles are small enough to go deep into the lungs. Particulate matter can cause premature death in people with heart or lung disease. Particulate matter has also been linked to nonfatal heart attacks, irregular heartbeat, and difficulty breathing. While individuals who already have health problems are more likely to be harmed by particulate matter, healthy people can be injured by these small particles as well.[5]

Carbon Monoxide is a gas that you cannot see or smell. It is released into the air by motor vehicles, so it is more likely in cities where there are many motor vehicles.[6] Carbon Monoxide is harmful when inhaled because it results in blood not being able to carry as much oxygen. Since we need oxygen to live, carbon monoxide pollution can be harmful to anyone, but it is most harmful for people with already low oxygen levels.[7]

Nitrogen Oxides are another type of air pollutant, also from emissions from cars, trucks, buses, power plants, and off-road equipment.[8] Nitrogen oxide can cause inflammation of the airways in healthy people, breathing problems in people who have asthma or other lung problems, and worsen existing heart disease. Anyone who lives within 300 feet of a major highway, railroad, or airport, will be exposed to higher levels of Nitrogen Oxides. Unfortunately, that includes about 16% of housing in the United States.[9]

Sulfur Dioxides are gases created from the burning of fossil fuels at power plants and industrial facilities. They also result from burning fuels containing high levels of sulfur, by locomotives, large ships, non-road equipment, and other industrial processes.[10] They cause breathing problems and increase other asthma symptoms.[11]

Lead is also considered to be a type of air pollutant. Lead used to be released into the air from gasoline, but while laws currently prevent lead from being in gasoline, lead from past pollution is still commonly found in dirt, especially in urban areas.[12] Lead is especially dangerous for children, and can cause behavioral problems, lower IQ, and learning problems. In adults, lead exposure is linked to high blood pressure and heart disease.[13]

Often, smog is mentioned as a sign of air pollution. While it is an obvious sign of air pollution, most smog is invisible to the human eye.

Recent Findings

In 2015, researchers used mathematical models to find out how many deaths were caused by air pollution in 2010. They concluded that particulate matter air pollution caused adults to die earlier from chronic obstructive pulmonary disease (COPD), heart disease, and lung cancer, and for infants to die from acute lower respiratory illnesses (such as pneumonia, bronchitis, or flu). They estimated that 3.3 million deaths in 2010 were a result of particulate matter air pollution. If nothing is done to reduce particulate matter air pollution, the authors anticipated that in 2050 6.6 million people will die earlier as a result of air pollution. The authors found that “residential and commercial energy use” contributed most to the amount of deaths worldwide from particulate matter air pollution in 2010. However, the major contributors to particulate matter air pollution in the United States are emissions from vehicles and power generation.[14] This is the first study to calculate the number of deaths caused by a type of air pollution.

A different study published in late 2015 concluded that airborne coal particles result in more fatal heart attacks than other particles in the air.[15]

In 2017, a Harvard study that looked at 22 million deaths in the U.S. found that people 65 and older are more likely to die on days when air quality is poor. This means that even short-term exposure to air pollution can be dangerous as we get older. The EPA’s Clean Air Act Amendments have decreased the levels of pollutants in the air, which experts estimate has saved at least 30,000 lives in the U.S. Keeping and improving these amendments could save more lives and improve air quality even more.[16,17]

The Bottom Line

Air pollution will continue to harm adults and children unless drastic changes are made. While some air pollution is visible to the human eye, most cannot be seen. You can use a website or an app to monitor air quality, in order to reduce your exposure to all types of air pollution. Below are some websites and apps for monitoring air quality. On days when the air quality index is bad, it is best to avoid the risks and stay indoors. While pollution is risky for everyone, children, elderly, and people with heart or lung problems need to be especially careful.

If you would like to learn more about how you can reduce air pollution, click here.

Air Quality Index Websites

http://www.airnow.gov/

http://aqicn.org/map/world/

Air Quality Index Apps

EPA AIRNow

Global Air Quality Monitoring & Forecast

Air Bubbles: Air Quality in Real Time

Global Air Quality – Real Time Air Pollution Indices

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

References

  1. What Are the Six Common Air Pollutants? (2015, September 18). Retrieved December 4, 2015, from http://www3.epa.gov/airquality/urbanair/
  2. Ground Level Ozone | US Environmental Protection Agency. (2015, October 1). Retrieved December 4, 2015, from http://www3.epa.gov/ozonepollution/
  3. Health Effects- Ozone Pollution. (2015, October 1). Retrieved December 4, 2015, from http://www3.epa.gov/ozonepollution/health.html
  4. Particulate Matter | US Environmental Protection Agency. (2015, September 10). Retrieved December 4, 2015 from http://www3.epa.gov/pm/
  5. Health Effects- Particulate Matter. (2015, September 10). Retrieved December 4, 2015, from http://www3.epa.gov/pm/health.html
  6. Carbon Monoxide | US Environmental Protection Agency. (2015, September 10). Retrieved December 4, 2015 from http://www3.epa.gov/airquality/carbonmonoxide/
  7. Health Effects- Carbon Monoxide. (2015, September 10). Retrieved December 4, 2015, from l http://www3.epa.gov/airquality/carbonmonoxide/health.html
  8. Nitrogen Oxides | US Environmental Protection Agency. (2015, September 10). Retrieved December 4, 2015 from http://www3.epa.gov/airquality/nitrogenoxides/
  9. Health Effects- Nitrogen Oxides. (2015, September 10). Retrieved December 4, 2015, from http://www3.epa.gov/airquality/nitrogenoxides/health.html
  10. Sulfur Dioxide | US Environmental Protection Agency. (2015, September 10). Retrieved December 4, 2015 from http://www3.epa.gov/airquality/sulfurdioxide/
  11. Health Effects- Sulfur Dioxide. (2015, September 10). Retrieved December 4, 2015, from http://www3.epa.gov/airquality/sulfurdioxide/health.html
  12. Lead | US Environmental Protection Agency. (2015, September 10). Retrieved December 4, 2015 from http://www3.epa.gov/airquality/lead/
  13. Health Effects- Lead. (2015, September 10). Retrieved December 4, 2015, from http://www3.epa.gov/airquality/lead/health.html
  14. Lelieveld, J., Evans, J., Fnais, M., Giannadaki, D., & Pozzer, A. (2015). The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature, 367-371. Retrieved December 4, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/26381985
  15. Thurston, G., Burnett, R., & Turner, M. (2015). Ischemic Heart Disease Mortality and Long-Term Exposure to Source-Related Components of U.S. Fine Particle Air Pollution. Environ Health Perspect. doi:DOI:10.1289/ehp.1509777
  16. Di, Q., Dai, L., Wang, Y., et al. (2017). Association of Short-Term Exposure to Air Pollution with Mortality in Older Adults. JAMA. 318(24): 2446-2456. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/2667069?redirect=true. Accessed on January 5, 2018.
  17. Ridley, D., Heald, C., Ridley, K., and Kroll, J. (2017). Causes and Consequences of Decreasing Atmospheric Organic Aerosol in the United States. PNAS. doi.org/10.1073/pnas.1700387115. Retrieved from http://www.pnas.org/content/early/2017/12/18/1700387115. Accessed on January 5, 2018.