Category Archives: Prevention

Do Lesbians Need Cervical Cancer Screening? What You Need to Know

Cervical Cancer & HPV, Prevention, , ,

Meg Seymour, PhD

Regular cervical cancer screening is an important way to prevent cervical cancer or detect it while it is still in the early stages and can be treated more easily.[1] Lesbians are less likely to get screened for cervical cancer than heterosexual and bisexual women, because many face barriers to accessing healthcare.[2] For example, they are less likely than heterosexual women to have a primary healthcare provider and are more likely to have negative experiences with healthcare providers, such as feeling discriminated against.[3,4] 

Another important reason why lesbians are not screened as often as other women is because many believe that they are less likely to get cervical cancer.[5] Some lesbians are erroneously told by their healthcare providers that they do not need cervical cancer screenings due to not having sex with men.[6] In fact, lesbians also develop cervical cancer and they have similar rates of cervical abnormalities to other women.[3] Cervical cancer screening is recommended for all women with a cervix, with no exceptions.[7] 

Can lesbians get cervical cancer?

Almost all cervical cancer is caused by human papillomavirus, commonly referred to as HPV.[8] HPV is the most common sexually transmitted infection (STI), and some strains of it can cause cancer.[9] HPV usually goes away by itself without causing any harm, but if it does not go away it can cause cancer. For more information about HPV and other STIs, you can read this article. (STIs are sometimes referred to as sexually transmitted diseases [STDs].)

Some lesbians believe the myth that HPV can only be transferred through men’s bodily fluids, so they falsely believe that they cannot get HPV or develop cervical cancer.[10] However, research has found that HPV can be transferred between women who are only having sex with other women[11]: through contact between genitals, oral contact with genitals, digital contact with genitals, and sharing sex toys.[12] The CDC notes that “the most reliable way to avoid transmission of STDs is to abstain from oral, vaginal, and anal sex or to be in a long-term, mutually monogamous relationship with a partner known to be uninfected.”[7] However, for those who are not interested in abstinence or who do not have a monogomous long-term partner, it is important to practice safe sex.[13] 

Additionally, many lesbians have had sex with men earlier in their lives, and they may have been infected with HPV from those male partners. It can take as much as 10-20 years for a woman to develop cervical cancer after she was first exposed to HPV,[14,15] Lesbians are able to contract HPV from either past sexual experiences with men or from current experiences with female sexual partners.  

Additional causes of cervical cancer

There is not conclusive research comparing the rate of cervical cancer among lesbians with the rate among other women. However, lesbians are more likely than heterosexual women to smoke, and smokers are twice as likely to get cervical cancer than non-smokers, because smoking makes it harder for the immune system to fight HPV.[14,16] If you are interested in information on how to quit smoking, you can read this article. 

Lesbians are also more likely than heterosexual women to have an imbalance of good and bad bacteria in the vagina that is called bacterial vaginosis[17], and researchers have found that HPV is more common among women who have bacterial vaginosis.[18] Bacterial vaginosis can sometimes lead to inflammation, causing health complications such as preterm birth or pelvic inflammatory disease. Bacterial vaginosis often does not cause any symptoms, but a common symptom is a “fishy” vaginal odor.[19]   

The bottom line

Lesbians should be sure to get the recommended cervical cancer screenings. Failure to have proper screening may delay a diagnosis of cervical cancer until the cancer has already progressed to a more advanced stage. This can lead to a greater likelihood of dying from the cancer.[20]

For more information on when women are recommended to get screenings, you can read this article. For information about HPV vaccines, you can read this article. 

 

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.     Centers for Disease Control and Prevention. What Should I Know About Screening? Cdc.gov. https://www.cdc.gov/cancer/cervical/basic_info/screening.htm. Updated August 2019. 
  2.     Takemoto ML, Menezes MD, Polido CB, Santos DD, Leonello VM, Magalhães CG, Cirelli JF, Knobel R. Prevalence of sexually transmitted infections and bacterial vaginosis among lesbian women: systematic review and recommendations to improve care. Cadernos de Saude Publica. 2019; 35:e00118118.
  3.     McNair RP. Lesbian health inequalities: a cultural minority issue for health professionals. Medical Journal of Australia. 2003; 178(12):643-5.
  4.     Tracy JK, Schluterman NH, Greenberg DR. Understanding cervical cancer screening among lesbians: a national survey. BMC Public Health. 2013 Dec 1;13(1):442.
  5.     British Broadcasting Corporation. Lesbian women cervical screening myth is ‘dangerous’. Bbc.com.  https://www.bbc.com/news/health-48802285#:~:text=The%20%22dangerous%20myth%22%20that%20gay,vast%20majority%20of%20cervical%20cancers.. 2019. 
  6.     Munson S, Cook C. Lesbian and bisexual women’s sexual healthcare experiences. Journal of Clinical Nursing. 2016; 25(23-24):3497-510.
  7.     Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports. 2015; 64(RR-03):1.
  8.     Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus (HPV). Cdc.gov. https://www.cdc.gov/cancer/hpv/basic_info/cancers.htm#:~:text=Almost%20all%20cervical%20cancer%20is,cancer%20is%20caused%20by%20HPV. Updated November 2019. 
  9.     Centers for Disease Control and Prevention. Genital HPV Infection – Fact Sheet. Cdc. gov. https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Updated August 2019. 
  10. Curmi C, Peters K, Salamonson Y. Lesbians’ attitudes and practices of cervical cancer screening: a qualitative study. BMC Women’s Health. 2014; 14(1):2.
  11. Doull M, Wolowic J, Saewyc E, Rosario M, Prescott T, Ybarra ML. Why girls choose not to use barriers to prevent sexually transmitted infection during female-to-female sex. Journal of Adolescent Health. 2018; 62(4):411-6.
  12. Reiter PL, McRee AL. HPV infection among a population-based sample of sexual minority women from USA. Sexually Transmitted Infections. 2017; 93(1):25-31.
  13. McNair R. Risks and prevention of sexually transmissible infections among women who have sex with women. Sexual Health. 2005; 2(4):209-17.
  14. Waterman L, Voss J. HPV, cervical cancer risks, and barriers to care for lesbian women. The Nurse Practitioner. 2015 Jan 16;40(1):46-53.
  15. McGill University Division of Cancer Epidemiology. Facts about HPV. Mcgill.ca. https://www.mcgill.ca/hitchcohort/hpvfacts. 2020. 
  16. American Cancer Society. Risk Factors for Cervical Cancer. Cancer.org. https://www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/risk-factors.html. Updated January 2020. 
  17. Evans AL, Scally AJ, Wellard SJ, Wilson JD. Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting. Sexually Transmitted Infections. 2007; 83(6):470-5.
  18. Liang Y, Chen M, Qin L, Wan B, Wang H. A meta-analysis of the relationship between vaginal microecology, human papillomavirus infection and cervical intraepithelial neoplasia. Infectious Agents and Cancer. 2019; 14(1):1-8.
  19. Mayo Clinic. Bacterial vaginosis. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/symptoms-causes/syc-20352279. Updated May 2019.
  20. JK, Lydecker AD, Ireland L. Barriers to cervical cancer screening among lesbians. Journal of Women’s Health. 2010 Feb 1;19(2):229-37.

Is Vaping Safer than Smoking Cigarettes?

Diet, Habits, & Other Behaviors, news-you-can-use, Prevention, , ,

Laura Gottschalk, PhD, John-Anthony Fraga, Jared Hirschfield, Diana Zuckerman, PhD, National Center for Health Research

Electronic cigarettes, or e-cigarettes, are being marketed as the “safe” new alternative to conventional cigarettes. By February 2020, reports of 68 deaths and more than 2,800 vaping-related hospitalizations due to lung illnesses have made it clear that vaping can be even more dangerous than smoking.1,2

The CDC has reported that Vitamin E acetate is a potential cause for the outbreak, but it might not be the only one.2 Many of the patients report vaping marijuana products or marijuana and nicotine products, but others only vaped nicotine products. Until these reports of hospitalized teens and adults are scrutinized in greater depth, we won’t know what types of vaping are most dangerous and under what circumstances.

E-cigarettes come in a variety of forms and include vape mods, Juuls, and vape pens. There are brand name products (Juul is the most widely used) and “home-made” versions.  Some contain high levels of nicotine, while others contain marijuana or just contain flavoring.  The focus of this article is on e-cigarettes because most of the research that exists has been done on them, but much of the information below is relevant to these other products as well.

The big questions are: Are they safe?  Will they reverse the decline in smoking—giving new life to an old habit—or can they help people quit smoking?  Here is what you need to know.

What are E-cigarettes?

E-cigarettes are battery-operated devices that were initially shaped like cigarettes, but now include vape mods, Juuls, and vape pens. Some look like flash drives or highlighter pens, making it easy for teens to hide them in plain sight.  The brand-name products contain nicotine, an addictive drug that is naturally found in tobacco and that stimulates, causes stress during withdrawal, and then feels relaxing as continued exposure follows withdrawal. It is the nicotine in cigarettes that makes smoking so addictive, and the same is true for most vaping and juuling. These electronic products allow nicotine to be inhaled, and they work by heating a liquid cartridge containing nicotine, flavors, and other chemicals into a vapor. Because e-cigarettes heat a liquid instead of tobacco, what is released is considered smokeless.3

Is Vaping Safer than Smoking Traditional Cigarettes?

The key difference between traditional cigarettes and e-cigarettes and related products is that the latter don’t contain tobacco. But, it isn’t just the tobacco in cigarettes that causes cancer and other serious diseases. Traditional cigarettes contain a laundry list of chemicals that are proven harmful, and e-cigarettes have some of these same chemicals.

While smoking can cause lung cancer, breast cancer, emphysema, heart disease, and other serious diseases, those diseases usually develop after decades of smoking. In contrast, in 2019 it became clear that vaping could cause seizures and serious lung damage after just a year, possibly less, based on CDC reports of patients hospitalized for lung damage caused by vaping.2,3 While there have been warnings about the possible risk of e-cigarettes for a decade, it was not expected that they could cause such severe damage in such a short period of time.

The COVID-19 pandemic has raised even more concerns about the safety of vaping. Youths aged 13-24 years old who have used e-cigarettes are more likely to be diagnosed with COVID-19, be tested for the virus, and to experience Covid-19 symptoms.4

Since 2009, FDA has pointed out that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could be exposed.” For example, in e-cigarette cartridges marketed as “tobacco-free,” the FDA detected a toxic compound found in antifreeze, tobacco-specific compounds that have been shown to cause cancer in humans, and other toxic tobacco-specific impurities.5 Another study looked at 42 of these liquid cartridges and determined that they contained formaldehyde, a chemical known to cause cancer in humans.6 Formaldehyde was found in several of the cartridges at levels much higher than the maximum EPA recommends for humans. In 2017, a study published in the Public Library of Science Journal showed that significant levels of benzene, a well-known carcinogen, were found in the vapor produced by several popular brands of e-cigarettes.7

The body’s reaction to many of the chemicals in traditional cigarette smoke causes long-lasting inflammation, which in turn leads to chronic diseases like bronchitis, emphysema, and heart disease.8 Since e-cigarettes also contain many of the same toxic chemicals, there is no reason to believe that they will significantly reduce the risks for these diseases.

In fact, a preliminary study presented at the 2018 annual meeting of the American Chemical Society found that vaping could damage DNA.9 The study examined the saliva of 5 adults before and after a 15-minute vaping session. The saliva had an increase in potentially dangerous chemicals, such as formaldehyde and acrolein. Acrolein has been proven to be associated with DNA damage, for example, and DNA damage can eventually cause cancer.10

A study of mice funded by the National Institutes of Health found that e-cigarette smoke could cause mutations in DNA that could increase the risk of cancer. These specific mutations have been shown to potentially contribute to the development of lung and bladder cancer in mice exposed to electronic cigarette smoke. The researchers claim that these chemicals could also induce mutations leading to cancer in humans. It has not been reported how many of those harmed had used juul devices. While many of those harmed had vaped marijuana, many also used nicotine e-cigarettes,11 so the risks of “juuling” need to be carefully and immediately studied.

Because they are smokeless, many incorrectly assume that e-cigarettes are safer for non-smokers and the environment than traditional cigarettes. However, a study published in the International Journal of Hygiene and Environmental Health found that the use of e-cigarettes results in increased concentrations of volatile organic compounds (VOCs) and airborne particles, both of which are potentially harmful when inhaled.12 Although e-cigarette vapor may not result in the obvious smell and visible smoke of traditional cigarettes, it still has a negative impact on air quality, especially when vaping indoors.

There are no long-term studies to back up claims that the vapor from e-cigarettes is less harmful than conventional smoke. Cancer takes years to develop, and e-cigarettes were only very recently introduced to the United States. It is almost impossible to determine if a product increases a person’s risk of cancer or not until the product has been around for at least 15-20 years. Despite positive reviews from e-cigarette users who enjoy being able to smoke them where regular cigarettes are prohibited, very little is known about their safety and long-term health effects.

There is also danger from e-cigarettes exploding in the user’s mouth or face.  Last year, the British Medical Journal used data from several agencies to estimate that there were roughly 2,035 e-cigarette explosions and burn injuries in the U.S. just in a three-year period from 2015 to 2017. One of the authors of the study stated that the number was likely higher as such incidents were not well tracked. The report also said that e-cigarettes, commonly powered by a lithium-ion battery, could overheat to the point of catching fire or exploding, a phenomenon known as “thermal runway.”13

Can Vaping Help to Cut Down or Quit Smoking Regular Cigarettes?

If a company makes a claim that its product can be used to treat a disease or addiction, like nicotine addiction, it must provide studies to the FDA showing that its product is safe and effective for that use. On the basis of those studies, the FDA approves or doesn’t approve the product. So far, there are no large, high-quality studies looking at whether e-cigarettes can be used to cut down or quit smoking long-term. Most of the studies have been either very short term (6 months or less) or the participants were not randomly assigned to different methods to quit smoking, including e-cigarettes. Many of the studies are based on self-reported use of e-cigarettes. For example, a study done in four countries found that e-cigarette users were no more likely to quit than regular smokers even though 85% of them said they were using them to quit.14 Other year-long studies, conducted in the U.S., had similar findings.  A study published in a prestigious medical journal in 2014 found that although smokers may believe they are vaping e-cigarettes to help them quit,  6-12 months after being first interviewed, nearly all of them are still smoking regular cigarettes.15 Similarly, a year-long study published in 2018 compared smokers who used e-cigarettes to traditional cigarette smokers, and concluded that e-cigarette users were more likely to say they were trying to quit but no more likely to successfully kick the smoking habit, with 90% of e-cigarette users still smoking regular cigarettes at the end of the study.  Until there are results from well-conducted studies, the FDA has not approved e-cigarettes for use in quitting smoking.16

Teenagers, Children, and Vaping

According to survey data collected between 2014 and 2017, 9% of middle and high schoolers reported that they were current vaping users. Vaping was most common among Native Hawaiian and Pacific Islanders (18%), as well as American Indian and Alaskan Native teens (13%). About 10% of White and Hispanic teens vaped, and vaping was least common among Black (5%) and Asian teens (4%).17 The percentage of teens who reported vaping doubled between 2017 and 2019.18 In 2019, about 28% of highschoolers and 11% of middle schoolers reported e-cigarette use. Most teens who vaped reported that they used flavored products.19 Two 2020 surveys found that the percentage of students vaping decreased early in the year. A CDC study analyzing data from the National Youth Tobacco Survey, a study of over 14,000 students, found that about 20% of 9th-12th grade students and 5% of 6th-8th grade students reported that they used e-cigarettes in the last 30 days.20 A different survey conducted by researchers from the University of Michigan, funded by the National Institute on Drug Abuse, studied over 8,000 students in only the 10th and 12th grades, and found that 22% reported vaping in the last 30 days.21 Although these numbers are still high, and comparable to the statistics in 2018,17 they are notably lower than 2019. E-cigarette use may have dropped due to growing awareness of the dangers of these products, including media coverage of young men hospitalized with serious lung damage.21,22 The drop may also be due to raising the legal age for the purchase of tobacco products and the ban on flavored products.21,23

It is important to note that these surveys conducted about e-cigarette use in 2020 were collected between January and March of 2020, and the surveys were stopped due to the COVID-19 pandemic.  

An online survey conducted in May 2020 measured how e-cigarette use changed during the pandemic, during a time where many people are staying at home.24 The survey included almost 1,500 participants under 21 (the legal age to purchase tobacco products) who reported e-cigarette use. Over half of the underage e-cigarette users who responded to the survey reported that they had changed their e-cigarette use during the pandemic. About 20% of the sample had quit using e-cigarettes altogether, about 17% reduced their use slightly or by half, and another 9% actually increased their nicotine use. 

The researchers followed up by asking those participants who reduced their e-cigarette use for the reasons why they lowered it. About 14% reported that the primary reason for reducing was because they were at home and their parents would know, 18% said the primary reason was because they can no longer get the tobacco products, 23% said it was because they know e-cigarette use harms the lungs, and another 37% said that their reasons were a combination of those 3 reasons. Of those who increased their use during the pandemic, about 25% reported that it was due to boredom, 15% because they were stressed, 7% because they needed a distraction, and about 50% said that their reasons were a combination of those 3 reasons. 

Future research is needed to measure whether e-cigarette use has changed even more as the pandemic has continued, as well as to measure the overall percent of youth still using e-cigarettes. 

E-cigarette and juul use by young people is worrisome for several reasons:

  1.     The younger people are when they begin smoking, the more likely it is they will develop the habit: nearly 9 out of 10 smokers started before they were 18.25
  2.     Nicotine and other chemicals found in e-cigarettes, juuls, etc. might harm brain development in younger people.26
  3.     Vaping may introduce many more young people to smoking who might otherwise never have tried it, and once they are addicted to nicotine, some may decide to get their “fix” from regular cigarettes. Whether vaping or juuling is a “gateway” to regular cigarettes or not, young people who use them risk becoming addicted to nicotine and exposing their lungs to harmful chemicals.
  4.   While smoking can cause permanent lung damage over the years, vaping can cause inflammation resulting in hospitalization and permanent damage after just a few weeks or months.27,28

The sharp rise in vaping among youth highlights the need to stop manufacturers from targeting teenagers with candy-like flavors and advertising campaigns. Although the FDA banned flavors for reusable vape devices, flavored disposable e-cigarettes are still being sold.20 However, in July 2020, FDA issued warnings to 10 companies selling flavored disposable e-cigarettes, notifying them to remove their products from the market because they do not have the authorizations required to sell them.29 

Even children who are too young to smoke have been harmed by e-cigarettes and related products. The liquid is highly concentrated, so absorbing it through the skin or swallowing it is far more likely to require an emergency room visit than eating or swallowing regular cigarettes. In 2012, less than 50 kids under the age of six were reported to poison control hotlines per month because of e-cigarettes. In 2015, that number had skyrocketed to about 200 children a month, almost half of which were under the age of two!30

Many e-cigarettes look like USB devices, and some are made to look like other products, in order to disguise their use. The Director of Communications at the FDA’s Center for Tobacco Products has written this guide to help parents identify these hidden e-cigarettes. The FDA has also helped create this pamphlet for parents and teens to discuss the risks of vaping, and it provides resources for saying “no” and for quitting.

For more information about juuls, check out our article here.

How are these products regulated?

The FDA was given the power to regulate the manufacturing, labeling, distribution and marketing of all tobacco products in 2009 when President Obama signed into law the Family Smoking Prevention and Tobacco Control Act and in 2010 a court ruled that the FDA could regulate e-cigarettes as tobacco products.31

E-Cigarette Ad

It wasn’t until 2016 that the FDA finalized a rule to regulate e-cigarettes, which would ban the sale of e-cigarettes to anyone under the age of 18 and would require all e-cigarettes that hit shelves after February 15, 2007 to go through a “premarket review,” the process that the FDA uses to determine whether potentially risky products are safe.25 Companies were to be given from 18 months to two years to comply with this rule and prepare their applications. However, in 2017, the Trump administration appointed a new FDA Commissioner, Dr. Scott Gottlieb, who defended the safety of e-cigarettes and delayed implementing the rules until 2022.9 Nevertheless, as the epidemic of e-cigarette use among youth became obvious, in 2018, Commissioner Gottlieb threatened to crack down on the advertising of e-cigarettes to children under 18.32 Critics have questioned whether sales and ads can be effectively restricted. Moreover, Commissioner Gottlieb resigned in 2019, and it is unclear how the agency will respond to the growing evidence that vaping can cause serious harm. However, in 2019, a federal court ruled that the FDA must implement regulations in May 2020 instead of waiting until 2022.

In September, President Trump responded to the health crisis by proposing a ban on flavored e-cigarettes. Two months later, the administration has not taken any action as Trump states that he is worried children will seek out unsafe alternatives if flavors are banned. In the meantime, individual states have always had the power to pass laws restricting the sale and use of e-cigarettes. Current laws pertaining to e-cigarettes are available on the Public Health Law Center website.

The Bottom Line

E-cigarettes, juuls, and other similar products have not been around long enough to determine the harm they cause in the long run. Unfortunately, many people, including teenagers, are under the impression that e-cigarettes are safe or that they are effective in helping people quit smoking regular cigarettes. Studies by the FDA show that e-cigarettes contain some of the same toxic chemicals as regular cigarettes, even though they don’t have tobacco. There is evidence that some of these toxic chemicals can cause DNA damage that can cause cancer. More important, the reports of teens and adults who died or were hospitalized due to vaping are proof that vaping can be extremely dangerous even after just a few weeks, months, or years.

The big three tobacco companies—Lorillard, Reynolds American, and Altria Group—all have their own e-cigarette brands, so it’s not surprising that e-cigarettes are being marketed and advertised much the way regular cigarettes used to be. Here are the 7 Ways E-Cigarette Companies Are Copying Big Tobacco’s Playbook.

Although there are clearly serious dangers from vaping, more research is needed to confirm the impact of vaping on DNA damage, especially in children. Meanwhile, claims that e-cigarettes are an effective strategy to quit smoking are not supported by the evidence thus far. In addition, more toxicological studies and epidemiological studies are needed to understand the hundreds of reports of permanent lung damage and deaths from vaping.  It is essential to find out whether some types of vaping are more dangerous than others in the short-term and the long-term.  To understand the risks for everyone who vapes, research is needed to compare the risks of specific brands of e-cigarettes with tobacco products, as well as to neither smoking nor vaping.

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. Robert Langreth. More Evidence Links Vaping Lung Injuries to Vitamin E Acetate. December 20, 2019.
    https://www.bloomberg.com/news/articles/2019-12-20/more-evidence-links-vaping-lung-injuries-to-vitamin-e-acetate 
  2. Centers for Disease Control and Prevention. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Updated 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
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  22. Grady D. A Young Man Nearly Lost His Life to Vaping. The New York Times. October 15, 2019. https://www.nytimes.com/2019/10/15/health/vaping-thc-illness.html  
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  25. Centers for Disease Control and Prevention. Fact sheets: Youth and tobacco use. Updated 2019. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/
  26. Centers for Disease Control and Prevention. Preventing tobacco use among youth and young adults. 2012. http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm
  27. Scutti S. Teen develops ‘wet lung’ after vaping for just 3 weeks. CNN. May 18, 2018. https://www.cnn.com/2018/05/17/health/case-study-teen-vaping-wet-lung/index.html
  28. Song MA, Reisinger SA, Freudenheim JL, Brasky TM, Mathé EA, McElroy JP, Nickerson QA, Weng DY, Wewers MD, Shields PG. Effects of electronic cigarette constituents on the human lung: A pilot clinical trial. Cancer Prevention Research. 2020 Feb 1;13(2):145-52.
  29. U.S. Food and Drug Administration. FDA Notifies Companies, Including Puff Bar, to Remove Flavored Disposable E-Cigarettes and Youth-Appealing E-Liquids from Market for Not Having Required Authorization. Updated July 2020. https://www.fda.gov/news-events/press-announcements/fda-notifies-companies-including-puff-bar-remove-flavored-disposable-e-cigarettes-and-youth 
  30. Kamboj A, Spiller HA, Casavant MJ, et al. Pediatric exposure to e-cigarettes, nicotine, and tobacco products in the United States. Pediatrics. 2016;137(6). pii: e20160041. https://pediatrics.aappublications.org/content/137/6/e20160041.long
  31. Food and Drug Administration. Regulation of E-Cigarettes and Other Tobacco Products. FDA News & Events. April 25, 2011.
  32. Saltzman J, Freyer F. The FDA issues a warning: Teen vaping is ‘an epidemic.’ Boston Globe. September 13 2018. https://www.bostonglobe.com/metro/2018/09/12/fda-cracks-down-vaping-orders-makers-address-sales-minors/JaiqQYzZAl4CINLufnkKlL/story.html

Can Belly Fat Cause Cancer?

Diet, Habits, & Other Behaviors, Prevention, , , , , ,

Ammu Dinesh and Claire Viscione, National Center for Health Research

Belly fat is common among men and women. However, when a person’s body shape looks more like an apple than a pear, that could increase their likelihood of developing cancer. 

More than two-thirds of adult Americans are overweight or obese.1 Most people know that obesity increases the risk of diabetes, heart disease, and high blood pressure. But did you know that being overweight increases your chances of developing cancer, and that having an “apple” body shape due to belly fat can increase your chances of developing cancer even if you are not overweight?

Why is belly fat dangerous?

Whether your body fat is located at your waist (giving you an apple shape) or hips (giving you a pear shape) makes a difference to your health. Women tend to gain more belly fat as they get older. Regardless of their weight, white, black, and Latina women with a waistline measurement of 35 inches or more have higher health risks. This is also true for Asian women with a waistline of 31 inches or more. Although it is important to get rid of excess fat in general, belly fat is the most threatening to your health.

Physicians use often use body mass index (BMI) to estimate whether you are overweight or obese. However, determining your waist circumference is just as important. Even if you are not overweight or obese, if you have a lot of belly fat, you are more likely to develop cancer.

Unlike the fat that sits just beneath the skin, the fat that sits around internal organs is called visceral fat.2 This fat is the most dangerous, and it is typically what shows up as belly fat. If you measure your waistline, you can get a good idea of whether you have a dangerous amount of belly fat. 

Women Men
Low health risk 31.5 inches or less 37 inches or less
Intermediate health risk 31.6 – 34.9 inches 37.1 – 39.9 inches
High health risk 35 inches or more 40 inches or more

Table 1. What does your waistline measurement mean? 2

Several studies have looked at the relationship between belly fat and cancer. One study followed over 150,000 post-menopausal women ages 50-79 for about 20 years.3 This study found that women who have extra belly fat are at higher risk of death regardless of their weight. Causes of death in the study included cardiovascular disease and cancer. The women of normal weight who had extra belly fat tended to be older, nonwhite, and with less education and income. They were also less likely to use menopausal hormones and to exercise. 

To figure out your BMI for the chart below, enter your height and weight into this calculator.

Apple Shape (Extra Belly Fat) Not “Apple Shape”
Not Overweight (BMI below 25) 20% more likely to die from cancer within 20 years —
Overweight (BMI of 25-29.9) 19% more likely to die from cancer within 20 years 4% less likely to die from cancer within 20 years
Obese (BMI of 30 or higher) 26% more likely to die from cancer within 20 years 4% less likely to die from cancer within 20 years

Table 2. Likelihood of death due to cancer in women based on BMI.3

Women who were not overweight or obese but had extra belly fat were just as likely to die from cancer as overweight women with extra belly fat.

A different study followed over 3,000 men and women for 7 years.4 They used CT scans and physical exams to look at the fat throughout the body. Over the course of the study, the men and women developed 141 cases of cancer, 90 heart-related incidents, and 71 deaths from various causes. The study found that people with more belly fat, specifically visceral fat, were about 44% more likely to develop cancer and heart disease, even when adjusting for waist circumference. 

What can you do?

As you can see, belly fat can be very dangerous, especially for women, even if they are not overweight. Losing weight or preventing weight gain can lower health risks. By exercising regularly, you can get rid of unhealthy belly fat. It is also important to change your diet to eat foods that are high in nutrients and essential vitamins. You can do this by eating more fresh vegetables, nuts, and whole-grain breads instead of processed meat, red meat, candy, pasta, and white bread. These few changes can help you lose belly fat and improve the quality and length of your life.

Local bans on unhealthy food and drinks may also be effective in reducing belly fat. A 2019 study shows that a ban on the sale of sugar-sweetened beverages at a large college campus substantially decreased consumption and led to significantly less belly fat.5 Students who stopped drinking the beverages had improved insulin resistance and lower cholesterol. The combination of the ban and a brief motivational talk was even more effective than the ban by itself.

Learn more about how extra body fat can increase your risk for developing cancer, and how you can make a commitment to your health and reduce risky belly fat:

 

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

 

References:

  1. Center for Disease Control and Prevention. FastStats- Overweight Prevalence. CDC.gov. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Updated June 13, 2016.
  2. Harvard Health Publishing. Abdominal obesity and your health. Health.Harvard.edu. https://www.health.harvard.edu/staying-healthy/abdominal-obesity-and-your-health. September 2005. Updated January 20, 2017.
  3. Sun Y, Liu B, Snetselaar LG, Wallace RB, Caan BJ, Rohan TE, et al. Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women. JAMA Network Open. 2019;2(7):e197337. https://www.ncbi.nlm.nih.gov/pubmed/31339542.
  4. Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body Fat Distribution, Incident Cardiovascular Disease, Cancer, and All-Cause Mortality. Journal of the American College of Cardiology. 2013; 62(10): 921-925. http://www.onlinejacc.org/content/62/10/921.
  5. Epel ES, Hartman A, Jacobs LM, Leung C, Cohn MA, Jensen L, et al. Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health. JAMA Network Open. 2019. doi:https://doi.org/10.1001/jamainternmed.2019.4434

The Dangers of Juuling

Diet, Habits, & Other Behaviors, news-you-can-use, Prevention

John-Anthony Fraga, National Center for Health Research

What is Juuling? Is it safer than smoking?

A new type of e-cigarette called “juul” has become so popular that it is now about 68% of the $2 billion e-cigarette market. The “juul” is especially popular among children and young adults due to its sleek and discreet design, its ability to be recharged on a laptop or wall charger within one hour, and its liquid-filled cartridges that come in popular flavors like cool mint, creme brulee, and fruit medley.

As of February of 2018, 68 deaths and more than 2,800 cases of serious lung illness related to e-cigarettes have been reported to the CDC. [9] It was not initially known whether those harmed had used juul devices. However, various 2019 reports state that all types of e-cigarettes were used by the teens and adults who were harmed by vaping, so the risks of “juuling” need to be carefully and immediately studied. [10]

Juuling has become very common at teenage hangouts and even at school. Medical professionals are very concerned because juul delivers higher concentrations of nicotine than other e-cigarettes. Not only is nicotine highly addictive, but it is also toxic to fetuses and is known to impair brain and lung development if used during adolescence.[1] It is not replacing cigarette smoking but rather encouraging it: A 2017 study found that non-smoking adults were four times more likely to start smoking traditional cigarettes after only 18 months of vaping, which includes “juuling.”[7] For more information about e-cigarettes in general, check out our article here.

How does the Juul Work?

According to Juul Labs, the company that owns and sells the juul e-cigarette, the device uses an internal, regulated heating mechanism that creates an easily inhaled aerosol. This mechanism prevents the batteries in the juul from overheating and exploding, which has been a problem for other brands of e-cigarettes. Juul is easy to use because there are no settings to adjust or control. All that is required is a non-refillable juul pod cartridge that clicks into the top of the juul and contains a nicotine e-liquid formula. This e-liquid is heated and converted into vapors that are inhaled by the user. One of the reasons it is so popular among youth is that it is so easy to use – no prior experience or knowledge required. All they have to do to intake nicotine is to put a juul to their mouth and inhale.

What makes Juuls different from other e-cigarettes?

The increased harm of juuls compared to other e-cigarettes is due to the concentration and contents of its juul pods. The e-liquid is 5% nicotine by volume, which is more than twice the concentration of nicotine in similar devices like the Blu e-cig cartridge (2.4% nicotine). This increases the risk of addiction; in fact, a study done by the UK’s Royal College of Psychiatrists showed that nicotine is about as addictive as cocaine and even more addictive than alcohol and barbiturates (anti-anxiety drugs).[2]

The impact on the developing brain is also of great concern. Brain imaging studies of adolescents who began smoking at a young age had markedly reduced activity in the prefrontal cortex of the brain, an area critical for a person’s cognitive behavior and decision making, leading to increased sensitivity to other drugs and greater impulsivity.[3] The amount of nicotine in one juul pod is equivalent to a pack of cigarettes. Since teens often use multiple pods in one sitting, they can unknowingly become exposed to unsafe levels of nicotine that can have immediate and long-term health consequences. In 2016, the Food and Drug Administration (FDA) was given the authority to regulate e-cigarettes such as juul but has allowed e-cigarette manufacturers to postpone their applications for FDA approval until August 2022. Meanwhile, these harmful devices can remain on the market and continue influencing adolescents to become addicted to nicotine.[8]

Another reason why the juul is a unique threat to teens is its patented formula of nicotine. While other brands use a chemically modified form called “freebase nicotine,” juuls use “nicotine salts” that more closely resemble the natural structure of nicotine found in tobacco leaves. This makes the nicotine more readily absorbed into the bloodstream and makes the vapor less harsh so that it is easier to inhale more nicotine for longer periods of time.

In addition to this patented formula, juul pods contain a greater amount of benzoic acid, 44.8 mg/mL, compared to other e-cigarette brands, which are in the range of 0.2 to 2 mg/mL. According to the Center for Disease Control and Prevention (CDC), benzoic acid is known to cause coughs, sore throat, abdominal pain, nausea, and vomiting if exposure is constant, which is the case when using a juul.[4] This is due to how juuls utilize the properties of benzoic acid to increase the potency of the nicotine salts in its e-liquid.

What makes Juuls popular among children and teens?

Since juuls are small, discreet, and closely resemble a USB drive, they can be easily hidden and used in a wide variety of settings, such as the classroom. Teachers and school administrators across the nation are finding students juuling when their backs are turned: Students can take a hit, blow the small, odorless puff of smoke into their jacket or backpack, and continue their school work in a matter of seconds. Compared to other forms of teenage rebellion, juuling is especially dangerous as middle and high school students are unknowingly becoming addicted to nicotine at an alarming rate.

Because a person must be at least 21 to purchase a juul or juul pod, a juul black market is the source for many teens, through eBay or Craigslist. In response, the FDA contacted eBay to raise concerns about listings of juul products on its website, resulting in the removal of the listings and the creation of measures to prevent new listings from being posted.[5]

In April 2018, FDA Commissioner Scott Gottlieb announced that he was creating a Youth Tobacco Prevention Plan aimed at stopping the dramatic rise in the use of e-cigarette and tobacco products among youth. The FDA specifically asked Juul Labs for documents related to product marketing and research on the health, toxicological, behavioral, or physiological effects of their products in order to understand why youth are so attracted to them.[6] Additionally, Juul Labs is currently facing lawsuits in several states claiming that its products were deceptively marketed to youth under the legal smoking age. The FDA now plans to create enforcement policies for e-cigarette manufacturers, including juul, that are marketing their products to children and teenagers.

The Bottom Line:

The popularity of juuls among adolescents exposes them to large amounts of nicotine that can have adverse health risks for their physical and emotional development. While juuls are called e-cigarettes, they look nothing like them, making it easy for children and teens to secretly use them without a parent, guardian, or teacher noticing. This may be just a temporary trend, but if the FDA does not quickly do more to restrict flavors that appeal to adolescents and to educate the public about the risks, it is likely to create an enormous increase in young people addicted to nicotine.

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

References:

  1. England, L., Bunnell, R., F. Pechacek, T., Tong, V., & A. McAfee, T. (2015). Nicotine and the Developing Human (Vol. 49).
  2. Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet, 369(9566), 1047-1053. doi:https://doi.org/10.1016/S0140-6736(07)60464-4
  3. Musso, F., Bettermann, F., Vucurevic, G., Stoeter, P., Konrad, A., & Winterer, G. (2007). Smoking impacts on prefrontal attentional network function in young adult brains. Psychopharmacology, 191(1), 159-169. doi:10.1007/s00213-006-0499-8
  4. Centers for Disease Control and Prevention. Safety Material Data Sheet: Benzoic Acid. Accessed July 30, 2018. Available at: https://www.cdc.gov/niosh/ipcsneng/neng0103.html
  5. “Statement from FDA Commissioner Scott Gottlieb, M.D., on new enforcement actions and a Youth Tobacco Prevention Plan to stop the youth use of, and access to, JUUL and other e-cigarettes. ” FDA News & Event. FDA, April 24, 2018. Accessed: July 30, 2018. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm605432.htm
  6. “Official Request of Information for JUUL Labs.” FDA Rules and Regulations, FDA. April 24, 2018. Accessed: July 30, 2018. https://www.fda.gov/downloads/TobaccoProducts/Labeling/RulesRegulationsGuidance/UCM605490.pdf
  7. Primack, B. A., Shensa, A., Sidani, J. E., Hoffman, B. L., Soneji, S., Sargent, J. D., . . . Fine, M. J. (2018). Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults. The American Journal of Medicine, 131(4), 443.e441-443.e449. doi:10.1016/j.amjmed.2017.11.005
  8. “FDA’s Comprehensive Plan for Tobacco and Nicotine Regulation” FDA Newsroom, FDA. August 6, 2018. Accessed: August 8, 2018. https://www.fda.gov/TobaccoProducts/NewsEvents/ucm568425.htm
  9. Centers for Disease Control and Prevention. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Updated 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
  10. Johnson CK.  What we know so far about the US vaping illness outbreak.  AP: The Washington Post.  September 10, 2019.  washingtonpost.com/national/health-science/what-we-know-so-far-about-the-us-vaping-illness-outbreak/2019/09/10/146e4fbe-d40a-11e9-8924-1db7dac797fb_story.html

Buy a Sleep Mask! It’s an Investment in Your Health

Breast Cancer, Colon Cancer, Environmental Exposures, Prevention
Jessica Becker, Cancer Prevention and Treatment Fund

A study published in 2023 found that wearing an eye mask to block light while sleeping overnight in the home improves memory and alertness the next day.  That should help with driving, learning, and other important activities5.

The new research did not evaluate why the eye mask was so beneficial, but previous research shows that sleeping in total darkness allows your body to produce as much of the hormone melatonin as possible. This is good because when your production of melatonin drops, you are at greater risk of breast and/or colorectal cancer and other health risks.

What is Melatonin?

Melatonin is a hormone that is naturally produced in your body. It is secreted by the pineal gland, which is buried deep in the brain. Melatonin is only produced at night and only when it is dark, which means that melatonin production peaks between 3:00 a.m. and 5:00 a.m. for most people. This hormone helps to regulate your circadian rhythm, which is like your body’s natural clock. When melatonin and several other chemicals are released, you feel drowsy and your body temperature lowers. In addition to this sleep-cycle function, melatonin also works as an antioxidant. This means that it can help prevent damage to your DNA that can result from aging, exposure to cancer-causing chemicals, or harmful rays from the sun. Preventing damage to DNA is important because DNA damage can cause cancer.

Doesn’t My Body Produce Enough Melatonin?

There have been major advancements in technology over the last two centuries, one being the light bulb. Because of the light bulb (and electricity, in general), we are able to stay awake and active much later, so the night is not as dark as it used to be. Think of New York City: the city that never sleeps. Cities are so lit up at night that it can be hard to see the stars. This is referred to as “light pollution.”  And, of course, even in the middle of nowhere, you can keep your lights on all night in your house.

Our ability to turn night into day has allowed for more night shift work, often called “the graveyard shift.” Even if you don’t work on the late shift, you may be working at home late at night or staying up late watching TV or using the internet.  Unfortunately, this kind of schedule has many effects on your body, including reducing the amount of melatonin produced. But it is not just night owls or shift workers who suffer from a decreased production of melatonin. Sleep studies show that almost everyone wakes up at some point during the night, even if we do not remember it. Unless you have blackout shades on your windows, there is a good chance that some light is coming into your bedroom and that your eyes are registering this light during those wakeful periods.[2]

New technology is compounding the effects of light pollution. Early incandescent light bulbs that were dim and yellow and did not affect melatonin production very much. Now, artificial light emits more blue wavelengths. For example “Cool White” fluorescent bulbs are a very popular choice of light bulb because they are bright, moderately energy efficient, and relatively inexpensive. They also produce a lot of blue light which is why they have a “cool” effect. Maybe you have noticed while driving that certain people’s headlights appear to be very bright and have a blue tint to them. These new headlights produce blue wavelengths of light. Unfortunately, research shows that blue wavelengths of light are especially effective at reducing melatonin production in humans.[3] All types of computer monitors and television screens also emit blue light.

Why Is Having Less Melatonin A Bad Thing?

Believe it or not, the International Agency for Research on Cancer (IRAC) classified shift work as a probable human carcinogen in 2007. There have been numerous studies showing a link between night shift work and an increased incidence of breast cancer. For instance, a 2003 study done in the Netherlands found that by working half a year at night, a person’s risk of breast cancer increased 150%.[3] This major study found that nurses who worked night shifts at least 3 times a month for 15 years or more had a 35% increased risk of colorectal cancer.[3] If you’re still unconvinced, a 2009 study conducted in 147 communities in Israel found that women who lived in neighborhoods where it was bright enough to read a book outside at midnight had a 73% higher risk of developing breast cancer than women living in areas without outdoor lighting.[2]

What Can I Do To Limit My Chances Of Getting Cancer Because of Light At Night?

The good news is that there are easy and inexpensive ways to limit the amount of light you are exposed to at night. For starters, if you have electronic appliances in your bedroom that produce light (like a clock radio or cable box), pick those that have red lights as opposed to green or blue lights. Walmart, Target, Best Buy, and many other stores all carry alarm clocks and radios that display the time in red numbers. These brands are not more expensive than their blue numbered counter-parts. Studies show that red lights don’t cause as much of a decrease in the amount of melatonin produced by your body.[4] Also, if you have a television or computer in your bedroom, turn it off before you go to sleep.

It is also a good idea to limit the amount of time you spend in front of a screen at night. If you spend a few hours a night in front of your computer, whether or not you’re not in your bedroom, you are decreasing the amount of melatonin that is being produced in your brain. Most screens today offer a “night mode” which reduces the amount of blue light used and creates an orange tint. This is a recommended setting to use before bed.

Also, since melatonin production is highest between the hours of 3:00 am and 5:00 am, make sure you’re in bed and asleep by 3:00 a.m., and if at all possible, sleep until at least 5:00 am. While you probably will not be able to petition your community to get the street light in front of your house turned off, you can buy blackout shades to block the light. Most department stores sell blackout shades, and they are relatively inexpensive. If you don’t want to invest a penny more in “window treatments,” consider using a sleep mask. Airlines sometimes give them away in travel kits, but you can also buy them online or in a department store. Besides lowering the risk of getting certain cancers, sleep masks can also help you fall asleep faster, have a better night’s sleep, and feel much better the next day. Those are great benefits for such a simple, no-risk strategy.

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

  1. Navara J, Nelson R. The Dark Side Of Light At Night: Physiological, Epidemiological, and ecological consequences. Journal of Pineal Research. 2007, (43)
  2. Chepesiuk R. Missing the Dark: Health Effects of Light Pollution. Environmental Health Perspectives. 2009, (117)
  3. Pauley S. Lighting For The Human Circadian Clock: Recent Research Indicated That Lighting Has Become A Public Health Issue. Medical Hypotheses. 2003
  4. Reiter R. Circadian Disruption and Cancer: Making the Connection. The New York Academy of Sciences. 2009
  5. Greco, V., Bergamo, D., Cuoccio, P., Konkoly, K. R., Muñoz Lombardo, K., & Lewis, P. A. (2023). Wearing an eye mask during overnight sleep improves episodic learning and alertness. Sleep, 46(3), zsac305. https://doi.org/10.1093/sleep/zsac305

Are Annual Prostate Cancer Screenings Necessary? Should Early Stage Prostate Cancer Be Treated?

Prevention, Prostate Cancer, Prostate Cancer,
By Krystle Seu, Dana Casciotti, PhD, Brandel France de Bravo, MPH, Mingxin Chen, MHS, and Nicholas Jury, PhD

Although usually not fatal, prostate cancer is second leading cause of cancer deaths for men in the United States, after lung cancer.[1] One in every eight men will be diagnosed with prostate cancer in his lifetime.1 Most cases are in men 65 and older, and most deaths occur in men 75 and older.2 Annual screenings would seem to be an important way to prevent prostate cancer.  But there is a hot debate within the medical community: Do routine prostate cancer screenings lead to unnecessary treatment that does more harm than good?

Should I Get Screened?

Diagnostic tests for prostate cancer are recommended for any man who has symptoms of prostate cancer, such as pain or changes in urination. Men over the age of 50 who have no symptoms sometimes undergo screening tests. In May 2012, the U.S. Preventive Services Task Force recommended against prostate-specific antigen (PSA) screening tests for men of any age.3 However, in May 2018, the Task Force revised their recommendation, stating that men ages 55-69 years old should talk to their doctor about the potential benefits and harms of PSA screening. The USPSTF continues to recommend against PSA screening in men ages 70 and older.4

What about other methods of screening, like digital rectal exams, which are usually done together with PSA testing? The Task Force continues to conclude that they tend to do more harm than good.

The U.S. Preventive Services Task Force is an independent group of medical professionals that reviews all evidence on preventive health care services. In 2008, the Task Force had said screening was not recommended for men over 75, but wasn’t sure about its value for men younger than 75.5 In 2009, the American Urological Association issued new guidelines saying that annual screening was no longer recommended.6

The reason why these experts concluded that screening was rarely necessary is that prostate cancer grows very slowly.  Even without treatment, many men with prostate cancer will live with the disease until they eventually die of some other, unrelated cause.  However, there is concern that without screening, some men are being diagnosed with prostate cancer when it is more advanced and more likely to be fatal.  While annual screening seems unnecessary, this article will help you decide whether occasional screening is a good idea for you.

Types of Prostate Cancer Screening: PSA Blood Tests and Digital Rectal Exams

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

Most screening tests are not 100% accurate, but these prostate tests are especially inaccurate.  Most men with a high PSA level (>4ng/mL) do not have prostate cancer (this is known as a false positive), and some men with prostate cancer have a low PSA level (this is called a false negative). The DRE also results in many false positives and false negatives. Using both screening methods together will miss fewer cancers but also increases the number of false positives, which can lead to more testing (usually biopsies of the prostate) and possibly result in medical complications. A biopsy to determine if there is a cancerous growth in the prostate involves inserting a needle, usually through the rectum, to remove a small sample of prostate tissue.

PSA Velocity

Researchers are also trying to determine if other types of PSA testing might be more accurate in detecting prostate cancer, such as changes in PSA levels when a man has multiple tests over time. The rate of change of PSA level from one test to the next is known as “PSA velocity.”

One study examined if PSA velocity could improve cancer detection compared to standard PSA and DRE screening tests.7 Because men with high PSA levels and positive DRE results typically undergo prostate biopsies to determine the presence of cancer, this study evaluated if PSA velocity helped detect cancer in men with low PSA and negative DRE results. Over 5,500 men were included in the study and men with high PSA velocity-almost 1 in 7 men-were biopsied. The researchers found that doing biopsies on the basis of high PSA velocity in the absence of a high PSA or positive DRE would lead to a large number of biopsies but would not improve cancer detection.

What Recent Research Tells Us About Prostate Cancer Screening

Depending on how often screening is done, it may help reduce the chances of dying of prostate cancer, but the research indicates that the vast majority of men with prostate cancer die of a different cause, even if they are not treated.

Several years ago, two major research studies have tried to shed light on the value of regular screening: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and the European Randomized Trial of Screening for Prostate Cancer (ERSPC).8 The PLCO studied 76,000 men, aged 55-74, for 7-10 years and found that the death rate from prostate cancer was low, and that it did not differ between the men who were screened every year for the first six years of the study and those who received their usual care (which ranged from no screening to occasional screening).9 For most of the patients, “usual care” included at least one screening during the first seven years of the study. There were also no significant differences in overall death rates between the groups. Although the randomized portion of the study was completed in 2006, researchers are still studying the patients to see how long they live.10

The European study (ERSPC) included 182,000 men, ranging from 50 to 74 years old, from seven different European countries.11 In these countries, “regular screening” is usually every 4 years, although it is every 2 years in Sweden. Those men were compared to men of the same age who did not get any prostate cancer screening. After the men were studied for an average of 13 years, the researchers found that the patients who had PSA screening were 27% less likely to die of prostate cancer.8 However, they did not live longer than the other men, because they died of other causes.

A follow-up to the ERSPC study, which tracked the men for an average of 11 years, found an even greater reduction in prostate cancer deaths-29% over the longer follow-up period.12 To prevent 1 death from prostate cancer, the program needed to screen 1,055 men and treat 37 men.  More important, although deaths from prostate cancer were lower in the PSA screened group, there were no differences in overall mortality between the two groups.  In other words, the PSA screening reduced deaths from prostate cancer but did not save lives because those men were more likely to die from other causes.

Recent updates to a 2010 meta-analysis (which means researchers “pooled” data from many different but comparable studies) of six randomized, controlled prostate cancer screening trials (including the PLCO and ERSPC studies) further support the U.S. Preventive Services Task Force recommendations. Analysis of data on almost 330,000 men showed no significant difference in the risk of death from prostate cancer between the men who received PSA screenings and those who did not.13

A United Kingdom study published in 2018 in the prestigious medical journal JAMA involved over 160,000 men between the ages of 50 to 59 years. The study found that a one-time PSA screen increased the chances of diagnosing prostate cancer, but did not change the chances of dying from prostate cancer. Over a 10-year period, about 4.3% of men who had a one-time PSA test were diagnosed with prostate cancer compared to about 3.6% of men who did not have a PSA screen. The one-time PSA screen was able to detect prostate cancers that were lower grade and less likely to be dangerous.

Importantly, there was no evidence that having a PSA screen test saved lives. In men who were diagnosed with prostate cancer, the chances of dying from the prostate cancer within 10-years of diagnosis were about 3 in 10,000 (that’s less than half of a percent), and that was the case whether the men had a PSA screening or not. This means that a PSA test may detect more prostate cancers, but these are likely cancers that would not have been harmful. This study does not show that one-time screening with PSA would be helpful, and it could be harmful. The researchers have planned to look at these issues more closely in a longer term study.14

Benefits and Harms of Screening

The benefit of screening is that the disease is often curable with early detection (90% or better).  Common treatments like surgery or radiation aim to remove or kill all cancerous cells in the prostate.  If the cancer spreads beyond the prostate before it is treated, it is often fatal.  However, the cancer usually grows so slowly that it is often equally safe to wait until there are symptoms before attempting to diagnose prostate cancer. Symptoms of prostate cancer might include urinary problems, difficulty having an erection, or blood in the urine or semen.

The harms of screening include 1) inaccurate results leading to unnecessary biopsies and complications, and 2) complications from unnecessary treatment. Even if a man has prostate cancer, if he does not have symptoms he may not need to be treated. Experts estimate that between 18% and 85% of prostate cancers detected by these screening tests would never become advanced enough to harm the patient.  This wide range of uncertainty, however (is it less than 1 out of 5 or more than 4 out of 5?) just adds to the confusion.

Unnecessary treatment costs a lot of money, but the main concern is the complications, which include serious and long-lasting problems, such as urinary incontinence and erectile dysfunction.15

Long before the Task Force made its recommendation, many doctors and patients questioned whether annual prostate cancer screenings were a good idea, since the disease is rarely fatal. Many also question whether treating early prostate cancer, the kind of prostate cancer screening tests mostly find, is a good idea. Treating early prostate cancer does not appear to help men live longer, and for many it drastically reduces their quality of life.

Doctors and scientists are searching for better tests for prostate cancer detection. Many experts believe that a family history of prostate cancer or other cancers should influence how often a man chooses to get PSA screening.  However, the studies described below, which led to the Task Force’s recommendation against PSA screening, suggest that annual screenings for all men are not a good idea.

Is Surgery Effective for Men with Early-Stage Prostate Cancer?

When they hear the word “cancer,” many men want it treated immediately no matter how slow it is growing or how unlikely it is to be fatal. The question is: if found in its early stages, should prostate cancer be treated?  The answer to that question has changed in the last decade, with approximately 60% of U.S. men with low-risk prostate cancer choosing “active surveillance” in 2018, compared to less than 20% eight years earlier.16 Active surveillance, also called “watchful waiting” includes careful monitoring of the cancer by the physician, rather than surgery, radiation, or other treatment. The percentage of men choosing monitoring instead of treatment is even higher in Sweden and Australia.

The evidence supporting active surveillance is more than a decade old. In July 2012, a study by researchers at the Department of Veterans Affairs was published in the New England Journal of Medicine, examining the effectiveness of surgery in men with early-stage prostate cancer.17 Known as the Prostate Cancer Intervention versus Observation Trial, or PIVOT, the study compared surgical removal of the prostate with no prostate cancer treatment. The 731 men who participated in the study, with an average age of 67, were randomly assigned to one of the two groups and followed for 8 to 15 years. All the men were enrolled between 1994 and 2002, with a final check-up taking place in 2010. Men in both groups went to the doctor every six months during the study, and men in the observation-only group were offered palliative therapy (which focuses on reducing suffering) or chemotherapy to relieve symptoms due to the cancer spreading to other parts of the body. Neither therapy can eliminate the cancer and, therefore, are not treatments.

The findings suggest that prostate cancer surgery does not save the lives of men with early-stage prostate cancer. Only 7% of the participants died of prostate cancer or from treatment during the study: 21 or 5.8% of those had their prostate removed and 31 (8.4%) who did not undergo surgery. The difference between the surgery and observation groups was not statistically significant, which means that the smaller number who died in the surgery group could have been due to chance. The prostate cancer spread to the bone in 4.7% of the surgery patients and to 10.6% of the observation or no-treatment group. Even when cause of death wasn’t limited to prostate cancer, the two groups died at about the same rate: 47% of the men who had surgery died during the study period as compared with 50% in the observation group.

The only men who benefited from the surgery were those with a PSA of 10 ng per milliliter or higher and men with riskier tumors: their overall risk of dying during the study period — not necessarily from prostate cancer — was lower than in the observation group. Surgery reduced the risk of dying from any cause by 13.2% among men with a PSA of 10 ng per milliliter or higher. For men with intermediate risk tumors (determined by a PSA value of 10.1 to 20.0 ng per milliliter, a score of 7 on the Gleason scale, or a stage T2b tumor), surgery reduced their risk of dying by 12.6%, but for men with high risk tumors, the reduction in risk by 6.7% was not statistically significant. That means it could have happened by chance.

In September 2016, the prestigious New England Journal of Medicine published a 10-year study by researchers from University of Oxford, which provided solid evidence that neither surgery nor radiation treatments save lives.18 The study compared the death rates of three patient groups: surgery, radiation, and active monitoring, which is sometimes called active surveillance. Between 1999 and 2009, the study randomly assigned 1643 men with diagnosed prostate cancer to the three groups to receive radical surgery (553 men), radical radiotherapy (545), or active monitoring (545). Unlike the PIVOT study, patients in the “active monitoring group” underwent tests to determine if their prostate cancer had progressed; these were conducted every 3 months for the first year, and every 6 to 12 months after that. The patients had an average (median) of 10 years of follow-up.

At the final check-up, 169 men had died, and there was no significant difference among the three groups of prostate cancer patients. Only 17 of these were deaths from prostate cancer: 5 in the surgery group, 4 in the radiotherapy group, and 8 in the active-monitoring group. However, prostate cancer was more likely to progress or spread in the group of men who were monitored rather than treated.

This 2016 study was the first to compare the effectiveness of surgery, radiotherapy and active monitoring. The findings suggest that treatment does not improve the chances of a man living longer, since most of the men will be dying of other causes rather than prostate cancer. Since prostate cancer treatment can cause serious side effects such as erectile dysfunction and incontinence, active monitoring is now recognized as a reasonable option. In fact, due to studies like this, active monitoring (also called active surveillance) is considered the preferred option for most men with low-risk prostate cancer.19 The number of men in the United States who receive active monitoring instead of active treatment has been increasing in recent years. In 2010, only 13% of men with prostate cancer received active monitoring, compared to 33% of men in 2015.

One small study found that high intensity exercise may be beneficial for men undergoing active monitoring. The study found that men who ran on a treadmill for 40 minutes, 3 times a week for 12 weeks had lower PSA levels after the 12 weeks than before they started the exercise regimen, but that was not true for men who did not do the exercise regimen. The researchers note that exercise increases cardiorespiratory fitness, which could inhibit the progression of prostate cancer for men on active monitoring.20

Unfortunately, a 2020 study of over 80,000 men with low risk, localized prostate cancer found that active monitoring is not equally common across all regions of the United States and across all men.19 Men with Medicaid, as well as men living in counties where fewer residents have a college education, were less likely to receive active monitoring. Although rates of active monitoring were the same for Black and White men, the study found that Hispanic men were less likely to receive it. The researchers could not identify why this ethnic difference exists, but they suggested that it may be due to factors such as differences in how often the option is offered by doctors and patients’ preferences. The study also found that single men were more likely to use active monitoring than married men.

Since prostate cancer treatment can cause serious side effects such as erectile dysfunction and incontinence, active monitoring seems to be a reasonable option for many men, especially those with lower risk prostate cancers.

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. American Cancer Society. Key Statistics for Prostate Cancer. Cancer.org. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Updated January 2021. 
  2. National Cancer Institute. Cancer Stat Facts: Prostate Cancer. Seer.cancer.gov. https://seer.cancer.gov/statfacts/html/prost.html. 
  3. Moyer VA. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2012;157(2):120-34.
  4. Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, Davidson KW, Doubeni CA, Ebell M, Epling JW, Kemper AR, Krist AH. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018 May 8;319(18):1901-13.
  5. Calonge N, Petitti DB, Dewitt TG, Dietrich AJ, Gregory KD, Harris R, Isham GJ, Lefevre ML, Leipzig R, Loveland-Cherry C, Marion LN. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 2008; 149(3):185-91.
  6. Greene KL, Albertsen PC, Babaian RJ, Carter HB, Gann PH, Han M, Kuban DA, Sartor AO, Stanford JL, Zietman A, Carroll P. Prostate specific antigen best practice statement: 2009 update. The Journal of Urology. 2009; 182(5):2232-41.
  7. Vickers AJ, Till C, Tangen CM, Lilja H, Thompson IM. An empirical evaluation of guidelines on prostate-specific antigen velocity in prostate cancer detection. Journal of the National Cancer Institute. 2011; 103(6):462-9.
  8. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, Kwiatkowski M, Lujan M, Määttänen L, Lilja H, Denis LJ. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. The Lancet. 2014; 384(9959):2027-35.
  9. Andriole GL, Crawford ED, Grubb III RL, Buys SS, Chia D, Church TR, Fouad MN, Gelmann EP, Kvale PA, Reding DJ, Weissfeld JL. Mortality results from a randomized prostate-cancer screening trial. New England Journal of Medicine. 2009; 360(13):1310-9.
  10. National Cancer Institute. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Prevention.cancer.gov. https://prevention.cancer.gov/major-programs/prostate-lung-colorectal-and-ovarian-cancer-screening-trial.
  11. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M, Denis LJ. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine. 2009; 360(13):1320-8.
  12. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M, Denis LJ. Prostate-cancer mortality at 11 years of follow-up. New England Journal of Medicine. 2012; 366(11):981-90.
  13. Djulbegovic M, Neuberger MM, Dahm P. Prostate-cancer mortality after PSA screening. The New England Journal of Medicine. 2012; 366(23):2228-9.
  14. Barry MJ. Screening for prostate cancer: is the third trial the charm?. JAMA. 2018; 319(9):868-9.
  15. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A. Quality of life and satisfaction with outcome among prostate-cancer survivors. New England Journal of Medicine. 2008; 358(12):1250-61.
  16. Al Hussein Al Awamlh B, Barocas DA, Zhu A, et al. Use of Active Surveillance vs Definitive Treatment Among Men With Low- and Favorable Intermediate–Risk Prostate Cancer in the US Between 2010 and 2018. JAMA Intern Med. 2023; doi:10.1001/jamainternmed.2022.7100
  17. Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I. Radical prostatectomy versus observation for localized prostate cancer. New England Journal of Medicine. 2012; 367:203-13.
  18. Hamdy FC, Donovan JL, Lane J, Mason M, Metcalfe C, Holding P, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. New England Journal of Medicine. 2016; 375:1415-24.
  19. Washington SL, Jeong CW, Lonergan PE, Herlemann A, Gomez SL, Carroll PR, Cooperberg MR. Regional Variation in Active Surveillance for Low-Risk Prostate Cancer in the US. JAMA Network Open. 2020; 3(12):e2031349-.
  20. Kang DW, Fairey AS, Boulé NG, Field CJ, Wharton SA, Courneya KS. Effects of exercise on cardiorespiratory fitness and biochemical progression in men with localized prostate cancer under active surveillance: the erase randomized clinical trial. JAMA Oncology. 2021 Oct 1;7(10):1487-95.

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.

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

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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.

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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