Category Archives: Prevention

BRCA1 and BRCA2 mutations: when your genes increase your cancer risk

Breast Cancer, Breast Cancer, Ovarian Cancer, Prevention
Laurén A. Doamekpor, MPH

When Angelina Jolie announced that she had removed both of her healthy breasts to reduce her risk of breast cancer, she explained that she had inherited the BRCA1 gene mutation, which increases her chances of someday developing breast cancer. This is why she decided to have a preventive (or prophylactic) double mastectomy. Angelina’s public decision drew attention to women with BRCA1 and BRCA2 mutations and the choices they make. Click here to read our response to Angelina’s double mastectomy, published in the Huffington Post.

BRCA1 and BRCA2 gene mutations also increase a woman’s chances of having ovarian cancer. Ms. Jolie has not yet had her ovaries removed.

What are BRCA1 and BRCA2?

BRCA1 and BRCA2 are human genes that produce proteins that suppress tumors and repair damage to our DNA. If there is a mutation in one of these genes and they do not work properly, DNA damage may not be repaired. This can eventually cause cancer.

If you have a BRCA1 or BRCA2 mutation, what are the chances of getting breast or ovarian cancer?

Women who have no family history of breast cancer and don’t carry the BRCA1 or 2 gene mutation, have only a 12% chance of getting breast cancer in their lifetime.1 But women with BRCA1 have about a 55% to 65% chance of developing it by the time they turn 70; the likelihood is a little lower for women with BRCA2 at 45%.2 3

Even though women with BRCA1 or BRCA2 are about 5 times more likely to get breast cancer than the average woman, women with these mutations make up only 5% to 10% of all breast cancer cases. In other words, fewer than 1 in 10 women with breast cancer have either BRCA1 or BRCA2.4

Ovarian cancer is less common than breast cancer. Fewer than 2% of women who have neither BRCA1 or BRCA2, nor a family history of ovarian cancer, will develop ovarian cancer. But, 39% of women with BRCA1 will develop ovarian cancer by age 70, and approximately 11%-17% with BRCA2 will develop ovarian cancer by 70.2 3

Doctors will often suggest testing for the BRCA1 and BRCA2 genes in women with family members diagnosed with breast or ovarian cancer before age 50, family members with cancer in both breasts or multiple breast cancers, and women who come from Ashkenazi Jewish backgrounds.

If you have BRCA1 and BRCA2, what can you do to lower your risk for breast or ovarian cancer?

If you find out that you have the BRCA1 or BRCA2 mutation, it doesn’t mean you will definitely get breast or ovarian cancer.

There are a few ways you can lower your risk of breast cancer:

1) More frequent breast exams to detect cancer as early as possible. Some experts recommend that women with BRCA1 or BRCA2 begin breast cancer screening as early as age 25 4, but that doesn’t mean mammograms should start at such an early age. Young women with BRCA mutations should get screened using magnetic resonance imaging (MRI). MRIs are more accurate than mammograms for young women and do not expose breasts to as much radiation as mammograms do. While early screening can be helpful, if a woman’s genes place her at higher risk, she needs to realize that regular radiation to the breasts at an early age could increase her risk of cancer.

2) Take an estrogen-blocking pill such as tamoxifen. Many breast cancers feed off the estrogen produced naturally by a woman’s body so interrupting the production and flow of estrogen can reduce a woman’s risk of getting breast cancer. Taking tamoxifen after being treated for breast cancer, for instance, usually cuts the risk of breast cancer recurring by about half. However, the effectiveness of raloxifene or tamoxifen in women with BRCA1 and BRCA2 has not been studied specifically yet. 4

3) Preventive mastectomy (removal of the breasts). When a woman with BRCA1 or BRCA2 gets both of her breasts surgically removed, she reduces her chances of getting breast cancer by as much as 95%.5 Why is there still some risk? Because some breast tissue is left behind after surgery, and cancer can develop in that tissue or on the nearby chest wall.6

4) The removal of both ovaries and the fallopian tubes, called salpingo-oophorectomy. The ovaries produce estrogen which make the more common breast cancers more likely to grow, so removing the ovaries and fallopian tubes works much like tamoxifen. Research shows that women with BRCA1 or BRCA2 can reduce their breast cancer risk up to 50% by removing just their ovaries. 5 Removing the ovaries and fallopian tubes is the only known method of reducing the risk of ovarian cancer.

What about having children? While having children reduces the chances of developing the most common types of breast cancer, research published in 2014 found that women with BRCA1 or BRCA2 mutations who decide not to have children are no more likely to develop breast cancer than women with the mutations who do have children. For women with BRCA1 who want to have children, it’s helpful to know waiting until after 30 to have a child and breastfeeding longer—for at least 1-2 years—seems to lower their risk of breast cancer. Delayed childbearing and longer breastfeeding did nothing to lower breast cancer risk among women with BRCA2, however.7

Maintaining a healthy weight and exercising regularly can reduce the chances of breast and ovarian cancer. For women with BRCA1 or BRCA2, some studies show that women who were overweight (BMI>25) at age 18 and lose at least 10 lbs between age 18 and 30 are less likely to develop early-onset breast cancers.8

What women with BRCA 1 and BRCA2 can do to reduce their risk of ovarian cancer

Other than getting a salpingo—oophorectomy (removing the ovaries and fallopian tubes), which can reduce a woman’s risk of ovarian cancer by 90% 9, there is little else a woman with BRCA mutations can do to lower her risk of ovarian cancer. Even after having her ovaries removed, a woman with BRCA mutations will still have a small chance of getting ovarian cancer in the peritoneum (a thin layer of tissue that lines the inside of the abdomen). This can happen if some ovarian tissue is left behind after surgery or if ovarian cancer cells have already spread to that part of the body before surgery.10

The drawback to getting your ovaries and fallopian tubes surgically removed is that you won’t be able to have children naturally and will have to adopt or use some form of assisted reproductive technology like IVF with frozen embryos or frozen eggs. Moreover, studies show that women who have had their ovaries removed are more likely to suffer heart disease, stroke, lung cancer, and depression or anxiety disorders. And the risk of these illnesses is higher the younger the woman is when her ovaries are taken out. Also, if a woman has her ovaries removed before going through menopause, the surgery will cause a sudden drop in estrogen and bring on early menopause.11

There is no widely accepted screening to detect ovarian cancer early. In fact, the U.S Preventative Services Tasks Force recommends against yearly screenings for ovarian cancer in women except those with BRCA1, BRCA2 or a family history of ovarian cancer. Some medical groups recommend transvaginal ultrasound examinations and the CA-125 blood test. But research shows that these screening tools are not very accurate and do not reduce a woman’s chances of dying from ovarian cancer.

Bottom Line

For any woman—whether she is a BRCA carrier or not–maintaining a healthy weight and exercising regularly can reduce the chances of breast and ovarian cancer. You can learn more about ovarian cancer here and more about the risks and benefits of preventive mastectomies to reduce the risk of breast cancer here.

There are other ways women with BRCA1 or BRCA2 mutations can lower their risk of breast and ovarian cancer, such as screening to detect cancer early, surgery to remove breasts, ovaries, and fallopian tubes, estrogen-blocking drugs, and losing weight if they are overweight. While screening regularly for breast cancer with MRIs is safe, surgery and drugs have side effects and risks. Women with the BRCA mutations will want to consult with several different doctors to discuss what is important to them at each phase of their reproductive lives, and weigh the risks and benefits of each prevention strategy.

Endometrial cancer: what you need to know

Other Cancers, Prevention,
By Laurén Doamekpor, M.P.H.

What is endometrial cancer?

Endometrial cancer—also called uterine cancer—is the most common cancer affecting a woman’s reproductive system. It is diagnosed when tumors start growing in the lining of the uterus, which is called the endometrium. Studies show that endometrial cancer is much more likely to occur in women who have already reached menopause, and most endometrial cancer is diagnosed around age 70.12 When physicians and medical experts talk about endometrial cancer, they often refer to it as type I or type II. Type I endometrial cancer is more common, and is influenced by levels of the female hormone estrogen in a woman’s body.13 Anything that affects a woman’s estrogen levels can potentially raise or lower a woman’s risk of developing type I endometrial cancer.14 Type II is less common and does not seem to be related to estrogen.15

In 2013, 49,560 new cases of endometrial cancer were diagnosed in the U.S., and about 8,000 women are expected to die from it this year.16

What are common symptoms of endometrial cancer?

Abnormal vaginal bleeding or discharge are frequently reported symptoms, as is pain in the pelvic area, and pain during intercourse.17  However, a woman can have endometrial cancer without having any of these symptoms, and women can have these symptoms without having cancer. You know your body best, so it is important to see your doctor if you experience any symptoms that seem out of the ordinary.

Who is at risk?

Some of the factors that increase a woman’s chances of getting endometrial cancer are out of her control, but she can reduce her risks.  These factors increase a woman’s risks of endometrial cancer:

  • Had her first menstrual period before age 126
  • Has a family history of endometrial cancer6
  • Has or had trouble getting pregnant6
  • Has used or is using tamoxifen, a drug used to treat or prevent some types of breast cancer. Tamoxifen blocks estrogen to the breast, starving cancer cells that like to feed off of estrogen, but it acts like estrogen on the uterus.6
  • Had menopause after age 5518
  • Is obese – Studies suggest that obesity may be the largest risk factor for endometrial cancer.4

The more menstrual cycles a woman has in her life, the greater her risk.  That is why either early menstruation or late menopause (or both) can increase a woman’s risk of getting endometrial cancer.  And that is why taking birth control pills lowers a woman’s risk of endometrial cancer. Oral contraceptives eliminate “real” menstruation, replacing it with “withdrawal bleeding.”19

Screening and diagnosis

For women without symptoms, there are no accepted guidelines for a routine screening test.  That is why it is important to see your doctor if you experience any symptoms.  Most cases (80%) are diagnosed at an early stage because of symptoms, and as a result survival rates are high9. Most women with symptoms that are consistent with endometrial cancer will receive one or more of the following tests, in addition to a physical exam and blood tests:

  • Pelvic exam: A pelvic exam will allow your doctor to check your vagina and uterus for any unusual changes in size or shape.
  • Transvaginal ultrasound: This type of ultrasound (sound waves) makes a picture of the uterus, and can be used to detect small masses.
  • Biopsy: A biopsy involves the removal of tissue from the uterus to test whether cancer cells are present. 20

However, screening all women instead of only screening women with symptoms will often result in unnecessary biopsies because of false-positive transvaginal ultrasound results. for that reason, screening should be limited to symptomatic women to minimize anxiety and complications from biopsies.9

What are the treatment options?

If you have been diagnosed with endometrial cancer, treatment depends on the type of uterine cancer you have and how far it has spread, your age, and how fast the tumor is likely to grow.21 Treatment usually includes:

  • Surgery to remove the tumors
  • Chemotherapy
  • Radiation therapy
  • Hormone therapy to block hormones and keep them from feeding cancer cells 10
  • Immunotherapy12-15

The effectiveness of treatments can vary. For example, a 2023 study found that adding radiation to chemotherapy treatment did not increase how long endometrial cancer patients lived12 However, immunotherapy in addition to chemotherapy, has been shown to significantly improve outcomes according to the results of two different randomized clinical trials.13,14 Experts have predicted that these studies will convince doctors and patients to incorporate immunotherapy into the treatment of all patients with endometrial cancer,

How can you lower your risk of endometrial cancer?

Did you know that being overweight or obese increases your risk of many types of cancer, including endometrial cancer?  Keeping your weight down is the number one way you can reduce your risk, so limit the number of calories you eat and drink and stay (or get) active.  You can read more about the link between excess weight and cancer here. Scientists have proposed a few different explanations for this link, but one of them is that fat tissues secrete hormones, including estrogen. Abnormal amounts of estrogen circulating in the body increase a woman’s chances of developing type I endometrial cancer.

Dropping pounds (or at least not gaining weight) offers many health benefits in addition to lowering your risk of endometrial cancer. Shedding pounds can be a challenge. One of the easier ways is to cut down on sodas and other sweetened drinks that are high in calories with zero nutritional value.  A 2013 study found that women who drank a lot of sugar-sweetened beverages, such as Coke, Pepsi, and other carbonated beverages (such as 7-Up, Sprite), or non-carbonated drinks such as lemonade or Hawaiian Punch, were more likely to develop type I endometrial cancer than women who didn’t drink them, regardless of their body mass index (BMI), how physically active they were, or whether they had a history of diabetes or smoking. The study was based on postmenopausal, mostly white women who participated in the Iowa Women’s Health Study.  We don’t know if the results would be identical for younger women, or women of color, but we do know that these types of sugary beverages are generally harmful because they cause weight gain and do not provide nutrition.22 (Although the drinks are called “sugary,” most are made with corn syrup, not sugar.)

Physical activity is another way to control or reduce your weight and is one of the NRC’s seven recommended ways to maximize your health. Everyone can benefit from regular exercise, because it reduces the risk of heart disease and diabetes and can help you sleep better and improve your mood.23 Simple changes to your daily routine can make a difference. Read here to learn how to begin an exercise routine that works for your schedule.

The bottom line

If you’re having any pain in the pelvic area or experiencing unusual bleeding or discharge, be sure to tell your doctor.  Many of the factors that increase your risk of endometrial cancer are out of your control. What you can control is what you eat and drink. You can lower your chances of endometrial cancer and many other cancers by keeping your weight down and staying active.

 

  1. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, & Vergote I. Endometrial cancer. The Lancet. 2005;366(9484):491-505.  ▲
  2. Setiawan, VW, Yang HP, Pike MC, McCann SE, Yu H, Xiang Y, Wolk A et al. Type I and II Endometrial Cancers: Have They Different Risk Factors? Journal of Clinical Oncology. 2013;31(20): 2607-2620.  ▲
  3. Doll A, Abal M, Rigau M, Monge M, Gonzalez M, Demajo S, et al. Novel molecular profiles of endometrial cancer-new light through old windows. J Steroid Biochem Mol Biol. 2008;108(3–5):221–229.  ▲
  4. Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F. Factors associated with Type I and Type II endometrial cancer. Cancer Causes & Control. 2010;21(11):1851-1856.  ▲
  5. National Cancer Institute SEER Cancer Statistics Factsheets: Endometrial Cancer. National Cancer Institute. Available at: http://seer.cancer.gov/statfacts/html/corp.html. Accessed November 26, 2013.  ▲
  6. National Cancer Institute. What you need to know about cancer of the uterus. Risk Factors. Available at: http://www.cancer.gov/cancertopics/wyntk/uterus/page4. Accessed November 26, 2013.  ▲
  7. Setiawan VW, Pike MC, Kolonel LN, Nomura AM, Goodman MT, Henderson BE. Racial/ethnic differences in endometrial cancer risk: the multiethnic cohort study. Am J Epidemiol. 2007;165(3):262-270.  ▲
  8. Combination oral contraceptive use and the risk of endometrial cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. JAMA. 1987;257(6):796-800.  ▲
  9. Trojano, G., Olivieri, C., Tinelli, R., Damiani, G. R., Pellegrino, A., & Cicinelli, E. (2019). Conservative treatment in early stage endometrial cancer: a review. Acta bio-medica : Atenei Parmensis, 90(4), 405–410. https://doi.org/10.23750/abm.v90i4.7800
  10. National Cancer Institute. What You Need To Know About Cancer of the Uterus- Diagnosis. 2010. Available at:http://www.cancer.gov/cancertopics/wyntk/uterus/page6. Accessed November 25, 2013.  ▲
  11. National Cancer Institute. What You Need To Know About Cancer of the Uterus- Treatment. 2010. Available at:http://www.cancer.gov/cancertopics/wyntk/uterus/page8. Accessed November 26, 2013.  ▲
  12. Nelson, R. (2023).No Survival Benefit to Radiation Add-on in Endometrial Cancer. Medscape. https://www.medscape.com/viewarticle/990236?ecd=WNL_confwrap_230405_MSCPEDIT&uac=140425SY&impID=5307712#vp_1
  13. Eskander, R., Sill, M., Beffa, L., et al. (2023).Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer. NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa2302312
  14. Mirza, M., Chase, D., Slomovitz, B., et al. (2023).Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer. NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa2216334
  15. Nelson, R. (2023)’Home Run’: Immunotherapy Add-on for Advanced Endometrial Cancer. Medscape. https://www.medscape.com/viewarticle/990179?ecd=WNL_confwrap_230405_MSCPEDIT&uac=140425SY&impID=5307712
  16. Inoue-Choi M, Robien K, Mariani A, Cerhan JR, Anderson KE. Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer among Postmenopausal Women.Cancer Epidemiol Biomarkers Prev. 2013. doi:10.1158/1055-9965.EPI-13-0636  ▲
  17. Centers for Disease Control and Prevention. Physical Activity and Health. Available at:http://www.cdc.gov/physicalactivity/everyone/health/. Accessed December 2, 2013.  ▲

Haz-Map: Is Your workplace putting your health at risk? How you can find out

Environmental Exposures, Prevention
By Danielle Pavliv
2012

Have you ever wondered if where you work could be harming your health? Now you can find out. The National Library of Medicine’s Environmental Health and Toxicology division has an online database that lets you see what hazards, if any, you are being exposed to. It’s called “Haz-Map,” and it links jobs with illnesses and injuries that have been reported. Haz-Map is the product of occupational health science, which studies workplace safety and is “devoted to the anticipation, recognition, evaluation, and control” of workplace conditions which may cause illness or injury.[end Industrial Hygiene. Occupational Safety & Health Administration. United States Department of Labor. Available at: http://www.osha.gov/dte/library/industrial_hygiene/industrial_hygiene.html.]

Haz-Map began in 1991 with about 700 chemicals. Over time, chemical and biological agents known to cause health problems were added. Currently, it covers about 6000 chemical and biological agents and 235 occupational diseases.[end Fact Sheet: Haz-Map. U.S. National Library of Medicine. National Institutes of Health. May 2011. Available at: http://www.nlm.nih.gov/pubs/factsheets/hazmap.html.] Information on the website is regularly updated as new research is conducted. The new Haz-Map design allows you to search by job, disease, chemical or biological agent, or even by symptom or medical problem: click here to see it.

Interested in learning about the risks associated with your job? Simply click on “High Risk Jobs” or “Industries,” and search alphabetically or by the type of job. Are you a bartender? It turns out that working with the limes and celery often used for cocktails can cause rashes, and working continuously with wet hands may result in inflammation near your fingernails. Haz-Map shows that exposure to secondhand smoke increases the risk of lung cancer (smoking is banned in bars and restaurants in many states, but not all). Hairdresser? Working with dyes and bleach can cause asthma-and so can wearing latex gloves! Law enforcement officer? Policeman and detectives can both at risk of heat-related illnesses, and the firing ammunition can increase the risk of lead poisoning. Physicians and other types of health care providers are exposed to many different risky pathogens by handling needles and caring for sick patients, but can lower those risks by taking proper precautions.

You can also search Haz-Map by disease to see what jobs are associated with certain illnesses. Leukemia, for example, is more prevalent among workers exposed to radiation (such as health professionals working with X-rays and people who work at nuclear power plants) and workers who are regularly exposed to benzene, such as painters, printing press operators, and gas station attendants (since benzene is used in inks, rubber, paint removers, and gasoline). Mesothelioma, a rare cancer with a poor prognosis, is usually caused by exposure to asbestos, which is less likely today but is still in old insulation, textiles, cement and roof shingles.

Facts and Figures

How many people are harmed by their job? The most recent data from the Bureau of Labor Statistics (from 2010) show that fatal and nonfatal workplace injuries and illnesses have decreased since the 1990s.[end Injuries, Illnesses, and Fatalities. Bureau of Labor Statistics. United States Department of Labor. 2012. Available at: http://www.bls.gov/iif/home.htm.] The reason might be because there have been many safety measures implemented to limit exposure to chemical, biological and physical dangers and minimize health risks in case of an emergency. However, a trend away from industrial jobs and more toward service and other “desk” jobs that don’t pose the same kinds of dangers may be another factor.

Fatal occupational injuries in 2010: 4,690 total

  • Sex: 4,322 men and 368 women died on the job
  • Age: more deaths occurred in the 45-54 age range (1,189) than any other
  • Race: 3363 fatalities among white men and women occurred, while 412 black people and 707 Hispanics died.
  • Occupation: Most of the deaths (1,160) occurred in transportation-related occupations, 780 to construction workers, 545 in management, 363 to workers performing installation, maintenance and repair
  • Event: 1,857 deaths were attributed to transportation accidents. Many of these were among individuals working in the transportation industry, such as truck drivers, but some worked in other occupations that involve transporting, such as drilling workers driving diesel trucks to drilling sites. Assaults and violent acts resulted in 832 workplace fatalities. Contact with objects and equipment caused 738 deaths, and 646 people fell to their death. A smaller number (414) died from exposures to harmful substances.

We have a long way to go but times have changed

In 1995, 6,275 fatal occupational injuries occurred-almost 2,000 more than in 2010. Of these, 605 were due to exposure to harmful substances, as compared to 414 in 2011. The rate of fatal work injuries per 100,000 workers decreased from 5 in 1995 to 3.6 in 2010. Instances of nonfatal injuries and illnesses also decreased significantly, from 8.1% of workers in 1995 to 3.8% in 2010.

Organizations that study and regulate workplace health and safety

All of the organizations below are devoted to the study and regulation of workplace hazards:

  • The American Conference of Governmental Industrial Hygienists, or ACGIH, is an independent organization that formed in 1938.[end About: History. American Conference of Governmental Industrial Hygienists. May 2012. Available at: http://www.acgih.org/about/history.htm.] Originally, the organization offered membership to industrial hygiene (also known as occupational health) professionals in the U.S. and all governmental industrial hygiene professionals in other countries. Today, all occupational and environmental health professionals in the U.S. and other countries around the world can obtain a membership. Nine ACGIH committees focus on different aspects of the field such as agricultural safety and health, small businesses, and limits for chemical substances.
  • Several decades later, under the Nixon Administration, the OSH (Occupational Safety and Health) Act was passed in 1970.[end Occupational Safety and Health Act of 1970. Occupational Safety and Health Administration. December 1970. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=OSHACT&p_id=2743.] With this act, Congress established OSHA, the Occupational Safety and Health Administration. OSHA creates and enforces standards to ensure safe working conditions for Americans.
  • The OSH Act also created the National Institute of Occupational Safety and Health, or NIOSH, which focuses on performing research and making recommendations to reduce the likelihood of workplace injury and illness.

How much exposure is too much?

Both OSHA and ACGIH have set standards or regulations for exposure to workplace health hazards. ACGIH created the term “threshold limit value” or TLV.[end Policy Statement on the Uses of TLVs and BEIs. American Conference of Governmental Industrial Hygienists. February 2008. Available at: http://www.acgih.org/TLV/PolicyStmt.htm.] This is the amount of a chemical substance a worker can be exposed to daily for his or her entire career without experiencing health problems related to the chemical. The TLV is just a guideline or recommendation, so it cannot be legally enforced.

The permissible exposure limit (PEL), on the other hand, is a legal limit set by OSHA. Unlike a TLV, PELs are not based on daily exposure over an entire working lifetime. Rather, they are typically given as a time-weighted average (TWA), which is measured over the course of an 8-hour workday.[end Permissible Exposure Limits (PELs). Occupational Safety and Health Administration. United States Department of Labor. October 2006. Available at: http://www.osha.gov/SLTC/pel/.] Sometimes, a PEL is measured as a ceiling limit, which is the amount of chemical that should never be exceeded at any time. A short-term exposure limit (STEL) is the amount of chemical in the air averaged over 15 minutes. Why are there so many different standards? In most jobs, chemical concentration fluctuates significantly throughout the day, so it is best to assess chemical presence and hazards in several different ways.

Safety measures

There are many safety efforts that have been designed and implemented to protect workers from various dangers. For instance, construction workers often use hard hats, shoes that will guard their feet from heavy objects, and earplugs if they will be around loud noises. Doctors and other health care professionals wear antibacterial gloves, and they must wear masks to protect themselves around contagious patients, and to protect immune-compromised patients from the germs doctors may be carrying. For workers who come into contact with dangerous chemicals, rubber gloves and air respirators are used to reduce risk. It is better to focus on minimizing exposure to harmful substances or other dangerous situations than to use protective equipment, but these safety measures can save lives when there is no viable alternative.

The Haz-Map can be a useful tool if you are curious about potential hazards at your workplace or a loved one’s, or if you just want to know more about different chemical and biological agents and how people can be exposed to them. Explore the Haz-Map using the search function, or just browse by job, disease, or hazardous agent.

Breast Thermography Cannot Replace Mammograms

Breast Cancer, Prevention
Dana Casciotti, PhD, Cancer Prevention and Treatment Fund

In June 2011 the Food and Drug Administration (FDA) issued a warning to women who undergo breast cancer screening:  Do not replace mammograms with thermograms.

Thermograms are pictures of the breast made with a special type of camera (an infrared camera) that shows patterns of heat and blood flow near the surface of the breast.  Supporters of thermography say that these pictures can help doctors see new blood vessel growth, the very earliest sign that a tumor could develop.  Supporters also claim the pictures help identify very early tumors that are not big enough to find with other screening tests.  Thermograms are less painful than mammograms because they do not require squeezing the breast, and they also don’t expose the breast to radiation.  This sounds great, but does it really work?

Early detection of breast cancer is very important because it can save lives and reduce the need for mastectomy (surgery to remove the breast) or chemotherapy.  However, the FDA said there is currently not any “valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition including the early detection of breast cancer or other breast disease.”[1]

Some research shows that thermography might be useful in combination with mammography, especially for women with dense breasts.[2,3] With mammography, dense breast tissue looks white and so does a cancerous tumor, so it is often hard to detect cancer.  Younger women tend to have denser breasts, so mammography in combination with thermography might be more accurate, especially for young women at high risk of breast cancer because of close relatives with breast cancer. Breast cancer screening is not recommended for young women with an average risk of breast cancer.[1]

More research on thermography should be done to determine whether it is truly useful for early detection.  As mentioned above, thermography can identify the earliest signs of tumor growth.  However, these early signs do not necessarily mean breast cancer will develop and they are generally too early to require treatment. Even though it is an easy procedure that simply takes a picture of the breast, its risks might outweigh the benefits if it results in unnecessary follow-up and treatment. That’s why more research is needed to determine if thermography can replace mammography for breast cancer screening.

The FDA is worried that ads for thermography facilities, web sites, and mobile units are misleading women. For example, here is an ad that calls breast thermography “the safe alternative to mammography.” That is not true. Thermography may be a safer test since it does not expose women to radiation, but there is not enough evidence that it is effective and can be used alone for breast cancer screening.

References:

  1. U.S. Food and Drug Administration. Thermographic Imaging Systems for Breast Cancer Screening: FDA Safety Communication. June 2, 2011.  Accessed on 6/8/11 http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm257707.htm.
  2. Arora N, Martins D, Ruggerio D, et al. (2008).  Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. Am J Surg. Oct;196(4):523-6.
  3. Kennedy DA, Lee T, Seely D (2009). A comparative review of thermography as a breast cancer screening technique. Integr Cancer Ther. Mar;8(1):9-16.

Doctors were Paid to Praise Hormone Replacement Therapy

Medical Treatments with Cancer Risks, Prevention
September, 2010

The Haunting of Medical Journals: How Ghostwriting Sold “HRT”

This article, written by Adriane Fugh-Berman of Georgetown University Medical Center, which appears in the September 2010 issue of PLoS Medicine, reveals the ethically questionable ways in which Wyeth Pharmaceuticals promoted Prempro, a menopausal hormone replacement medication.

Wyeth paid highly respected physicians to allow their names to be listed as authors of research studies, reviews, commentaries, and letters to the editor, although they had not actually conducted or analyzed the research nor written the articles.  These articles were published in medical journals and widely quoted, persuading doctors that hormone therapy was necessary and beneficial to reduce the detrimental effects of menopause and aging on women.  Research subsequently proved that most of the “benefits” were unfounded, and that the truth was sometimes exactly the opposite of the claims: for example, hormone therapy had a negative rather than positive impact on memory.

Lung Cancer and African Americans

Lung Cancer, Lung Cancer, Prevention, Treatment & Management
Sarah Miller, RN, Cancer Prevention and Treatment Fund

For years, doctors and medical researchers have been puzzled by the fact that African-Americans are more likely to die from lung cancer than people of any other race or ethnicity, although they are not more likely to smoke. How could this be? Is it because they don’t get diagnosed and treated in time, is it genetic, or is there something else going on? Research indicates that a combination of factors may be responsible for the unequal rates of death from lung cancer.

The Problem

African-Americans are disproportionately affected by lung cancer. The percentage of African-American men diagnosed with lung cancer each year is at least 30% higher than among white men, even though they have similar rates of smoking as white men. In fact, African-American men tend to smoke fewer cigarettes per day than white male smokers. While African-American women are less likely to smoke than white women, they are about as likely to develop lung cancer and die from lung cancer as white women. African-Americans also tend to be diagnosed with lung cancer at a younger age. Research has examined many possible explanations for these differences.

Is it Genetic?

Scientists have recently identified several genes that are linked to lung cancer. People who have these genes and smoke are more likely to develop lung cancer than other smokers. They have also found genes that cause a person to metabolize nicotine differently, which could be a factor in whether a person develops lung cancer.6 Some of these genes have been found to be more common in people with African ancestry. This suggests that genetics may have a role in the higher rates of lung cancer among African-Americans.

Genetics are only a part of the equation, though. There are many other factors that contribute to differences in lung cancer rates and in death from lung cancer.

Does the Type of Cigarettes Matter?

Tobacco companies have a long history of targeting the African-American community with advertisements for menthol cigarettes. As a result, about 80% of African-American smokers smoke menthol cigarettes, compared with only 20% of white American smokers.

Many researchers have tried to find a link between lung cancer and menthol cigarettes. Some have theorized that the “cooling” effect of menthol cigarettes allows menthol smokers to inhale the smoke more deeply, which could cause more damage to their lungs. Others have speculated that menthol cigarettes might be more addictive than regular cigarettes.

While studies have shown that smokers of menthol cigarettes may have a more difficult time quitting, and are more likely to smoke their first cigarette sooner after waking in the morning than people who smoke regular cigarettes, researchers have not been able to find any chemical properties of menthol cigarettes that make them more addictive.

Smokers of menthol cigarettes do not, on average, smoke any more cigarettes in their lifetime than regular cigarette smokers, and research so far has failed to show that menthol cigarettes cause more cases of cancer than other kinds of cigarettes.

The one obvious problem with menthol cigarettes is that the menthol makes cigarette smoke less harsh for first-time smokers. Because, of this, many young teens smoke them. In fact, while smoking is declining among adults and adolescents, menthol cigarettes are becoming increasingly popular among both adults and kids ages 12-17. Since we know that people who begin smoking at younger ages are more likely to become regular smokers, it is troubling that there is a product available that helps teens to start smoking. Although African-American teens start smoking later than white teens, they disproportionately smoke menthol cigarettes.

Does the Environment Affect Lung Cancer Disparities?

Industries that produce heavier air pollution (for example, factories, oil refineries, and chemical plants) are often located in African-American communities. Exposure to pollution from working in or living near these industries can increase a person’s risk for lung cancer.,

A person who smokes and is exposed to air pollution is at higher risk for lung cancer than a smoker who is not exposed to air pollution. People who are exposed to air pollution on the job are at especially high risk. The fact that these polluting industries are frequently located in African American communities and employ members of that community may also help to explain why African-Americans are disproportionately affected by lung cancer.

Is it Because of Differences in Treatment?

While differences in diagnosis and treatment don’t explain why more African-Americans develop lung cancer, it may help to explain the higher death rate from lung cancer among blacks.

One study of all the lung cancer patients in the Florida Cancer Registry found that the survival time for African-American patients diagnosed for lung cancer was shorter than that of white patients. The researchers also found that the entire difference in survival time between African-Americans and whites could be attributed to the fact that white patients tended to get more timely and appropriate treatment.

They concluded that if African-American patients could begin treatment as early as white patients, and were provided the best treatment for their condition, then their survival time would catch up with that of white patients.

Another study found that many patients with a certain type of lung cancer, for which surgical removal of part of the lung offers the best chance for a cure, did not get the proper surgery. Shockingly, only 62% of all patients who would have a good chance of the surgery helping them had the surgery. When the researchers separated the results out by race, 66% of white patients who were appropriate candidates had the surgery while only 55% of African-American patients who were appropriate candidates had the surgery. While this is bad news for all patients with this type of lung cancer, it is worse news for African-Americans since they were substantially less likely than white patients to get the surgery.

Why Don’t African-American Patients Receive the Proper Treatment?

One reason that African American patients are less likely to receive the proper treatment than white Americans may be that they are less likely to have health insurance. While about 13% of white American adults under the age of 65 are uninsured, 21% of African American adults in the same age group are without health insurance. Uninsured patients may decide against treatment because they can’t afford it, or may have a difficult time finding a hospital that is willing to provide the treatment to uninsured patients.

Another reason that African American patients do not always receive the most appropriate care is that there seem to be communication problems between providers and patients.

Studies have found that the type of communication a patient has with a doctor or health care provider has an impact on his or her decision-making about treatments. In the long-term, this has a huge impact on the state of a person’s health.

Health care providers are increasingly pressured to fit more patient visits into shorter time periods. Because of this, providers have less time to spend getting to know each patient. In this type of situation, people tend to make snap judgments.

Providers make a judgment based on their first impression of a person (what they think of that person after glancing at his or her chart and based on personal appearance). This judgment influences the provider’s judgment about what medical information the patient wants or doesn’t want, what type of treatment the patient is likely to find acceptable, and how reliable the person will be with his or her follow-up care.

Patients, too, know that they have only a short time for an appointment. They also may judge a provider based on his or her appearance and make assumptions. They may assume that the provider is very knowledgeable and that they should just do what the provider says. Patients may also assume, based on a snap judgment, that the provider will not respond well to being asked questions, that the provider does not care about the patient, or that the provider is not going to be helpful.

Research has shown that when the provider is of a different race or culture than the patient, these breakdowns in communication are more severe and have more negative results in terms of the quality of care a patient receives.

What is Being Done to Reduce Disparities in Lung Cancer Survival?

While healthcare providers and lawmakers recognize that this is a serious problem, they also recognize that there is no quick fix.

One step that is being taken by medical schools is to try and attract more African-American students. Currently, African-Americans are under-represented in the medical profession. The assumption is that African-American physicians be able to communicate more effectively with African-American patients, and that they will be able to educate their colleagues to do so as well.

Many people are also trying to limit advertising of menthol cigarettes, especially ads that target African-American teens.

Some public health advocates are urging the FDA to ban menthol in cigarettes. Other flavored cigarettes (“bidis”) have already been banned on the principle that they attract teens to smoking and make cigarettes more tolerable. Since we know that menthol also makes smoking more desirable for teens, and since it is a flavoring for cigarettes, it makes sense that it should be banned along with the other flavors. Banning menthol cigarettes would likely reduce the number of African-American teens that smoke, and might help reduce lung cancer deaths among African-American men and women.

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