Category Archives: Other Cancers

Do Heartburn Medications Cause Kidney Disease? Dementia?

Diana Zuckerman, PhD and Farzana Akkas, MSc,

In 2016, research was published indicating that people who take popular heartburn medications are more likely to develop serious kidney disease.[1] In 2023, research was published showing that people prescribed these popular medications are more likely to develop dementia. If you take any of these drugs, how worried should you be? And are there safer medications that work just as well?

Prilosec, Nexium Prevacid, Kapidex, Aciphex and Protonix are all a type of drugs called Proton Pump Inhibitors (PPI). There are several other drugs of this type as well.  They are all used to treat heartburn and acid reflux. In a 2016 study lead by Dr. Morgan Grams of Johns Hopkins University, people who use PPI are more likely to develop chronic kidney disease compared to those who take other types of heartburn medication.  The higher the dose or the more often they take these drugs, the more likely they are to develop kidney disease.[1] In the first of several expected settlements, in October 2023 AstraZeneca agreed to pay $425 million to settle about 11,000 lawsuits in the United States that claimed that Nexium and Prilosec caused chronic kidney disease. AstraZeneca did not admit wrongdoing under the settlement, part of broader litigation against makers of PPI that involve several major pharmaceutical companies.

Even more important, the researchers found that most of the 15 million Americans who were prescribed a PPI don’t really need them.  One in four of long-term users can stop taking them without suffering from more heartburn or acid reflux.[1]

Since the research on dementia is more recent, let’s focus on that first. The 2023 study of more than 5,000 people ages 45 and older who did not have dementia at the start of the study concluded that those who take PPI for 4.5 years or longer are more likely to develop dementia.[2] The study compared more than 4,000 people who did not take the drugs to 1,490 adults who took PPI for up to 2.8 years, between 2.8 to 4.4 years, or for more than 4.4 years. During the 30 years of the study, 585 people (10%) developed dementia. Of the people who did not take the drugs, 425 people developed dementia, which equals 1.9% per year. Of the 497 people who took the drugs for more than 4.4 years, 58 people developed dementia, which equals 2.4% per year. THESE numbers seem small but they add up over time (for example, 38 compared to 48 over 20 years). Researchers did not find a SIGNIFICANT increase in dementia for people who took the drugs for fewer than 4.4 years. This study does not prove that PPI causes dementia but it shows an association which could be caused by the drugs or could be caused by an unknown behavior or medical condition that causes both heartburn and dementia. More research is needed to determine whether long-term PPI use actually causes dementia.

The evidence regarding PPIs and kidney disease is more conclusive. Even before the 2016 study, research had shown that people who take these drugs are more likely to have painful kidney problems such as acute kidney injury and acute interstitial nephritis.[3, 4, 5, 6, 7] The 2016 study is important because the patients taking a PPI developed chronic kidney disease, which is more serious.  It means that their kidneys can no longer filter blood effectively, which can cause kidney failure. Those patients will need dialysis.

Do PPI cause these health problems or does overeating cause these problems? To address this question, the researchers compared results of PPI users to people taking a different type of heartburn medication called H2 blocker users (such as Pepcid, Tagamet and Zantac). After statistically controlling for heath factors such as obesity and hypertension, they found that people who used a PPI were still more likely to develop chronic kidney disease when compared to people using H2 blockers.  And, those who took the PPI medication twice a day were more likely to develop chronic kidney disease than those who took it once a day.

Another study, based on more than 190,000 veterans taking heartburn medication came to a similar conclusion. Regardless of their age and health, the PPI users in that study also were more likely to develop chronic kidney disease than the veterans taking H2 blockers.[8]

H2 blockers like Pepcid, Tagamet or Zantac are less expensive and seem to be safer than the PPI medications.  Many of them are available without a prescription.  And of course, a major cause of heartburn and acid reflux is our health habits. Maintaining a healthy weight and quitting smoking helps reduce the chances of heartburn or acid reflux.  If that doesn’t work, some people find it helpful to avoid spicy or greasy food, chocolate, mint, and coffee until the symptoms go away.[9]

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

  1. Lazarus, B., Chen, Y., Wilson, F. P., Sang, Y., Chang, A. R., Coresh, J., & Grams, M. E. (2016). Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Internal Medicine JAMA Intern Med, 238.
  2. Northuis, C., Bell, E., Lutsey, Pm. George, K., Gottesman, R., Mosley, Tom., Whitsel, E., & Lakshminarayan K. (2023). Cumulative Use of Proton Pump Inhibitors and Risk of Dementia: The Atherosclerosis Risk in Communities Study. American Academy of Neurology.
  3. Blank ML, Parkin L, Paul C, Herbison P. (2014). A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use. Kidney Int., 86(4):837-844.
  4. Sierra F, Suarez M, Rey M, Vela MF. (2007) Systematic review: proton pump inhibitor–associated acute interstitial nephritis. Aliment Pharmacol Ther.,26(4):545-553.
  5. Antoniou T, Macdonald EM, Hollands S, et al. (2015) Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study. CMAJ Open, 3(2):E166-E171.
  6. Klepser DG, Collier DS, Cochran GL. (2013) Proton pump inhibitors and acute kidney injury: a nested case-control study.BMC Nephrol, 14:150.
  7. Leonard CE, Freeman CP, Newcomb CW, et al. (2012) Proton pump inhibitors and traditional nonsteroidal anti-inflammatory drugs and the risk of acute interstitial nephritis and acute kidney injury. Pharmacoepidemiol Drug Saf, 21(11):1155-1172.
  8. Xie, Y., Bowe, B., Li, T., Xian, H., Balasubramanian, S., Al-Aly, Z. (2016). Proton Pump Inhibitors and Risk of Incident CKD and Progression to ESRD. Journal of The American Society of Nephrology, 27.
  9. Kang, J. H., & Kang, J. Y. (2015). Lifestyle measures in the management of gastro-oesophageal reflux disease: Clinical and pathophysiological considerations. Therapeutic Advances in Chronic Disease, 6(2), 51-64.

Plastic Wrap and Plastic Food Containers: Are They Safe?

Avery Nork, Kiren Chauhan, Brandel France de Bravo, MPH, National Center for Health Research

Is it safe to warm up food in plastic containers or using plastic wrap in the microwave or the oven?  In 2016, President Obama signed a law that strengthened the Toxic Substances Control Act that requires testing of chemicals to make sure they are safe. Prior to that law, more than 60,000 chemicals on the market had gone untested. With that enormous backlog, it may be decades before the EPA has tested the thousands of chemicals that are widely used today. So, let’s look into this issue more carefully.

What harmful chemicals, if any, does plastic have? Two major chemicals to watch out for are phthalates (used to soften plastics) and bisphenol A (BPA), which is used to make very hard, shatterproof plastic (it usually has #7 on the bottom) and is also found in the lining of canned foods and beverages. When phthalates and BPA get into our bodies, they affect estrogen or testosterone. BPA, phthalates, and other chemicals known as endocrine disruptors act like hormones in our body and affect our natural hormone production.  These types of chemicals have been linked to cancer, problems in the reproductive organs, and several other health problems.1 In addition, a 2023 study found that children exposed to phthalates in the womb or during their first year of life were more likely to develop behavioral, attention, and learning disorders. That’s why six phthalates are banned by law from children’s products, and why the FDA is studying BPA to determine if it should be banned from baby bottles and the lining of food and beverage cans.

Plastic wrap has been ‘phthalate free’ since 2006, but in the United States it is made of polyvinyl chloride or PVC and contains a “plasticizer” called di(2-ethylhexyl)adipate or DEHA. DEHA is not a phthalate but is chemically very similar to the phthalate called DEHP.

Studies in the 1990s showed that DEHA can cause liver tumors in mice, and other studies showed that DEHA migrates from plastic wrap into food—particularly high fat foods such as cheese. A 1998 study by Consumers Union tested plastic-wrapped foods and found DEHA levels higher than what is recommended and even permitted by European advisory committees and regulatory agencies.2 A 2014 study found DEHA in various cheeses as well as beef, chicken, and pork that was sold in clinging plastic wrap at grocery stores.3 A 2021 study found that DEHA triggered brain and heart injuries in rats, but research is needed to better understand the risks for humans.4

Similarly, high density polyethylene (HDPE) plastic containers, which are typically used to store household cleaners and pesticides but are sometimes used for food storage, tested positive for PFAS. The results of a 2023 experiment showed that PFAS were capable of transferring into food, and that if there are PFAS in your food storage, it will transfer into your food over time. The researchers tested olive oil, ketchup, and mayonnaise and found that all of them had detectable levels of PFAS after being in contact with an HDPE for a week. While HDPEs are currently not intended for food storage, there is nothing stopping plastic companies from using them that way. This could be potentially harmful to thousands of people by exposing them to high levels of PFAS.

“I don’t eat a lot of canned food and I don’t drink soda. Are there other ways that chemicals found in plastic could be getting into my food?”

Many foods are sold in plastic containers and most of us keep leftovers in food storage containers made out of plastic, such as Tupperware, Rubbermaid, other brands, as well as carryout containers from restaurants. While none of these containers seem to be made with phthalates (since those are usually relatively soft), some may have BPA. As companies have become more aware of the dangers of the plastics they were using, they replaced some chemicals with others. When we checked Rubbermaid’s website in 2023, it states that it currently makes no products with BPA or phthalates (if you want to see if any of your older Rubbermaid products contain BPA, check here). Tupperware says all of its products are BPA free as of 2010, but any older products still might contain levels of BPA. If you want to check if your Tupperware is BPA-free, check the bottom of the container. Any number 1 through 6 means it is BPA-free, but a 7 means there might be BPA in that product. In addition, the company that makes Saran Wrap changed the chemicals in its product, making it less clingy but less dangerous to our planet.5

Regardless of whether a plastic food container contains phthalates or BPA, it may not be entirely safe. Plastics break down over time, which means they can potentially release trace amounts of whatever chemicals they are made of into the food. This is more likely to happen when the plastic has been heated or when it’s old and has been subjected to repeated use or washings. In fact, numerous studies show that most, if not all, humans have microplastics in our bodies, often from the food and drinks we consume every day.6 Perhaps these chemicals are harmless, but there isn’t any research on the cumulative effect of constantly eating food stored or heated in these plastic containers. It would not be surprising to find out that they may not be as safe as many of us assumed.

So what about all that food we buy that says to microwave it in the plastic container it’s sold in?

That type of plastic is said to be “microwave safe,”, but this means it won’t melt in the microwave—it doesn’t mean that it won’t release small amounts of chemicals into your food. Anything not marked “microwave safe,” will soften and lose its shape in the microwave. “Take out” food containers or other disposable plastic food containers (like the ones that refrigerated foods such as soft cream cheese or butter are sold in) are especially unsafe to use in the microwave. In their study, Good Housekeeping researchers microwaved food in a variety of plastic containers labeled microwave safe and found no detectable levels of BPA (or phthalates) in most.7 But if your favorite containers have these chemicals, in addition to all the other ways you can be exposed to endocrine-disrupting chemicals and microplastics, you could end up with unhealthy levels of these chemicals in your body. Two Canadian environmentalists experimented on themselves for four days by exposing themselves to various chemicals found in food and beverage containers and other household objects and wrote a book called Slow Death by Rubber Duckie!

We need more research to know what plastics are safe—under what conditions and for what use. Until we have that information, you can “play it safe” and reduce the amount of chemicals getting into your food from plastic by following these tips:

  • Avoid allowing plastic wrap to come into contact with food, especially when heating or if the food has a high fat content (like meat or cheese). If you want to prevent food from splattering in the microwave, cover it with a microwave-safe dish or a paper towel.

  • Use glass or ceramic containers to microwave food and beverages, and avoid microwaving in plastic or disposable containers.8

  • Although 96% of canned foods from major supermarkets that were tested in 2019 were BPA free, you might want to throw away older canned goods in your home that still might have BPA in the lining.9

  • Look for drinks sold in cartons or glass. Some of the glass bottles may have lids lined with BPA, but even so, the top is not usually in contact with the beverage. If you carry a reusable water bottle, switch to stainless steel or make sure your sports bottle is “BPA-free.” [Do NOT re-use the kind of plastic bottles that bottled water is sold in, because they are not safe for repeated use.] Plastics that contain BPA are usually hard and make a clicking noise if you hit them with your fingernail or a fork or other metal utensil, and may have the number seven on the bottom.

Remember that all plastics break down when exposed to heat—whether in the microwave or dishwasher—and when exposed to strong soaps. Cracks and cloudiness are signs that a clear, reusable plastic container has started to break down and may be releasing BPA or other chemicals into your beverage or food.

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


  1. National Institutes of Health. (n.d.).
  2. Report to the FDA regarding plastic packaging. CR Advocacy. (n.d.).
  3. Cao, X. L., Zhao, W., Churchill, R., & Hilts, C. (2014). Occurrence of Di-(2-ethylhexyl) adipate and phthalate plasticizers in samples of meat, fish, and cheese and their packaging films. Journal of food protection, 77(4), 610–620.
  4. Behairy, A., Abd El-Rahman, G. I., Aly, S. S. H., Fahmy, E. M., & Abd-Elhakim, Y. M. (2021). Di(2-ethylhexyl) adipate plasticizer triggers hepatic, brain, and cardiac injury in rats: Mitigating effect of Peganum harmala oil. Ecotoxicology and environmental safety, 208, 111620.
  5. Emma KumerUpdated: May 18, 2023. (2023, May 18). Is it just us, or is Saran wrap less sticky?. Taste of Home.
  6. Pinto-Rodrigues, A. (2023a, April 10). Microplastics are in our bodies. here’s why we don’t know the Health Risks. Science News.
  7. Is it safe to heat food in plastic?. Good Housekeeping. (2022, August 16).
  8. Food Safety and Inspection Service. Cooking with Microwave Ovens | Food Safety and Inspection Service. (n.d.).
  9. Canned Foods. Center for Environmental Health. (2020a, January 27).

Can Daily Aspirin Prevent Both Heart Disease and Cancer?

Laura Gottschalk, Ph.D., Sasha Milbeck & Meg Seymour, PhD

Many adults take a low-dose aspirin (or “baby” aspirin) to prevent heart disease and possibly cancer. The most recent data indicates that in 2017, 23% of U.S. adults over 40 who did not have heart disease took low-dose aspirin to help prevent developing it.1 About 23% of people taking “baby” aspirin daily reported that they did so without a doctor recommending it. Should you take daily aspirin to prevent heart disease? The recommendations depend on your age, as well as other risk factors.

In April 2022, the United States Preventive Services Task Force (USPSTF) issued updated recommendations that people over 60 should not start taking low-dose aspirin, because the benefits do not outweigh the risks.2 For those ages 40-59 with a 10% or more chance of developing heart disease over the next 10 years, the USPSTF says the data are unclear. So, the decision to start taking low-dose aspirin should be made with one’s physician, weighing the risks (which vary among individuals) against the small benefits.

These recommendations are notably different from the USPSTF’s 2016 recommendations, which did not recommend against starting to take low-dose aspirin for those ages 60-69. The 2016 recommendations also recommended adults ages 50-59 with a 10% or more chance of developing heart disease over the next 10 years and who were willing to take daily aspirin for those 10 years begin to do so.3

What Are the Benefits and Risks?

Why have the recommendations changed over time, and what do we now know about the cardiovascular benefits of taking low-dose aspirin that we didn’t know a few years ago? A 2019 study combined the results of 13 clinical trials, all comparing daily aspirin to placebo or to no treatment.4 The combination study, called a meta-analysis, analyzed over 164,000 patients, who were followed for an average of five years. The researchers found that patients who used daily aspirin had fewer heart attacks and fewer ischemic strokes. However, the authors also found that people who took daily aspirin were more likely to have intracranial bleeding (inside the skull) and major gastrointestinal bleeding.

The USPSTF reviewed the research on low-dose aspirin in order to develop their recommendation, and drew similar conclusions.5 The analysis of over 161,000 patients found that people taking daily aspirin reduced their chances of a having at least one major cardiovascular event such as a heart attack or stroke by 2.5%. And yet, the analysis also found that people taking “baby” aspirin were not less likely to die from heart attacks or strokes. In addition, people taking daily aspirin were 1% more likely to experience major bleeding, such as gastrointestinal bleeding that resulted in a transfusion, hospital admission, intracranial bleeding, or death.

It is important to know who is most likely to experience harmful bleeding. Research has shown that the increased chances of bleeding begins relatively soon after starting to take “baby” aspirin on a daily basis, and it increases with age. Bleeding is more common among men, smokers, people with high blood pressure, people with liver disease, people with diabetes, and people with a history of gastrointestinal problems, such as peptic ulcer disease.5 Taking certain medications can also increase the risk of bleeding, including nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen), steroids (such as prednisone), and anticoagulants (such as warfarin). We agree with the USPSTF recommendation that these factors make dangerous bleeding more likely for anyone taking daily aspirin.

In a 2023 meta-analysis of 16 studies, researchers compared the risks and benefits of low-dose aspirin in adults who did not have cardiovascular disease who use statins to those who did not use statins.6 Statins are a group of drugs that lower LDL or “bad” cholesterol by helping the body slow down cholesterol production and rev up cholesterol removal. Researchers found that at every level of cardiovascular disease risk, the chances of developing major bleeding complications from daily aspirin were greater than the chances of the aspirin preventing heart attacks or other cardiovascular problems. That was true for patients taking low-dose aspirin alone or with a statin. For that reason, statins alone are now considered safer than low-dose aspirin for preventing heart attacks even for those with little or no risk.

According to the USPSTF, the benefits of daily aspirin use are different for someone in their 60s or 70s who has already been taking low-dose aspirin compared to someone in their 60s or 70s who is considering whether to start to take daily aspirin. For people already taking daily aspirin, the benefits become smaller with age, because the chance of serious bleeding increases with age.  Modeling data suggest it may be a good choice to consider stopping taking regular aspirin after around 75. However, stopping daily aspirin can lead to a “rebound” effect where the chances of cardiovascular events increases slightly within the first few weeks that is maintained for at least one year.7 The increased risk means that about one out of every 74 patients (1.4%) who discontinue use will experience a cardiovascular event, such as heart attack or stroke. The risk is higher than 1.4% for people who previously had a CVD event and lower for those who took daily aspirin to prevent a first CVD event.8 If you are currently taking daily low-dose aspirin and want to consider stopping, speak with your doctor about how to safely taper your use.

Does Daily Aspirin Prevent Cancer?

The USPSTF also reviewed scientific studies of whether daily low-dose aspirin can help prevent colorectal cancer. They found that four studies following patients for up to 10 years found no evidence that taking daily aspirin reduced the chances of developing colorectal cancer.5

The 2019 paper mentioned above also found that daily aspirin did not reduce the chances of dying of cancer, compared with no aspirin.4 In fact, one clinical trial in that meta-analysis (called ASPREE: Aspirin in Reducing Events in the Elderly) found that individuals who took aspirin were slightly more likely to die from cancers. Researchers analyzed the overall chance of dying from 14 common cancers, including colorectal cancer, and found that 3.1% of the participants taking daily aspirin had died a cancer-related death at five years follow-up, compared with 2.3% of those taking a placebo.9 This is a small difference but is it conclusive? Most participants in the ASPREE trial had never used low-dose aspirin regularly before joining the study, and that made it impossible to determine if taking “baby” aspirin regularly for many years is likely to increase or decrease the chances of dying of cancer.

However, a more recent, longer-term study, published in 2021 found that people who started using low-dose aspirin regularly at a younger age and who continued after age 70 were less likely to develop colorectal cancer than people who didn’t use low-dose aspirin.10 That study combined 2 large studies that included almost 95,000 patients.

The USPSTF 2022 analysis notes that the evidence about daily aspirin and colorectal cancer is highly variable, with randomized clinical trials showing no benefit and some long-term observational studies showing some possible benefit.11 Given these inconsistent results, the USPSTF does not recommend that older patients begin taking low-dose aspirin for the sole purpose of preventing colorectal cancer.

The Bottom Line: Should I Take a Daily Aspirin?

Overall, the choice to begin taking low-dose aspirin (or to continue if you are already taking it) should be a decision that you make with your healthcare provider, after weighing the potential risks and benefits. The research described above is a good reminder that aspirin is a drug that has risks even at low doses. For many people, aspirin’s risk of serious bleeding may outweigh the benefits of decreased cardiovascular events. However, if you have been taking low-dose aspirin, stopping to take it also has risks, especially if you previously had a cardiovascular event such as a heart attack or stroke. When discussing with your healthcare provider the possibility of taking daily aspirin, let them know:

  •       Your medical history and all the medicines you are currently using, whether they are prescription or over-the-counter,
  •       Any allergies or sensitivities you may have to aspirin, and
  •       Any vitamins or dietary supplements you are currently taking

To read our comments made to the USPSTF about their 2021 updates to their recommendation statement, click here.

Other Ways to Prevent Heart Disease and Cancer

In 2022, heart disease and cancer were the leading causes of death in adults in the United States.

To reduce your risk of heart disease, don’t smoke, exercise regularly, keep your cholesterol and blood pressure under control, and do what you need to do to prevent diabetes.  Being a man and being older also put you at risk, but those are factors you can’t control.

To reduce your risk of colorectal cancer, don’t smoke, don’t drink alcohol in excess, have a healthy diet, stay physically active, and maintain a healthy weight.  Being older, and having a family history of colon cancer, Crohn’s disease, or ulcerative colitis are the risk factors you can’t control.

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. O’Brien CW, Juraschek SP, Wee CC. Prevalence of aspirin use for primary prevention of cardiovascular disease in the United States: results from the 2017 National Health Interview Survey. Annals of Internal Medicine. 2019 Oct 15;171(8):596-8.
  2. Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication. April 26, 2022
  3. Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication. April 11, 2016.
  4. Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019;321(3):277-87.
  5. Guirguis-Blake JM, Evans CV, Perdue LA, Bean SI, Senger CA. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis No. 211. Rockville, MD: Agency for Healthcare Research and Quality; 2021. AHRQ publication no. 21-05283-EF-1.
  6. Khan SU, Lone AN, Kleiman NS, Arshad A, Jain V, Al Rifai M, et al. Aspirin With or Without Statin in Individuals Without Atherosclerotic Cardiovascular Disease Across Risk Categories. JACC: Advances. 2023 Feb;100197.
  7.  Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Archives of Neurology. 2005; 62(8):1217-20.
  8. Sundström J, Hedberg J, Thuresson M, Aarskog P, Johannesen KM, Oldgren J. Low-dose aspirin discontinuation and risk of cardiovascular events: a Swedish nationwide, population-based cohort study. Circulation. 2017; 136(13):1183-92.
  9. McNeil JJ, Nelson MR, Woods RL, Lockery JE, Wolfe R, Reid CM, Kirpach B, Shah RC, Ives DG, Storey E, Ryan J. Effect of aspirin on all-cause mortality in the healthy elderly. New England Journal of Medicine. 2018; 379(16):1519-28.
  10.  Guo C, Ma W, Drew DA, et al. Aspirin Use and Risk of Colorectal Cancer Among Older Adults. JAMA Oncology. Published online January 21, 2021. doi:10.1001/jamaoncol.2020.7338
  11. Mora S, Shufelt CL, Manson JE. Whom to Treat for Primary Prevention of Atherosclerotic Cardiovascular Disease: The Aspirin Dilemma. JAMA Intern Med. Published online April 26, 2022. doi:10.1001/jamainternmed.2022.1365

Statement of Dr. Diana Zuckerman, President, National Center for Health Research, March 8, 2023

Today the FDA announced that 19 women were reported in medical publications who developed squamous cell carcinoma (SCC) in the capsule around breast implants. This is more than the 10 women that FDA reported in September. Several of the women died.  It is important to know that 24 cases of SCC have been reported to the FDA, but it is not known if these cases overlap with the 19 that were published or if some of the 24 cases were reported more than once. Some of the women had silicone gel implants, some had saline implants, some textured, some smooth.  Some of the women got breast implants for augmentation, others for reconstruction after mastectomy.  That means that all women with breast implants need to be aware of this risk, even though it may be rare.

Last September, the FDA also reported 12 cases of lymphomas different from anaplastic large cell lymphoma (ALCL) that were also caused by breast implants.  The agency has not updated those numbers.

Liver Cancer: What is it and how to prevent it

An estimated 100,000 people live with liver cancer in the U.S.[1] with about 41,000 new cases each year.2 Although less common than many other cancers in the U.S., the rate of newly diagnosed liver cancer has tripled since 1980 and death rates have doubled.[2]  It is often diagnosed in late stages and when it is, the average survival after diagnosis is less than 4 months at stage 4, compared to more than 3 years at the earliest stage.[3]

Early diagnosis and reducing the risks of developing liver cancer would save thousands of lives each year.  Research indicates that liver cancer disproportionality affects Asian American and Pacific Islander (AAPI) communities, which is the fasted growing racial and ethnic minority in the US.[4] Asian Americans are almost twice as likely to be diagnosed with liver cancer than Non-Hispanic White Americans, and in 2019, liver cancer was the sixth leading cause of death among 25-44 year old Asian Americans.[5] A better understanding of those disparities could save many lives.

This article will explain the signs and symptoms of liver cancer and the steps you can take to prevent it. 

Symptoms and Outcomes of Liver Cancer

Many symptoms of liver cancer are also symptoms of liver damage, [6]which can include:

  • Jaundice (yellowing of the skin or the whites of the eyes)
  • Pain in the right abdomen or shoulder blade
  • Lump in your right abdomen

However, liver cancer can also result in symptoms that are typical of other illnesses:[7]

  • Weight or appetite loss
  • Nausea or vomiting
  • General weakness or fatigue 

Primary liver cancer refers to cancer that originates in the liver, and is usually a single large tumor, whereas liver cancer that originates from another region of the body but spreads to the liver is called liver metastases and usually consists of several small tumors.[6] Liver metastases are more common than primary liver cancer and may spread throughout the liver before they are detected, while primary liver cancer can cause symptoms very early.[6,8]

How can you prevent it? 

There are several things you can do to reduce your chances of developing primary liver cancer.

Get tested for Hepatitis C: Approximately half of all primary liver cancer can be attributed to a single cause: the Hepatitis C virus.[9] The virus causes inflammation to the liver, which can lead to scarring (or ‘cirrhosis’) and then ultimately to liver cancer. You can contract Hepatitis C by being in contact with the blood of an infected person, so injecting drugs. is the most common way the virus is spread in the U.S.[10] The virus may silently damage the livers of infected people for decades before any symptoms appear. In fact, about half of people with Hepatitis C don’t even know they are infected.[11] Of the 3.5 million Americans estimated to be infected with Hepatitis C, 81% are baby boomers who were likely infected before Hepatitis C was discovered in 1989.[9]

Since Hepatitis C often has no symptoms, it’s crucial to get tested. The CDC recommends that all adults get tested for Hepatitis C at least once in their life, and all pregnant women get tested during every pregnancy.[12] Persons who inject drugs or share needles should get tested regularly.[12]

Get vaccinated for Hepatitis B: Hepatitis B is thought to cause about 15% of Liver cancer cases in the U.S. Like Hepatitis C, Hepatitis B attacks the liver, and most people who have been infected don’t realize it.[13] While about 1 million more Americans are living with Hepatitis C than B,[13] Hepatitis B is 5-10 times more infectious and is most commonly spread from mother to child during birth.[14] It is also more commonly transmitted through sexual activity than Hepatitis C.[15] Fortunately, Hepatitis B can be prevented with a vaccine, while Hepatitis C currently cannot. The Hepatitis B vaccine is usually given as a series of 3 shots shortly after birth, 1-2 months after birth, and 6-18 months after birth.[16] As of 2022, the CDC recommends all unvaccinated children and adults age 19-59 receive the Hepatitis B vaccine.[17] 

Asian American and Pacific Islanders make up approximately half of all Americans currently infected with Hepatitis B, despite making up only 6% of the U.S. population. That is likely because Hepatitis B has circulated around many countries in East Asia, Southeast Asia, and the Pacific for thousands of years, and also because these regions have very low rates of infant Hepatitis B vaccinations.[18]

Get treated for Hepatitis B or C: There are many treatment options for chronic Hepatitis C that can reduce its viral load to an undetectable level and help prevent cancer-causing liver damage. Antiviral medications are one of the most common ways treat the virus. FDA has approved several antiviral medications for the treatment of either Hepatitis B or C in the US, and there continue to be new advances in treatment options. These antiviral medications may vary in terms of safety or effectiveness. For example,  information about two of the most widely used Hepatitis B antivirals (Baraclude and Vemildy) and Hepatitis C antivirals (Mavyret and Epclusa) are shown in the table below.[19,20] FDA has approved all these drugs as having benefits that outweigh the risks in treating Hepatitis B or C, but your doctor may suggest specific medications based on your Hepatitis diagnosis, preexisting conditions, and other health factors.

Name of antiviral Description and usage Unique advantages Side Effects (including % of patients who experience them)
Baraclude (Entecavir) Pill usually taken once a day for many months and up to a year or more to treat Hepatitis B. Shown to be more effective for those with resistance to other Hepatitis B drugs such as lamivudine or adefovir.19 Common

  • Liver Cancer (10-12%)21 
  • Low albumin in the blood, which can cause swelling, weakness, fatigue, or cramps (10-30%)21,22
  • Increases the risk of dangerous bleeding by lowering the platelets in the blood (10-20%)21,23
  • Elevated lipase, which may indicate disease of the pancreas (10-18%)21,24
  • Swelling in your lower legs or hands (10-16%)21

Rare / Serious

  • Kidney failure (0.1-1%)21
  • Lactic acid buildup, which can be fatal ^ 25

Enlarged liver^ 25

Vemlidy (Tenofovir alafenamide) Pill usually taken once a day for many months and up to a year or more to treat Hepatitis B. Very similar advantages to Entecavir when compared to other drugs.19 Research is needed to directly compare this drug with Entecavir to see if one is more effective than the other.19 Common

  • Headache (1-12%)26
  • Abdominal pain (1-10%)26
  • Nausea (1-10%)26
  • Fatigue (1-10%)26        
  • Rash (1-10%)26

Rare / Serious

  • Lactic acid buildup, which can be fatal ^ 27
  • Enlarged liver^ 27
Mavyret (Glecaprevir and Pibrentasvir) Pill usually taken once a day for 8-16 weeks to treat Hepatitis C. Only drug approved by FDA for a shorter 8-week treatment period instead of the usual 12-week period for other drugs.28 Common

  • Headache (10-17%)29
  • Itchy skin (10-17%)29
  • Fatigue (10-16%)29
  • Nausea (10-12%)29

Rare / Serious

  • Reactivation of Hepatitis B (for those co-infected) ^ 30
  • Allergic reaction (which can cause swelling or difficulty breathing) ^ 30
Epclusa (Sofosbuvir and Velpatasvir) Pill usually taken once a day for 12 weeks to treat Hepatitis C. Only drug approved to treat Hepatitis C in children as young as 6 years old.31 It is also the first medication to treat all 6 Hepatitis C genotypes.20  Common

  • Fatigue (10-32%)32
  • Headache (10-29%)32
  • Anemia (10-26%)32
  • Nausea (10-15%)32

Rare / Serious

  • Reactivation of Hepatitis B (for those co-infected) ^ 33
  • Allergic reaction (which can cause swelling or difficulty breathing) ^ 33

^ frequency not reported

Avoid alcohol and smoking: Alcohol is well known to damage the liver; an analysis of 112 studies found that consuming an average of just one alcoholic drink a day was associated with a 10% greater chance of developing liver cancer.[34] The annual average is of 9.5 new cases and 6.6 deaths from liver cancer for every 100,000 adults in the U.S.,[1] but a review of 28 studies that analyzed almost 5,000 new cases of liver cancer and more than 10,000 liver cancer deaths found that moderate and heavy drinkers (at least 1 drink/day for females and at least 2 drinks/day for males) were 42% more likely to be diagnosed with liver cancer and 17% more likely to die from it.[35] 

Smoking also significantly increases the chance of developing liver cancer. A 2018 study of more than 1 million Americans found that current smokers were 86% more likely to be diagnosed with liver cancer than non-smokers. Fortunately, the study also found that individuals who quit smoking at least 30 years ago had the same risk of liver cancer as those who had never smoked, suggesting that younger smokers who decide to quit smoking now can significantly reduce their future risk of developing liver cancer.

Maintain a healthy weight: Studies consistently show that being overweight or obese increases the risk of developing liver cancer;[36] In one analysis of 11 different studies, even after most studies controlled for the effects of age, sex, smoking, and other health conditions, being overweight (BMI between 25-30) increased the risk of liver cancer by 17%, while being obese (BMI 30 or above) increased the risk by 89%.[37] For example, one of the studies, of more than 780,000 Korean men, found a rate of liver cancer of 43 out of every 100,000 for men with a healthy weight (BMI 18.5-25), compared to 66 for every 100,000 for men who were obese.[38] This may be because fat tissue that accumulates in the liver can cause damaging inflammation, which may then lead to liver cancer.[36]

Taking steps to maintain a healthy weight through diet and exercise can therefore reduce the chances of developing liver cancer. An important question is whether losing weight through bariatric surgery also reduces the chances of developing liver cancer.[36] For example, in a study of 190 morbidly obese individuals with non-alcoholic steatohepatitis (a type of fatty liver disease that increases the risk of liver cancer), 85% were rid of the disease one year after bariatric surgery.[39] However, more long-term research is needed to investigate whether bariatric surgery reduces the risk of liver cancer or whether other factors are influencing those better outcomes.[36] For example, in a 2022 study, more than 5,000 adults with obesity who received bariatric surgery and more than 25,000 patients who received nonsurgical care were followed for an average of 6 years. While bariatric surgery patients had a lower rate of liver cancer (9 versus 15 cases per 100,000 people per year), this difference was not statistically significant when adjusted for other factors such as age, sex, smoking status, and medication use.[40]  That means that the differences were probably due to those other traits, not to the bariatric surgery itself.


  1. Cancer of the Liver and Intrahepatic Bile Duct – Cancer Stat Facts. SEER. Accessed August 4, 2022.
  2. Key Statistics About Liver Cancer. Accessed August 4, 2022.
  3. Survival | Liver cancer | Cancer Research UK. Accessed August 9, 2022.
  4. Budiman A, Ruiz NG. Key facts about Asian Americans, a diverse and growing population. Pew Research Center. Published 2021. Accessed December 16, 2021.
  5. Chronic Liver Disease and Asian Americans – The Office of Minority Health. Accessed August 4, 2022.
  6. The Warning Signs of Liver Cancer. Verywell Health. Accessed August 4, 2022.
  7. Liver cancer – Symptoms and causes. Mayo Clinic. Accessed August 4, 2022.
  8. Lee S. Liver metastases. Canadian Cancer Society. Accessed August 4, 2022.
  9. Viral Hepatitis and Liver Cancer. Published online 2016:3.
  10. Policy (OIDP) O of ID and H. Hepatitis C Basic Information. Published April 10, 2016. Accessed August 5, 2022.
  11. Hepatitis C – Symptoms and causes. Mayo Clinic. Accessed August 5, 2022.
  12. Schillie S. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep. 2020;69. doi:10.15585/mmwr.rr6902a1
  13. Policy (OIDP) O of ID and H. Viral Hepatitis in the United States: Data and Trends. Published April 20, 2016. Accessed August 5, 2022.
  14. What’s the Difference: Hepatitis B vs Hepatitis C? Hepatitis B Foundation. Published January 9, 2019. Accessed August 5, 2022.
  15. Sexual Transmission and Viral Hepatitis | CDC. Published April 22, 2021. Accessed August 5, 2022.
  16. CDC. Hepatitis B and the Vaccine (Shot). Centers for Disease Control and Prevention. Published August 2, 2019. Accessed August 5, 2022.
  17. CDC. Hepatitis B – Vaccination of Adults | CDC. Centers for Disease Control and Prevention. Published March 28, 2022. Accessed August 5, 2022.
  18. hepbtalk. Hepatitis B in Asian Populations. Hepatitis B Foundation. Published December 23, 2020. Accessed August 5, 2022.
  19. Chen LP, Zhao J, Du Y, et al. Antiviral treatment to prevent chronic hepatitis B or C-related hepatocellular carcinoma. World J Virol. 2012;1(6):174-183. doi:10.5501/wjv.v1.i6.174
  20. Hepatitis C Medications: A Full List. Healthline. Published May 4, 2022. Accessed August 10, 2022.
  21. Entecavir Side Effects: Common, Severe, Long Term. Accessed August 10, 2022.
  22. Hypoalbuminemia: Causes, Symptoms, Treatment & Outlook. Cleveland Clinic. Accessed August 12, 2022.
  23. Thrombocytopenia (low platelet count) – Symptoms and causes. Mayo Clinic. Accessed August 12, 2022.
  24. Durval A, Zamidei L, Bettocchi D, Luzzio MG, Consales G. Hyperlipidemic acute pancreatitis: a possible role of antiretroviral therapy with entecavir. Minerva Anestesiol. 2011;77(10):1018-1021.
  25. Entecavir (Oral Route) Side Effects – Mayo Clinic. Accessed August 10, 2022.
  26. Vemlidy Side Effects: Common, Severe, Long Term. Accessed August 10, 2022.
  27. Tenofovir Alafenamide (Oral Route) Side Effects – Mayo Clinic. Accessed August 10, 2022.
  28. Commissioner O of the. FDA approves treatment for adults and children with all genotypes of hepatitis C and compensated cirrhosis that shortens duration of treatment to eight weeks. FDA. Published March 24, 2020. Accessed August 5, 2022.
  29. Mavyret Side Effects: Common, Severe, Long Term. Accessed August 10, 2022.
  30. Mavyret side effects: What they are and how to manage them. Published July 27, 2022. Accessed August 10, 2022.
  31. Commissioner O of the. FDA Approves New Treatment for Pediatric Patients with Any Strain of Hepatitis C. FDA. Published March 24, 2020. Accessed August 5, 2022.
  32. Epclusa Side Effects: Common, Severe, Long Term. Accessed August 10, 2022.
  33. Epclusa: Side effects, for hepatitis C, dosage, and more. Published June 30, 2022. Accessed August 10, 2022.
  34. Chuang SC, Lee YCA, Wu GJ, Straif K, Hashibe M. Alcohol consumption and liver cancer risk: a meta-analysis. Cancer Causes Control. 2015;26(9):1205-1231. doi:10.1007/s10552-015-0615-3
  35. Park H, Shin SK, Joo I, Song DS, Jang JW, Park JW. Systematic Review with Meta-Analysis: Low-Level Alcohol Consumption and the Risk of Liver Cancer. Gut Liver. 2020;14(6):792-807. doi:10.5009/gnl19163
  36. Saitta C, Pollicino T, Raimondo G. Obesity and liver cancer. Annals of Hepatology. 2019;18(6):810-815. doi:10.1016/j.aohep.2019.07.004
  37. Larsson SC, Wolk A. Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies. Br J Cancer. 2007;97(7):1005-1008. doi:10.1038/sj.bjc.6603932
  38. Oh SW, Yoon YS, Shin SA. Effects of Excess Weight on Cancer Incidences Depending on Cancer Sites and Histologic Findings Among Men: Korea National Health Insurance Corporation Study. JCO. 2005;23(21):4742-4754. doi:10.1200/JCO.2005.11.726
  39. Lassailly G, Caiazzo R, Buob D, et al. Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients. Gastroenterology. 2015;149(2):379-388; quiz e15-16. doi:10.1053/j.gastro.2015.04.014
  40. Aminian A, Wilson R, Al-Kurd A, et al. Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity. JAMA. 2022;327(24):2423-2433. doi:10.1001/jama.2022.9009

Cancer of the Immune System (ALCL) and Breast Implants: Plastic Surgeons Study 173 Women

Diana Zuckerman, PhD, Cancer Prevention & Treatment Fund

In 2015, plastic surgeons who have been well known for defending the safety of breast implants published a study of 173 women with cancer of the immune system caused by breast implants. [1]   The study was paid for by a plastic surgery medical association and written by plastic surgeons who have defended the safety of breast implants for decades.

ALCL (Anaplastic Large Cell Lymphoma) develops near a breast implant but is not breast cancer – it is a cancer of the immune system.  The authors of this study point out that the first silicone breast implant was implanted in 1962 and the first publicly reported case of ALCL in a woman with silicone breast implants was in 1997. The authors reviewed 37 medical articles reporting on 79 patients and collected information about an additional 94 women with ALCL caused by breast implants.


Physicians first identified these 173 women with ALCL based on either seromas (a collection of fluid under the skin), a mass attached to the scar capsule surrounding the implant, a tumor that eroded through the skin, in a lymph node near the breast, or discovered during surgery to replace a breast implant. Whether the women had silicone gel or saline breast implants didn’t seem to make a difference, but many of the women had at least one textured breast implant.  Cosmetic augmentation patients and women who had breast implants to reconstruct their breasts after undergoing a mastectomy were both at risk of developing ALCL because of their implants.  Of the women whose ALCL spread outside of their scar capsule surrounding the implant, about half died from ALCL.

The authors pointed out that ALCL can be difficult to diagnose.  Although the fluid and scar capsule usually appear abnormal, they sometimes look normal. The authors recommend “that all fluid and capsule tissue from patients with seromas” should be tested for ALCL.  They point out that if the tumor is inside the capsule, removing both implants and the capsules may be the only treatment necessary.  However, if the tumor has developed just outside the capsule, chemotherapy with or without radiation is needed and usually effective.  Unfortunately, aggressive ALCL that has spread beyond the scar capsule area is usually fatal, regardless of treatment.

2017 Update

In March 2017, the U.S. Food and Drug Administration (FDA) reported that it had received 359 reports of ALCL among women with breast implants. Unfortunately, many cases of ALCL are not reported to the FDA.  The FDA’s announcement came after the World Health Organization (WHO) officially named the disease “breast implant associated ALCL (BIA-ALCL)” in 2016. In 2014, the National Comprehensive Cancer Network (NCCN) has also released a worldwide oncology standard for surgeons and oncologists to test for and diagnose the disease.

To read the official summary of this article, click here:

To read about another study on ALCL, click here.

To read more about what you need to know about ALCL, click here.


  1.  Brody GSDeapen DTaylor CRPinter-Brown LHouse-Lightner SRAndersen JSCarlson GLechner MGEpstein AL. Anaplastic Large Cell Lymphoma Occurring in Women with Breast Implants: Analysis of 173 Cases. Plastic and Reconstructive Surgery. Vol 135: 695, 2015.

Breast Implants and Cancer of the Immune System (ALCL): A History of Who Knew What When

Maura Duffy, Cancer Prevention & Treatment Fund

Experts now agree that breast implants can cause a type of cancer of the immune system.  The FDA finally admitted this risk of cancer in 2017, but other experts – including plastic surgeons — were aware of the risk years before.  Why did it take so long for FDA, the media, and women with implants to find out that choosing breast implants could increase their chances of developing a potentially fatal disease?

Anaplastic large cell lymphoma (ALCL) is a rare type of cancer of the immune system that usually develops in the lymph nodes, skin, lungs, or liver. However, ALCL sometimes develops in the breast area of women with breast implants.

In 2008 Dutch researchers published a report of 11 women with breast implants and ALCL, and concluded that the implants seemed to be associated with ALCL.[3]  Although published in the Journal of the American Medical Association (JAMA), this information was not widely reported.

The link between ALCL and breast implants was first reported by the FDA in January of 2011. In 2013, researchers at MD Anderson Cancer Center studied 60 women with breast implants who were diagnosed with ALCL in the breast. Since ALCL was thought to be diagnosed in only 1 woman in half a million, this was much higher than would be expected.[4]  In 2016, the World Health Organization (WHO) officially recognized BIA-ALCL.[5]  In 2017, the National Comprehensive Cancer Network (NCCN), a nonprofit network of cancer experts, released a worldwide oncology standard for surgeons and oncologists to test for and diagnose “breast implant associated ALCL (BIA-ALCL).” NCCN includes a guided algorithm for surgeons and oncologists to test for and diagnose the disease.  They concluded that any abnormal accumulation of fluid or a mass that develops near the breasts in women with breast implants must be evaluated.

And yet, it was not until March 2017 that the FDA finally updated its website to officially report that breast implants could cause ALCL. At the time of the FDA announcement, the agency reported that they had received 359 reports of ALCL among women with breast implants. Reports to the FDA of problems from medical devices are acknowledged to be the “tip of the iceberg” since surgeons frequently do not do these online reports.

How did women find out they had ALCL before the official announcement of BIA-ALCL was made? Most of them approached their doctors with symptoms such as pain, lumps, swelling, or asymmetry in their breasts years after getting implants.  Since breast implants are a “foreign body,” the body forms scar tissue around the implant to protect their body from this “foreign invader.”  The scar tissue surrounding the implant is known as the scar capsule. It is natural for the body to form scar tissue, and the scar tissue is only a problem if it tightens or hardens around the implants, causing pain and hardness known as “capsular contracture.”  Breast implant-associated ALCL is almost always found in the scar capsule surrounding the implant, not the breast tissue itself. It has been reported in women both with and without capsular contracture, as well as women with silicone gel or saline breast implants.[4]

ALCL is diagnosed by testing the fluid that collects around the implant, called a seroma.[5] Seroma is usually not caused by ALCL.  It is important to understand that even when ALCL is in the breast, it is not breast cancer, but rather a cancer of the immune system.  Most breast implant-associated ALCL has cancer cells within the fluid inside the scar capsule. That ALCL can be treated by removing the implant and the surrounding scar tissue. This surgery is known as a capsulectomy.

One study of nine women who had a capsulectomy after being diagnosed with BIA-ALCL found that all nine were disease free when they were studied 3.5 years later, and they did not require chemotherapy nor radiation treatment. However, some types of ALCL are more aggressive and need to be treated with chemotherapy or radiation. [6]

In December 2013, the study of 60 patients with breast implants and ALCL reported that the ALCL was more likely to be fatal for women who had a solid ALCL tumor than for women who had ALCL cancer cells in the surrounding fluid (known as effusion ALCL). All of the patients with effusion-type ALCL were still alive 5 years after their diagnosis, compared to only 75% of the patients with solid ALCL tumors. ALCL returned in only 14% of patients with effusion-type ALCL. Patients with solid ALCL tumors had a 50% recurrence rate.[7]

Longer studies with more patients are needed to determine if certain kinds of breast implants are more likely to cause ALCL.  Preliminary data indicate that most, but not all, women with BIA-ALCL had textured breast implants at some point.  Meanwhile, women with all types of implants should have routine follow-ups and should immediately see a doctor if one or both of their breasts become swollen.

For women with silicone implants, FDA recommends getting a breast coil MRI three years after getting the implants, and every two years after that.[8]

Although plastic surgeons and breast implant manufacturers admit that breast implants can cause ALCL, they claimed it was very rare.  For example, Allergan, a manufacturer of many different types of breast implants, claimed that “A woman is more likely to be struck by lightning than to get this condition.”[9]   However, 400 people are injured or killed by lightning every year,[10] which is why most people avoid situations where lightening can harm them.

In fact, the Australian version of the FDA now estimates that 1 in 1,000 women with breast implants will develop BIA-ALCL, [11] which is not nearly as rare as plastic surgeons and manufacturers have claimed.

Many women would not want to take the chance of developing cancer as a result of breast implants, and this is especially true for women who underwent mastectomies that were not medically necessary in an effort to reduce their chances of cancer returning.

It is also important to note that the link between breast implants and autoimmune diseases has been hotly debated for two decades, with many women reporting serious autoimmune symptoms that went away when their implants were removed.[11]  The scientific evidence regarding ALCL and implants once again raises questions about the possible impact of breast implants on autoimmune disease or symptoms such as joint pain, body pain, memory loss, and chronic fatigue.

For many years, women with breast implants were assured by implant companies, plastic surgeons, and the FDA that breast implants did not cause breast cancer or any other type of cancer. Evidence of a link to some types of cancer and to autoimmune diseases, including studies conducted by researchers at FDA and the National Cancer Institute, was dismissed. However, as everyone knows from data on lung cancer and smoking, it can take decades to determine if an exposure causes cancer or other serious diseases. Even a very strong carcinogen, such as tobacco, is very unlikely to cause lung cancer for at least 30 years.  For this reason, it is essential that physicians and researchers take a closer look at the link between breast implants and cancer of the immune system, as well as other immune disorders.

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


  1. Mazzucco, AE. Next Steps for Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol, 2014. Early release publication. June 16, 2014.
  2. S. Food and Drug Administration. 26 January 2011. Web. June 25, 2012, <>
  3. “Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants: Preliminary FDA Findings and Analyses.” January 2011. Center for Devices and Radiological Health. U.S. Food and Drug Administration. Web. June 25, 2012, <>
  4. “FDA Questions and Answers about Anaplastic Large Cell Lymphoma (ALCL).” U.S. Food and Drug Administration. 26 January 2011. Web. June 25, 2012, <>
  5. Kim B, Roth C, Young VL, Chung KC, van Busum K, et al. Anaplastic large cell lymphoma and breast implants: results from a structured expert consultation process. Plastic and Reconstructive Surgery. 2011 Sep;128(3):629-39.
  6. Aladily TN, Medeiros JL, Amin, MB, Haideri N, et al. Anaplastic Large Cell Lymphoma Associated with Breast Implants: A Report of 13 Cases. Am J Surg Pathol. 2012 June 36(6).
  7. end Miranda, et al. Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients. J Clin Oncol. 9 December 2013.
  8. FDA Update on the Safety of Gel-Filled Breast Implants.” June 2011. Center for Devices and Radiological Health. U.S. Food and Drug Administration. Web. June 25, 2012, target=”_blank”>>
  9. Edwards, Jim. “Breast Implant Maker Challenges FDA on Cancer Link.” CBS Money Watch. 27 January 2011. Web. 25 June target=”_blank”>
  10. Cooper, Mary Ann, MD. “Medical Aspects of Lightning.” National Weather Service. Web. 25 June 2012.
  11. Mazzucco, Anna, Ph.D and Zuckerman, Diana, Ph.D. “ALCL and Breast Implants: 2017 Update.” Breast Implant Information. Web. March 14, 2017. <>

ALCL and Breast Implants: 2017 Update

Anna E. Mazzucco, PhD and Diana Zuckerman, PhD, Cancer Prevention & Treatment Fund

In March, 2017, the U.S. Food and Drug Administration (FDA) updated its website to officially report that breast implants could cause a type of cancer of the immune system called anaplastic large cell lymphoma (ALCL).  They stated they have received 359 reports of ALCL among women with breast implants.

The FDA’s announcement came 10 months after the disease was named breast implant associated ALCL (BIA-ALCL) in a  World Health Organization publication in 2016, and a few months after the and the National Comprehensive Cancer Network (NCCN) released the first worldwide oncology standard for the disease.  NCCN includes a guided algorithm for surgeons and oncologists to test for and diagnose the disease.  They concluded that any abnormal accumulation of fluid or a mass that develops near the breasts months after breast implants were implanted must be evaluated.

The oncologists also state that even if the BIA-ALCL is confined to the scar capsule that surrounds the implant and even if that capsule is totally removed through proper explant surgery, the patient must be followed for 2 years.  Here is the link to their guidelines:

Although rare, it seems that BIA-ALCL is not “very rare.”  In Australia, which can track medical problems from any kind of implants better than the tracking of implants in the U.S., they estimate that BIA-ALCL affects one woman per 1,000 with breast implants.  The estimates were much lower in the U.S., but there is no reason to think BIA-ALCL is less likely to develop in women in the U.S.  Given the dramatic increase in diagnoses in recent years, it is clear that BIA-ALCL was under-diagnosed and under-reported for many years.

The sooner ALCL is diagnosed, the more likely it can be treated easily and effectively by removing the implants and capsule.  At later stages, treatment includes chemo and is less likely to be successful, as specified by researchers at the well-respected MD Anderson Cancer Center in a medical journal in 2013. Their study followed women for 5 years and found that ALCL related to breast implants sometimes requires chemotherapy, and approximately 25% of the implant patients with the more serious type of ALCL died during the 5 years following their diagnosis.[1] Dr. Anna Mazzucco published a response to this study,[2] urging physicians to respond quickly and to check patients who have swelling near their implants for ALCL. This would require cytology testing rather than testing for bacteria. The authors of the original study also published a response to Dr. Mazzucco’s article, expressing similar concerns.[3]

For more information, see our summary of that study here.

ALCL caused by breast implants can result in swelling, which is often mistaken for an infection and treated with antibiotics. Antibiotics are ineffective against ALCL and the delay in timely and appropriate treatment for ALCL is dangerous.

Unfortunately, some health insurance companies have traditionally not covered the cost of medical tests or treatment for women with breast problems related to cosmetic breast implants. The published articles on ALCL clearly indicate that this can result in undetected cancer of the immune system (ALCL), which can be fatal. In addition, delays in treatment for ALCL can be extremely expensive for patients and their insurance companies; the companies would be required to pay for treatment for ALCL when it is eventually diagnosed at a later stage.


  1. Miranda RN, Aladily TN, Prince HM, et al: Breast implant–associated anaplastic large-cell lymphoma: Long-term follow-up of 60 patients. J Clin Oncol 32:114-120, 2014.
  2. Mazzucco, AE. Next Steps for Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol, 2014.
  3. Miranda RN. Reply to AE Mazzucco. J Clin Oncol, 2014. Early Release publication. June 16, 2014.

Phthalates and Children’s Products

Paul Brown, Keris Krenn Hrubec, Dana Casciotti, PhD, Brandel France de Bravo, MPH, Stephanie Fox-Rawlings, PhD, Cancer Prevention & Treatment Fund

Phthalates are synthetic chemicals found in every home, in plastic toys, personal care products such as shampoos and lotions, vinyl floors, and shower curtains. They are also found in some medical products, such as saline bags, feeding tubes and catheters. They are used to make plastic flexible and to add fragrances to soap and other personal products.  Unfortunately, these chemicals don’t stay inside the products. Based on recent research on ants, scientists have concluded that the high levels of phthalates in the bodies of insects around the world are the result of phthalates in the air.[1] Because phthalates are released into the air and dust around us, they are found in human urine, blood, and breast milk.[2] Levels are highest in women and children ages 6 to 11. Young children may have higher levels of phthalates in their bodies because their hands find their way into their mouths more frequently: they touch objects made with phthalates and surfaces covered with phthalate dust, and then their hands touch their mouths.

Phthalates are called “endocrine disruptors” because they affect the body’s hormones by mimicking them or blocking them. They interfere with the body’s natural levels of estrogen, testosterone, and other hormones, which is why they are called “disruptors.” Endocrine disruptors are hard to study for several reasons: 1) we are exposed to very small quantities from many different sources every day, 2) researchers have proved that, unlike other chemicals, these appear to have more serious effects at lower levels than at higher levels.[3] Usually, we assume that the higher the dose or exposure, the greater the harm, but endocrine disruptors play by different rules. The director of the National Institute of Environmental Health Sciences, Linda Birnbaum, says that chemical manufacturers are asking “old questions” when they test for safety even though “science has moved on.”[4]

Hormones can increase the risk of some cancers, whether those hormones are natural or synthetic. Too much or too little of a hormone can be harmful. Is a child who is exposed to phthalates more likely to develop cancer as an adult?  No one knows for sure but animals exposed to phthalates are more likely to develop liver cancer, kidney cancer, and male reproductive organ damage.[5]

Phthalates are believed to also affect girls’ hormones, but the health impact is not yet known. Studies also show associations between children’s exposure to phthalates and the risk of asthma, allergies and bronchial obstruction.[6][7][8]

Researchers at Mount Sinai also found a link between obesity and phthalates.[9] They found that among overweight girls ages 6 to 8, the higher the concentration of certain phthalates (including low molecular weight phthalates) in their urine, the higher their body mass index (BMI).  BMI takes height and weight into account when determining if someone is overweight. A study among Danish children ages 4 to 9 found that the higher the concentration of phthalates (all of them), the shorter the child. This was true for girls and boys.[10] More research is needed to determine the impact of phthalates on height and BMI.

Even short-term exposure has now been linked to developmental deficits.[11] Researchers found that children in intensive care units were exposed to the phthalate DEHP through plastic tubing and catheters. The children had 18 times (!)  as much DEHP in their blood compared to children who had not spent time in the ICU. Four years later, the children who had been exposed to DEHP had more problems with attention and motor coordination. The researchers found that the DEHP caused these problems regardless of medical complications or treatments.

Prenatal Exposure to Phthalates

Childhood exposure to phthalates begins in the womb. Several studies that have tested phthalate levels in women in their third trimester of pregnancy have found health effects in the infants, toddlers, and older children of the mothers with the highest levels. There are many different types of phthalates. Most studies look at several types, and the effects tend to vary by type.  A 2011 study found that six-month-old boys whose mothers had the highest phthalate levels scored lower on brain and motor development tests.[12] The same effect was not true for female infants.

Research indicates that boys exposed to phthalates while in the womb may be more likely to develop smaller genitals and incomplete descent of the testicles.[13] Boys who are born with undescended testicles are 2-8 times more likely to develop testicular cancer later on than men born with both testicles descended[14] (their risk is lessened if they get corrective surgery before age 13.[15]). Studies by Harvard researchers have shown phthalates may alter human sperm DNA and semen quality.[16][17][18][19]

Columbia University researchers discovered that three-year olds with high prenatal exposure to two types of phthalates were more likely to have motor delays.[20] They also reported that three phthalates were linked to certain behavior problems in three-year olds, such as social withdrawal.  One phthalate in the study was linked to lower mental development in girls.

Other studies have also linked increased prenatal phthalate exposure to behavior problems. Researchers in Taiwan found an association with aggressive and disobedient behaviors in eight-year-olds of both sexes.[21][22] Similarly, researchers from Icahn School of Medicine at Mount Sinai found that higher levels of exposure to phthalates during gestation were associated with aggression, rule-breaking, and conduct problems for males only.[23]

Researchers at Mount Sinai School of Medicine studied the impact of prenatal exposure to “low molecular weight” phthalates—the kind often found in personal care products and the coatings of some medications—on the social behavior of children ages 7 to 9. Children who were exposed to higher levels of these phthalates, which include DEP and DBP, had worse scores for social learning, communication, and awareness.  This means they were less able to interpret social cues, use language to communicate, and engage in social interactions.[24]

What Is Being Done to Limit Children’s Exposure?

As of February, 2009, children’s toys and child care products sold in the U.S (such as teething rings and plastic books) cannot contain certain phthalates.  The ban on those phthalates is the result of a law passed in 2008, the Consumer Product Safety Improvement Act.  The law permanently bans certain kinds of phthalates (BBP, DBP and DEHP) from toys and child care products, and temporarily bans other phthalates (DIDP, DINP and DnOP) until a scientific board (the Chronic Hazard Advisory Panel) determines for the Consumer Product Safety Commission (CPSC) whether or not they are safe. In 2014 the Chronic Hazard Advisory Panel determined that stricter regulations were appropriate.[25] It stated that the permeant bans should remain on BBP, DBP and DEHP, and that DINP should be added to this list. Furthermore, because a large component of exposure to these chemicals comes from food and other products, it recommended increased regulation. The panel was less concerned about DIDP and DnOP, but recommended additional study. Finally, the panel recommended permanently banning DIBP, DPENP, DHEXP, and DCHP, and putting an interim ban on DIOP.

A few months before the 2008 bill passed, major retailers such as Wal-Mart, Target, and Babies “R” Us promised to remove or severely restrict children’s products containing phthalates by the end of 2008.[26] That provided added incentives for major companies making teething rings and other soft plastic products to stop using phthalates.

The ban in the U.S.followed similar bans in other countries.  In 2006, the European Union banned the use of 6 phthalates in toys that may be placed in the mouth by children younger than 3 years old.[27] The banned phthalates are DINP, DEHP, DBP, DIDP, DNOP, and BBzP.  Fourteen other countries, including Japan, Argentina, and Mexico, had also banned phthalates from children’s toys prior to the U.S.

Phthalate Exposure Continues

A 2014 study looking at data over a ten-year period (2001– 2010) found that exposures to some phthalates have declined while others have increased. Americans’ exposure to three substances permanently banned in toys and children’s products—DEHP, DBP and BBP—has declined. But exposure to other phthalates such as DiNP and DiBP, as measured in urine, has increased. The higher  levels of DiBP and other phthalates “suggest that manufacturers may be using them as substitutes for other phthalates even though the US EPA has expressed concern about their use.”[28] It is surprising that DiNP exposure has gone up since it was banned on an interim basis from children’s toys and children’s products.  Additionally, in 2013, California declared DiNP a carcinogen.[29]

Even with the ban on phthalates in children’s toys, children, and adults, too, continue to be exposed because these chemicals are in many products, including food packaging, pharmaceuticals, medical devices and tubing, soap, lotions, and shampoos.[30] Johnson & Johnson recently reformulated its baby shampoo to remove harmful chemicals,[31] and Proctor & Gamble has promised to eliminate the phthalate DEP from fragrances used in its products by the end of 2014.[32] DEP is used in personal care products  and “reductions in DEP exposures have been the most pronounced,” according to the 2014 study.[33] Ten years ago, more than a thousand companies pledged to remove “chemicals of concern from personal care products,” however, it is unclear how many have done so. The U.S. Food and Drug Administration (FDA) regulates many of these products, including baby shampoo and baby lotion.  If the FDA does not decide to ban phthalates from these products, legislation would be required to do so.

The U.S. Environmental Protection Agency (EPA) developed an “action plan” in 2010 for eight phthalates “because of their toxicity and the evidence of pervasive human and environmental exposure.” [34] The phthalates are being studied for health effects and for alternatives. The EPA developed two new rules for these chemicals. However, the rules were delayed and then withdrawn in 2013.[35] In 2014, seven of these phthalates were included in the Toxic Substances Control Act work plan, because of their potential for harm and the frequency of exposure.[36] The eighth phthalate (DnPP) was not included because it is no longer being used in new products. The chemicals on the work plan are to be assessed for additional study or regulation, but it is unclear when that assessment will occur.

While other government agencies are concerned about phthalates in specific products, the EPA’s job is to focus on the chemicals for use in any kind of product and establish safety standards for each phthalate.  A challenge for the EPA is to set safety standards that make sense given that people may be exposed to several phthalates from many different sources. Teenage girls, for instance, have been found to use up to 17 personal care products a day.[37] Setting safety standards for phthalates individually or for individual products without considering their interactions and cumulative effects could underestimate the real-world risks of phthalates to the health of children and adults.

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


  1. Rudel RA, Brody JG, Spengler JD, Vallarino J, Geno PW, Sun G, Yau A (2001). Identification of selected hormonally active agents and animal mammary carcinogens in commercial and residential air and dust samples. Journal of Air and Waste Management Association 51(4):499-513.
  2. Kato K, Silva MJ, Reidy JA, Hurtz D, Malek NA, Needham LL, Nakazawa H, Barr DB, Calafat AM (2003). Mono(2-ethyl-5-hydroxyhexyl) phthalate and mono-(2-ethyl-5-oxhexyl) phthalate as biomarkers for human exposure assessment to di-(2-ethylhexyl) phthalate. Environmental Health Perspectives 112: 327-330.
  3. Vandenberg et al. (2012). Hormones and Endocrine Disrupting Chemicals: Low-dose Effects and Nonmonotonic Dose Responses. Endocrine Reviews.  First published ahead of print March 14, 2012 as doi:10.1210/er.2011-1050.
  4. Cone, Marla and Environmental Health News. Low Doses of Hormone-Like Chemicals May Have Big Effects. Scientific American.march 15, 2012.
  5. Vastag, B., (2001). CDC Unveils First Report on Toxins in People, JAMA 285(14): 1827-1828.
  6. Jaakkola JJ, Knight TL (2008 July). The Role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: a systematic review and meta-analysis. Environ Health Perspect, 116(7): 845-53.
  7. Kanazawa A, Kishi R (2009 May). Potential risk of indoor semivolatile organic compounds indoors to human health. Nippon Eiseigaku Zasshi, 64(3): 672-82.
  8. Hsu NY, Lee CC, Wang JY, et al. (2012). Predicted risk of childhood allergy, asthma, and reported symptoms using measured phthalate exposure in dust and urine. Indoor Air. 22(3): 189-99.
  9. Teitelbaum SL, Mervish N, L Moshier E, Vangeepuram N, Galvez MP, Calafat AM, Silva MJ, L Brenner B, Wolff MS. (2012, January).Associations between phthalate metabolite urinary concentrations and body size measures in New York City children. Environmental Research 112:186-193.
  10. Boas M, Frederiksen H, Feldt-Rasmussen U, Skakkebaek NE, Hegedus L, Hilsted L, et al. (2010). Childhood exposure to phthalates: associations with thyroid function, insulin-like growth factor I, and growth. Environmental Health Perspectives 118:1458-1464.
  11. Verstraete S, Vanhorebeek I, Covaci A, Güiza F, Malarvannan G, Jorens PG, Van den Berghe G. (2016). Circulating phthalates during critical illness in children are associated with long-term attention deficit: a study of a development and a validation cohort. Intensive Care Med 42(3):379-92.
  12. Yeni Kim Y, Eun-Hee Ha, Eui-Jung Kim, et al. (2011). Prenatal Exposure to Phthalates and Infant Development at Six Months: Prospective Mothers and Children’s Environmental Health (MOCEH) Study, Environmental Health Perspectives. 119(10): 1495-500.
  13. Main KM, Skakkebaek NE, Virtanen HE, Toppari J (2010). Genital anomalies in boys and the environment. Best Pract Res Clin Endocrinol Metab.Apr;24(2):279-89.
  14. Toppari J, Kaleva M. Maldescendus testis. Horm Res 1999;51:261-9.
  15. Pettersson A et al. (2007) Age at surgery for undescended testis and risk of testicular cancer. New England Journal of Medicine 356:1835-41.
  16. Duty, S. M., M. J. Silva, et al., (2003). Phthalate exposure and human semen parameters. Epidemiology 14(3): 269-77.
  17. Duty, S. M., N. P. Singh, et al., (2003). The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay. Environ Health Perspect 111(9): 1164-9.
  18. Duty, S. M., A. M. Calafat, et al., (2004). The relationship between environmental exposure to phthalates and computer-aided sperm analysis motion parameters. J Androl 25(2): 293-302.
  19. Duty, S. M., A. M. Calafat, et al., (2005). Phthalate exposure and reproductive hormones in adult men. Hum Reprod 20(3): 604-10.
  20. Whyatt RM, Liu X, Rauh, VA, Calafat AM, Just AC, Hoepner L, Diaz D, et al. (2012). Maternal prenatal urinary phthalate metabolite concentrations and child mental, psychomotor and behavioral development at age three years.  Environmental Health Perspectives 120(2):290-5.
  21. Lien YJ, Ku HY, Su PH, Chen SJ, Chen HY, Liao PC, Chen WJ, & Want SL (2015). Prenatal Exposure to Phthalate Esters and Behavioral Syndromes in Children at 8 Years of Age: Taiwan Maternal and Infant Cohort Study. Environ Health Perspect 123(1): 95–100.
  22. Prenatal Phthalate Exposures and Neurobehavioral Development Scores in Boys and Girls at 6–10 Years of Age. Environ Health Perspect 122(5): 521–528.
  23. Kobrosly RW, Evans S, Miodovnik A, Barrett ES, Thurston SW, Calafat AM, & Swan SH (2014).
  24. Miodovnik A, Engel SM, Zhu C, et al. (2011). Endocrine disruptors and childhood social impairment.  Neurotoxicology Mar;32(2):261-7.
  25. CPSC. Chronic Hazard Advisory Panel on Phthalates and Phthalate Alternatives. 2014.
  26. Pereira, J. and Stecklow, S. (2008, May). Wal-Mart Raises Bar on Toy-Safety Standards, The Wall Street Journal.
  27. Sathyanarayana S, Swan SH et al., (2008, February). Baby Care Products: Possible Sources of Infant Phthalate Exposure, Pediatrics, Vol. 121, No. 2.
  28. Zota AR, Calafat AM, & Woodruff TJ (Advance on-line publication January 15, 2014) Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001-2010.
  29. Lee SM, (January 15, 2014). Banned chemicals replaced by worrisome ones, UCSF study shows. (San Francisco Chronicle).
  30. U.S. Food and Drug Administration (2008). Phthalates and Cosmetic Products. Retrieved November 4, 2009 at
  31. Thomas K (January 17, 2014). The ‘No More Tears’ Shampoo, Now With No Formaldehyde. The New York Times.
  32. Prcoter & Gamble Web site: What are Phthalates?  Accessed January 22, 2014.
  33. Zota AR, Calafat AM, & Woodruff TJ (Advance on-line publication January 15, 2014) Temporal Trends in Phthalate Exposures: Findings from the National Health and Nutrition Examination Survey, 2001-2010.
  34. EPA. Phthalates Action Plan Summary.
  35. Sheppard Kate (September 6, 2013). EPA Quietly Withdraws Two Proposed Chemical Safety Rules. Huffington Post.
  36. EPA. TSCA Work Plan for Chemical Assessments: 2014 Update.
  37. Environmental Working Group. 2008. Sutton R. Adolescent exposures to cosmetic chemicals of concern.

Stomach Cancer and Diet: Can Certain Foods Increase Your Risk?

Laura Gottschalk, PhD, Cancer Prevention & Treatment Fund

There is growing evidence that the foods we eat can increase the chances of developing certain types of cancer. A report by the World Cancer Research Fund International says that stomach cancer is one of them.

Stomach cancer is the fifth most common cancer worldwide and the third most common cause of death from cancer.[1] Older adults are more at risk to develop stomach cancer with most people in the U.S. being diagnosed over the age of 70.[2] Men are twice as likely to develop stomach cancer compared to women.[2]

You can’t control how old you are or whether you are a man or woman, but what you eat can either increase or decrease your chances of developing stomach cancer. The World Cancer Research Fund looked at all the scientific research that was available discussing diet, weight, physical activity, and the risk of stomach cancer.[3] After looking at 89 studies that examined nearly 77,000 cases of stomach cancer, the report concluded that each of the following can increase a person’s risk for developing stomach cancer.

  • Drinking three or more alcoholic drinks per day.
  • Eating foods preserved by salting, such as pickled vegetables and salted or dried fish, as traditionally prepared in East Asia.
  • Eating processed meats that have been preserved by smoking, curing or salting, or by the addition of preservatives. Examples: ham, bacon, pastrami, salami, hot dogs, and some sausages
  • Being overweight or obese, as measured by body mass index (BMI).

Based on their findings, the WCFR has made several recommendations to reduce your risk of stomach cancer:

  • Maintain a healthy weight
  • Be physically active
  • Eat a healthy diet that avoids processed meat and limits salt
  • Limit your alcohol consumption

These recommendations are good ones for preventing cancer in general, not just stomach cancer.

Still not convinced to give up your 6-packs, kimchi, and bacon just yet? This is just the latest of many studies showing that being overweight and eating processed meats increases your risk of cancer. And, previous research has also shown that drinking more alcohol increases your chances of developing cancer.[4] However, this is probably the most comprehensive study showing the link between a range of eating and drinking habits and stomach cancer.

In addition to what you eat, there are other aspects of your life that increase the risk of stomach cancer.

  • Smoking: It is estimated that 11% of stomach cancer cases are due to smoking.
  • Infection: A bacteria called pylori is known to cause chronic inflammation of the stomach which can lead to stomach cancer. Fortunately, food sanitation in developed countries dramatically cuts down on risk of infection.
  • Industrial chemicals: Exposure to dust and high-temperature environments in the workplace increases the risk of stomach cancer.

If you can’t reduce the risks of smoking, infection or industrial chemicals, changing your diet is the best option for reducing your chances of stomach cancer. Eating fresh vegetables and meats is better than preserved and processed ones. That doesn’t mean you should never eat another hot dog or slice of bacon, but it does mean trying to eat them only rarely. As with most things, moderation is key. Try and balance your diet:  don’t just decrease the amount of unhealthy foods you eat, but also increase the amount of healthy foods. Studies have shown that eating lots of fresh fruits and vegetables, especially citrus fruit,[5] may even reduce your chances of developing stomach cancer![3]

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


  1. end Centers for Disease Control and Prevention. “Global Cancer Statistics.”  Department of Health and Human Services. 02 Feb. 2015. Accessed: 05/04/2016.
  2. end National Cancer Institute. “What you need to know about stomach cancer.” NIH Publication No. 09-1554. Printed September 2009. Brochure.
  3. end World Cancer Research Fund International/American Institute for Cancer Research. Continuous “Update Project Report: Diet, Nutrition, Physical Activity and Stomach Cancer.” 2016. Available at:
  4. end IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. “Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. Exit Disclaimer.” IARC Monographs on the Evaluation of Carcinogenic Risks in Humans. 2012: 100(Pt E):373-472.
  5. end Bae JM, Lee EJ, et al. “Citrus fruit intake and stomach cancer risk: a quantitative systematic review.” Gastric Cancer. 2008;11(1):23-32.