Women over 75 who learned more about the risks and benefits of mammogram screenings were less likely to go through with the test in a new study.
Women should have a mammogram — an X-ray of the breast tissue scanning for early signs of cancer — every two years between ages 50 and 74, according to the U.S. Centers for Disease Control.
According to the U.S. Preventive Services Task Force, a government-backed expert panel, there isn't enough evidence to recommend for or against mammograms for older women.
A woman's choice to have a mammogram past the age of 75 should be based on her life expectancy, risk of disease and personal preference, study author Mara A. Schonberg, M.D., said.
"Approximately, 20 percent of U.S. women 75 and older have less than five year life expectancy and these women should not be screened since they are very unlikely to benefit and can really only be harmed," she said.
"About two thirds of women 75 and over have less than 10 year life expectancy and some experts would argue that these women are also unlikely to benefit. About one third of women have more than 10-year life expectancy and it probably makes sense to recommend screening to these women."
Dr. Schonberg studies patient decision making at Beth Israel Deaconess Medical Center in Brookline, Massachusetts.
For the study, 45 women over age 75 who had been regularly having mammograms, as recommended by their doctors, but had not had one in the previous 5 months were given the decision aid — a packet of information on the risks and benefits of screening for women in their age group — before deciding at a doctor's appointment whether or not to schedule another screening.
The women filled out an experience survey before reading the packet and again after their doctor's appointment.
The packet included information on breast cancer risk for women over 75 and the risks of screening including false positives and costly and stressful follow up testing.
For older women, many tumors that a mammogram would find would actually grow too slowly to harm the woman in her lifetime, Dr. Schonberg said. But nearly all women with breast cancer are treated for it, and the risks of treatment increase with age.
Based on the two surveys, women tended to be more informed about the benefits and risks after reading the packet than before.
Before reading the decision aid, 37 of the 45 women planned on having a mammogram, compared to 25 out of 45 who planned to do so after reading it.
According to medical records, 26 of the women had a mammogram in the two years following the study.
Dr. Schonberg thinks it would be feasible to give this type of decision aid to all women over 75 as they make screening decisions, but "it requires our health care system placing greater value and resources in decision support for patients."
Giving the decision aid to women over 75 before a visit with their primary care doctor seemed to work well in the study, but in the real world it would take resources to identify these women and send them the information, she said.
"In practice, it may be faster for a physician to simply recommend a mammogram than to discuss patients' preferences around screening," she said. Doctors should be compensated for spending time discussing this issue with patient, she said.
"In addition, most of the educational materials regarding mammography screening have been uniformly positive. It takes a change in culture to acknowledge that there are both benefits and risks to screening and that each woman should be allowed to make an informed decision for herself."
All women should be informed of the risks and benefits of screening, she said, but especially those over 75, since there are more risks and uncertain benefits for this group.
The study did not follow the women to determine which, if any, were later diagnosed with breast cancer.
"Most women over age 75 should not get mammograms," H. Gilbert Welch, M.D., a professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice in Hanover, New Hampshire, said. "But this is not unique to mammography, or women," he said.
Dr. Welch authored another study on the risks of mammography screening for older women in the same issue of JAMA Internal Medicine. In it, he estimates that for 1,000 women who get annual mammograms starting at age 50 for 10 years, "0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly."
"As people get older — closer to death — there is less reason to look for cancer early," he said. "Most people, men and women, over age 75 should not be screened for cancer."
Wednesday, January 8, 2014
Panel Backs Yearly Scans for Older, Heavy Smokers
A highly influential government panel of experts says that older smokers at high risk of lung cancer should receive annual low-dose CT scans to help detect and possibly prevent the spread of the fatal disease.
In its final word on the issue published Dec. 30, the U.S. Preventive Services Task Force (USPSTF) concluded that the benefits to a very specific segment of smokers outweigh the risks involved in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a distinguished professor of family medicine at the University of Missouri.
Specifically, the task force recommended annual low-dose CT scans for current and former smokers aged 55 to 80 with at least a 30 "pack-year" history of smoking who have had a cigarette sometime within the last 15 years. The person also should be generally healthy and a good candidate for surgery should cancer be found, LeFevre said.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
About 20,000 of the United States' nearly 160,000 annual lung cancer deaths could be prevented if doctors follow these screening guidelines, LeFevre said when the panel first proposed the recommendations in July. Lung cancer found in its earliest stage is 80 percent curable, usually by surgical removal of the tumor.
"That's a lot of people, and we feel it's worth it, but there will still be a lot more people dying from lung cancer," LeFevre said. "That's why the most important way to prevent lung cancer will continue to be to convince smokers to quit."
Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked. For example, a person who has smoked two packs a day for 15 years has 30 pack years, as has a person who has smoked a pack a day for 30 years.
The USPSTF drew up the recommendation after a thorough review of previous research, and published them online Dec. 30 in the Annals of Internal Medicine.
"I think they did a very good analysis of looking at the pros and cons, the harms and benefits," Dr. Albert Rizzo, immediate past chair of the national board of directors of the American Lung Association, said at the time the draft recommendations were published in July. "They looked at a balance of where we can get the best bang for our buck."
The USPSTF is an independent volunteer panel of national health experts who issue evidence-based recommendations on clinical services intended to detect and prevent illness.
The task force has previously ruled on mammography, PSA testing and other types of screening. It reports to the U.S. Congress every year and its recommendations often serve as a basis for federal health care policy. Insurance companies often follow USPSTF recommendations as well.
Weighing heavily in the task force's latest decision were the results from the U.S. National Cancer Institute's 2011 National Lung Screening Trial. That study, which involved more than 53,000 smokers across the United States, found that annual low-dose CT screenings could prevent one of five lung cancer deaths.
The guidelines revolve around who is at highest risk for lung cancer and who would be able to benefit most from early detection.
Smoking is the biggest risk factor for lung cancer, and causes about 85 percent of lung cancers in the United States. The risk for developing lung cancer increases with age, with most lung cancers occurring in people aged 55 and older.
However, the task force decided to limit CT screenings just to people who either still smoke or quit smoking within the past 15 years. "If you quit more than 15 years ago, because the risk of lung cancer goes down every year from the time you quit smoking, we would take you out of that high-risk category," LeFevre said.
The task force also had to weigh the benefits of early cancer detection against the potential harm caused by regular exposure to radiation from the CT scans, said recommendation co-author Dr. Linda Humphrey, a professor of medicine and clinical epidemiology at Oregon Health & Science University and associate chief of medicine at the Portland VA Medical Center.
"The radiation associated with low-dose CT is on the order of the radiation associated with mammography," Humphrey said earlier this year. "It's not a short-term risk, it's a long-term risk."
She added that there are a fair number of false positives involved in CT scans for lung cancer. These can be resolved through screening, but that adds to the number of radiation exposures a patient will receive.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
The panel also had to weigh whether their recommendation would send the message to smokers that they now don't have to quit because screening measures will prevent their death from lung cancer.
"The main message of all this should be that you should stop smoking," said former lung association board chair Rizzo, who is section chief of pulmonary/critical care medicine at Christiana Care Health System in Newark, Del.
"If you have started and you can't quit, there is an ability to screen for that early lung cancer, but the screening does not mean we're going to catch the cancer before it does you harm," Rizzo said. "This is not an excuse for people to keep smoking, simply because they think they can get screened adequately."
In its final word on the issue published Dec. 30, the U.S. Preventive Services Task Force (USPSTF) concluded that the benefits to a very specific segment of smokers outweigh the risks involved in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a distinguished professor of family medicine at the University of Missouri.
Specifically, the task force recommended annual low-dose CT scans for current and former smokers aged 55 to 80 with at least a 30 "pack-year" history of smoking who have had a cigarette sometime within the last 15 years. The person also should be generally healthy and a good candidate for surgery should cancer be found, LeFevre said.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
About 20,000 of the United States' nearly 160,000 annual lung cancer deaths could be prevented if doctors follow these screening guidelines, LeFevre said when the panel first proposed the recommendations in July. Lung cancer found in its earliest stage is 80 percent curable, usually by surgical removal of the tumor.
"That's a lot of people, and we feel it's worth it, but there will still be a lot more people dying from lung cancer," LeFevre said. "That's why the most important way to prevent lung cancer will continue to be to convince smokers to quit."
Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked. For example, a person who has smoked two packs a day for 15 years has 30 pack years, as has a person who has smoked a pack a day for 30 years.
The USPSTF drew up the recommendation after a thorough review of previous research, and published them online Dec. 30 in the Annals of Internal Medicine.
"I think they did a very good analysis of looking at the pros and cons, the harms and benefits," Dr. Albert Rizzo, immediate past chair of the national board of directors of the American Lung Association, said at the time the draft recommendations were published in July. "They looked at a balance of where we can get the best bang for our buck."
The USPSTF is an independent volunteer panel of national health experts who issue evidence-based recommendations on clinical services intended to detect and prevent illness.
The task force has previously ruled on mammography, PSA testing and other types of screening. It reports to the U.S. Congress every year and its recommendations often serve as a basis for federal health care policy. Insurance companies often follow USPSTF recommendations as well.
Weighing heavily in the task force's latest decision were the results from the U.S. National Cancer Institute's 2011 National Lung Screening Trial. That study, which involved more than 53,000 smokers across the United States, found that annual low-dose CT screenings could prevent one of five lung cancer deaths.
The guidelines revolve around who is at highest risk for lung cancer and who would be able to benefit most from early detection.
Smoking is the biggest risk factor for lung cancer, and causes about 85 percent of lung cancers in the United States. The risk for developing lung cancer increases with age, with most lung cancers occurring in people aged 55 and older.
However, the task force decided to limit CT screenings just to people who either still smoke or quit smoking within the past 15 years. "If you quit more than 15 years ago, because the risk of lung cancer goes down every year from the time you quit smoking, we would take you out of that high-risk category," LeFevre said.
The task force also had to weigh the benefits of early cancer detection against the potential harm caused by regular exposure to radiation from the CT scans, said recommendation co-author Dr. Linda Humphrey, a professor of medicine and clinical epidemiology at Oregon Health & Science University and associate chief of medicine at the Portland VA Medical Center.
"The radiation associated with low-dose CT is on the order of the radiation associated with mammography," Humphrey said earlier this year. "It's not a short-term risk, it's a long-term risk."
She added that there are a fair number of false positives involved in CT scans for lung cancer. These can be resolved through screening, but that adds to the number of radiation exposures a patient will receive.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
The panel also had to weigh whether their recommendation would send the message to smokers that they now don't have to quit because screening measures will prevent their death from lung cancer.
"The main message of all this should be that you should stop smoking," said former lung association board chair Rizzo, who is section chief of pulmonary/critical care medicine at Christiana Care Health System in Newark, Del.
"If you have started and you can't quit, there is an ability to screen for that early lung cancer, but the screening does not mean we're going to catch the cancer before it does you harm," Rizzo said. "This is not an excuse for people to keep smoking, simply because they think they can get screened adequately."
Many Women Still in Pain One Year After Breast Cancer Surgery
One year after breast cancer surgery, many women continue to experience pain, according to a new study.
Researchers revealed that the factors associated with the women's pain included chronic pain and depression before surgery, chemotherapy and radiation therapy.
"Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies," Dr. Tuomo Meretoja, of Helsinki University Central Hospital, and colleagues wrote in the report.
"Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients," the study authors added.
The research, published in the Jan. 1 issue of the Journal of the American Medical Association, involved 860 women younger than 75 years of age who had undergone surgery for breast cancer that had not spread to other parts of their body.
The women were treated at the Helsinki University Central Hospital between 2006 and 2010. Of these women, most experienced some degree of pain up to one year after their operation, the authors noted in a university news release.
The researchers asked the women to complete a questionnaire 12 months after surgery to determine if they continued to experience pain following their treatment. If so, the women were asked to rate the severity of their discomfort.
The study revealed that one year after surgery, about one-third of the women reported no pain. The investigators found, however, that nearly 50 percent did experience mild pain, 12 percent had moderate pain, and almost 4 percent felt severe pain.
"These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed," Meretoja and colleagues concluded.
Researchers revealed that the factors associated with the women's pain included chronic pain and depression before surgery, chemotherapy and radiation therapy.
"Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies," Dr. Tuomo Meretoja, of Helsinki University Central Hospital, and colleagues wrote in the report.
"Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients," the study authors added.
The research, published in the Jan. 1 issue of the Journal of the American Medical Association, involved 860 women younger than 75 years of age who had undergone surgery for breast cancer that had not spread to other parts of their body.
The women were treated at the Helsinki University Central Hospital between 2006 and 2010. Of these women, most experienced some degree of pain up to one year after their operation, the authors noted in a university news release.
The researchers asked the women to complete a questionnaire 12 months after surgery to determine if they continued to experience pain following their treatment. If so, the women were asked to rate the severity of their discomfort.
The study revealed that one year after surgery, about one-third of the women reported no pain. The investigators found, however, that nearly 50 percent did experience mild pain, 12 percent had moderate pain, and almost 4 percent felt severe pain.
"These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed," Meretoja and colleagues concluded.
Want to Quit Smoking? Here's Help
People who want to quit smoking cigarettes no longer have to suffer through cold-turkey withdrawal.
A number of options now exist, and though most have some side effects, experts generally believe that the benefits of quitting smoking far exceed the risks posed by side effects. Current options include:
Nicotine replacement therapy
A variety of nicotine replacement products have been approved by the U.S. Food and Drug Administration. They include the nicotine patch, gum, inhaler, lozenges and nasal spray, according to Hilary Tindle, director of the Tobacco Treatment Service at the University of Pittsburgh Medical Center.
Patches, gum and lozenges do not require a prescription. A doctor's prescription is necessary for nasal spray or the inhaler, according to the American Cancer Society.
Medications
Two medications can help smokers quit. One is bupropion (marketed as an antidepressant under the brand name Wellbutrin and as a quit-smoking aid under the brand name Zyban); the other is varenicline (Chantix). Tindle said that bupropion can be used in combination with nicotine replacement therapy, but that varenicline generally should not be, though she said there are rare exceptions to that rule. "Both varenicline and bupropion are effective," she said.
"Chantix has warnings for rare psychiatric side effects, but it's a very effective and wonderful drug that helps a lot of people quit smoking," said Dr. Gordon Strauss, a psychiatrist at Lenox Hill Hospital in New York City and founder of QuitGroups, a free smoking cessation service.
Alternative treatments
Alternative treatments also are available to help people quit smoking, including hypnosis and acupuncture. Tindle said there haven't been large trials on hypnosis or acupuncture so they're not included in national guidelines. But, she said that if the only downside to a treatment is the cost or the time involved, and someone really wants to try an alternative treatment, she doesn't discourage their use.
Social support
"The importance of social support has been minimized, but there are a lot of resources out there, like state quit lines," Strauss said. "It's a very important component of quitting."
Consider, for instance, 1-800-QuitNow, which connects you to your state quit line and guarantees five phone calls from a counselor to help you quit. Tindle said that people who called this number and took nicotine replacement therapy doubled their chances of successfully quitting smoking.
Electronic cigarettes
Although smoking cessation experts have yet to give e-cigarettes the green light, many consumers are already using them to become smoke-free. The devices use heat to turn nicotine and other chemicals into a vapor that's inhaled, much like smoking a cigarette. Most even look like a tobacco cigarette.
"E-cigarettes have been such a blessing in my life," said Elizabeth Phillips, a Philadelphia resident and former smoker. "I tried patches, gums and pills, and nothing worked. E-cigarettes combined with perseverance and the desire to quit helped me quit."
The bottom line?
Tindle and Strauss both emphasized that people shouldn't be discouraged if their first quit attempt isn't successful. For most people, it takes more than one try.
"Set a quit date, and realize that failure is part of the process," Strauss said. "Some people take up to 10 times to quit. Dieters know that when they're losing weight, it will take time. One day you may have a piece of apple pie, but the next day you start again. Relapses happen; be easy on yourself."
And as Tindle said, "Remember, no matter what your age, you'll benefit from quitting."
A number of options now exist, and though most have some side effects, experts generally believe that the benefits of quitting smoking far exceed the risks posed by side effects. Current options include:
Nicotine replacement therapy
A variety of nicotine replacement products have been approved by the U.S. Food and Drug Administration. They include the nicotine patch, gum, inhaler, lozenges and nasal spray, according to Hilary Tindle, director of the Tobacco Treatment Service at the University of Pittsburgh Medical Center.
Patches, gum and lozenges do not require a prescription. A doctor's prescription is necessary for nasal spray or the inhaler, according to the American Cancer Society.
Medications
Two medications can help smokers quit. One is bupropion (marketed as an antidepressant under the brand name Wellbutrin and as a quit-smoking aid under the brand name Zyban); the other is varenicline (Chantix). Tindle said that bupropion can be used in combination with nicotine replacement therapy, but that varenicline generally should not be, though she said there are rare exceptions to that rule. "Both varenicline and bupropion are effective," she said.
"Chantix has warnings for rare psychiatric side effects, but it's a very effective and wonderful drug that helps a lot of people quit smoking," said Dr. Gordon Strauss, a psychiatrist at Lenox Hill Hospital in New York City and founder of QuitGroups, a free smoking cessation service.
Alternative treatments
Alternative treatments also are available to help people quit smoking, including hypnosis and acupuncture. Tindle said there haven't been large trials on hypnosis or acupuncture so they're not included in national guidelines. But, she said that if the only downside to a treatment is the cost or the time involved, and someone really wants to try an alternative treatment, she doesn't discourage their use.
Social support
"The importance of social support has been minimized, but there are a lot of resources out there, like state quit lines," Strauss said. "It's a very important component of quitting."
Consider, for instance, 1-800-QuitNow, which connects you to your state quit line and guarantees five phone calls from a counselor to help you quit. Tindle said that people who called this number and took nicotine replacement therapy doubled their chances of successfully quitting smoking.
Electronic cigarettes
Although smoking cessation experts have yet to give e-cigarettes the green light, many consumers are already using them to become smoke-free. The devices use heat to turn nicotine and other chemicals into a vapor that's inhaled, much like smoking a cigarette. Most even look like a tobacco cigarette.
"E-cigarettes have been such a blessing in my life," said Elizabeth Phillips, a Philadelphia resident and former smoker. "I tried patches, gums and pills, and nothing worked. E-cigarettes combined with perseverance and the desire to quit helped me quit."
The bottom line?
Tindle and Strauss both emphasized that people shouldn't be discouraged if their first quit attempt isn't successful. For most people, it takes more than one try.
"Set a quit date, and realize that failure is part of the process," Strauss said. "Some people take up to 10 times to quit. Dieters know that when they're losing weight, it will take time. One day you may have a piece of apple pie, but the next day you start again. Relapses happen; be easy on yourself."
And as Tindle said, "Remember, no matter what your age, you'll benefit from quitting."
E-Cig Secondhand Vapor Less Harmful Than Tobacco Smoke
People standing near someone using an e-cigarette will be exposed to nicotine, but not to other chemicals found in tobacco cigarette smoke, according to a new study.
E-cigarettes, or electronic cigarettes, create a nicotine-rich vapor that can be inhaled, or 'vaped.'
Researchers and regulators have questioned whether e-cigarettes are a smoking cessation aid or may lure more young people toward smoking, as well as what effects they have on health.
"There is ongoing public debate whether e-cigarettes should be allowed or prohibited in public spaces," study co-author Maciej Goniewicz told Reuters Health in an email.
Goniewicz is a cancer researcher in the Department of Health Behavior at the Roswell Park Cancer Institute in Buffalo, New York.
"E-cigarettes contain variable amounts of nicotine and some traces of toxicants. But very little is known to what extent non-users can be exposed to nicotine and other chemicals in situations when they are present in the same room with users of e-cigarettes," Goniewicz said.
He and his colleagues conducted two studies of secondhand exposure to e-cigarette vapors in a laboratory. Their results were published in Nicotine and Tobacco Research.
In the first study, the researchers used an electronic smoking machine to generate vapor in an enclosed space. They measured the amount of nicotine as well as carbon monoxide and other potentially harmful gases and particles in the chamber.
The second study included five men who regularly smoked both tobacco cigarettes and e-cigarettes. Each man entered a room and smoked his usual brand of e-cigarette for two five-minute intervals over an hour while the researchers measured air quality. The room was cleaned and ventilated and the experiment was repeated with tobacco cigarettes.
The researchers measured nicotine levels of 2.5 micrograms per cubic meter of air in the first study. Nicotine levels from e-cigarettes in the second study were slightly higher at about 3.3 micrograms per cubic meter. But tobacco cigarette smoking resulted in nicotine levels ten times higher at almost 32 micrograms per cubic meter.
"The exposure to nicotine is lower when compared to exposure from tobacco smoke. And we also know that nicotine is relatively safer when compared to other dangerous toxicants in tobacco smoke," Goniewicz said.
E-cigarettes also produced some particulate matter, but regular cigarettes produced about seven times more. E-cigarettes didn't change the amount of carbon monoxide or other gases in the air.
"What we found is that non-users of e-cigarettes might be exposed to nicotine but not to many toxicants when they are in close proximity to e-cigarette users," said Goniewicz.
"It is currently very hard to predict what would be the health impact of such exposure," he added.
He said more research is needed to find out how the current findings correspond to "real-life" situations, when many people might be using e-cigarettes in a room with restricted ventilation.
"This is an interesting piece and points in the direction that a number of other studies are pointing, though it begins to expand the evidence on the potential effects to others," Amy Fairchild told Reuters Health in an email.
Fairchild was not involved in the new research, but has studied how e-cigarette use might impact views on regular cigarettes at the Columbia University Mailman School of Public Health in New York.
She said the study suggests e-cigarettes are far safer, both in terms of toxins and nicotine, than tobacco cigarettes when it comes to the health effects on bystanders - although more research is needed to know for sure.
"In locales considering extending smoking bans to e-cigarettes, I think that these data weaken the case for more sweeping bans," Fairchild said. "And so this begins to answer the question about why e-cigarettes are considered better: they reduce risks to both the user and to the bystander when compared to tobacco cigarettes."
Fairfield said the concern about vaping ultimately revolves around whether e-cigarettes are going to change broader patterns of smoking at the population level.
"There are potential harms, including promoting continued smoking of cigarettes and renormalizing cigarette smoking behaviors," Goniewicz said. "Regulatory agencies around the world will need to make a number of regulatory decisions about product safety that could have major effects on public health."
Goniewicz has received funding from a drug company that makes medications to aid smoking cessation. Another study author has received funds from an e-cigarette manufacturer.
E-cigarettes, or electronic cigarettes, create a nicotine-rich vapor that can be inhaled, or 'vaped.'
Researchers and regulators have questioned whether e-cigarettes are a smoking cessation aid or may lure more young people toward smoking, as well as what effects they have on health.
"There is ongoing public debate whether e-cigarettes should be allowed or prohibited in public spaces," study co-author Maciej Goniewicz told Reuters Health in an email.
Goniewicz is a cancer researcher in the Department of Health Behavior at the Roswell Park Cancer Institute in Buffalo, New York.
"E-cigarettes contain variable amounts of nicotine and some traces of toxicants. But very little is known to what extent non-users can be exposed to nicotine and other chemicals in situations when they are present in the same room with users of e-cigarettes," Goniewicz said.
He and his colleagues conducted two studies of secondhand exposure to e-cigarette vapors in a laboratory. Their results were published in Nicotine and Tobacco Research.
In the first study, the researchers used an electronic smoking machine to generate vapor in an enclosed space. They measured the amount of nicotine as well as carbon monoxide and other potentially harmful gases and particles in the chamber.
The second study included five men who regularly smoked both tobacco cigarettes and e-cigarettes. Each man entered a room and smoked his usual brand of e-cigarette for two five-minute intervals over an hour while the researchers measured air quality. The room was cleaned and ventilated and the experiment was repeated with tobacco cigarettes.
The researchers measured nicotine levels of 2.5 micrograms per cubic meter of air in the first study. Nicotine levels from e-cigarettes in the second study were slightly higher at about 3.3 micrograms per cubic meter. But tobacco cigarette smoking resulted in nicotine levels ten times higher at almost 32 micrograms per cubic meter.
"The exposure to nicotine is lower when compared to exposure from tobacco smoke. And we also know that nicotine is relatively safer when compared to other dangerous toxicants in tobacco smoke," Goniewicz said.
E-cigarettes also produced some particulate matter, but regular cigarettes produced about seven times more. E-cigarettes didn't change the amount of carbon monoxide or other gases in the air.
"What we found is that non-users of e-cigarettes might be exposed to nicotine but not to many toxicants when they are in close proximity to e-cigarette users," said Goniewicz.
"It is currently very hard to predict what would be the health impact of such exposure," he added.
He said more research is needed to find out how the current findings correspond to "real-life" situations, when many people might be using e-cigarettes in a room with restricted ventilation.
"This is an interesting piece and points in the direction that a number of other studies are pointing, though it begins to expand the evidence on the potential effects to others," Amy Fairchild told Reuters Health in an email.
Fairchild was not involved in the new research, but has studied how e-cigarette use might impact views on regular cigarettes at the Columbia University Mailman School of Public Health in New York.
She said the study suggests e-cigarettes are far safer, both in terms of toxins and nicotine, than tobacco cigarettes when it comes to the health effects on bystanders - although more research is needed to know for sure.
"In locales considering extending smoking bans to e-cigarettes, I think that these data weaken the case for more sweeping bans," Fairchild said. "And so this begins to answer the question about why e-cigarettes are considered better: they reduce risks to both the user and to the bystander when compared to tobacco cigarettes."
Fairfield said the concern about vaping ultimately revolves around whether e-cigarettes are going to change broader patterns of smoking at the population level.
"There are potential harms, including promoting continued smoking of cigarettes and renormalizing cigarette smoking behaviors," Goniewicz said. "Regulatory agencies around the world will need to make a number of regulatory decisions about product safety that could have major effects on public health."
Goniewicz has received funding from a drug company that makes medications to aid smoking cessation. Another study author has received funds from an e-cigarette manufacturer.
Can Nail Polish Give You Cancer?
Questions about the health risks of chemicals in nail polish are gaining new attention, The New York Times reports.
Concerns about potentially risky substances in nail polish were raised in 2006 when public health advocates began a nationwide campaign to raise awareness about three compounds in leading product brands — formaldehyde, a known carcinogen used as a hardening agent, and two materials linked to developmental defects: toluene, to evenly suspend color, and the plasticizer dibutyl phthalate, or DBP, to add flexibility and sheen.
In response to the campaign, many companies voluntarily removed these compounds from their products, but a 2012 investigation by the California Department of Toxic Substances Control found some simply changed their labels but continued using them. In addition, the European Union banned the use of DBP in cosmetics, but the Food and Drug Administration has not taken any regulatory action.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
Janet Nudelman, co-founder of the Campaign for Safe Cosmetics, an advocacy group, said the concern is that some people may be at risk from being exposed to such chemicals, but acknowledges most products are safe for consumers.
"No one is saying that occasional application of nail polish will cause long-term health consequences," she told The Times. But some researchers have suggested there may be concerns for those who work in nail salons and children, who are particularly susceptible to phthalates like DBP that pose developmental risks.
In fact, some pediatricians now warn against letting young girls, especially those young enough to chew on their fingers, wear polish.
Concerns about potentially risky substances in nail polish were raised in 2006 when public health advocates began a nationwide campaign to raise awareness about three compounds in leading product brands — formaldehyde, a known carcinogen used as a hardening agent, and two materials linked to developmental defects: toluene, to evenly suspend color, and the plasticizer dibutyl phthalate, or DBP, to add flexibility and sheen.
In response to the campaign, many companies voluntarily removed these compounds from their products, but a 2012 investigation by the California Department of Toxic Substances Control found some simply changed their labels but continued using them. In addition, the European Union banned the use of DBP in cosmetics, but the Food and Drug Administration has not taken any regulatory action.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
Janet Nudelman, co-founder of the Campaign for Safe Cosmetics, an advocacy group, said the concern is that some people may be at risk from being exposed to such chemicals, but acknowledges most products are safe for consumers.
"No one is saying that occasional application of nail polish will cause long-term health consequences," she told The Times. But some researchers have suggested there may be concerns for those who work in nail salons and children, who are particularly susceptible to phthalates like DBP that pose developmental risks.
In fact, some pediatricians now warn against letting young girls, especially those young enough to chew on their fingers, wear polish.
Can E-Cigarettes Help You Quit Tobacco Smoking?
It's the new year, a time when a smokers' thoughts often turn to quitting.
Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.
Here's what you need to know about e-cigarettes:
What is an e-cigarette?
The U.S. Food and Drug Administration (FDA) describes an e-cigarette as a battery-operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.
How does an e-cigarette work?
"Nicotine or flavorings are dissolved into propylene glycol usually, though it's hard to know for sure because they're not regulated," explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. "Then, when heated, you can inhale the vapor."
The process of using an e-cigarette is called "vaping" rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called "vapers" rather than smokers.
Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don't exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.
"Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying," Strauss said.
Where can e-cigarettes be used?
"People want to use e-cigarettes anywhere they can't smoke," Strauss said. "I sat next to someone on a plane who was using an e-cigarette. He was using it to get nicotine during the flight." But he noted that just where it's OK to use an e-cigarette -- indoors, for instance? -- remains unclear.
Wherever they're used, though, he said it's unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e-cigarette.
Can an e-cigarette help people quit smoking?
That, too, seems to be an unanswered question. Tindle said that "it's too early to tell definitively that e-cigarettes can help people quit."
A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e-cigarettes to quit smoking, she said. It compared nicotine-containing e-cigarettes to nicotine patches and to e-cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.
"E-cigarettes didn't do worse than the patch, and there were no differences in the adverse events," she said. "I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy."
Strauss noted that "although we can't say with certainty that e-cigarettes are an effective way to quit, people are using them" for that purpose. "Some people have told me that e-cigarettes are like a godsend," he said.
Former smoker Elizabeth Phillips would agree. She's been smoke-free since July 2012 with the help of e-cigarettes, which she used for about eight months after giving up tobacco cigarettes.
"E-cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking," Phillips said. "I consider my e-cigarette experience as a baby step that changed my life."
Are e-cigarettes approved or regulated by the government?
E-cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e-cigarettes as a tobacco product.
The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e-cigarettes are being marketed to children; some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e-cigarettes have not been well-studied, especially in children.
Are e-cigarettes dangerous?
"It's not the nicotine in cigarettes that kills you, and the nicotine in e-cigarettes probably won't really hurt you either, but again, it hasn't been studied," Strauss said. "Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it's hard to imagine anything worse. But, it's a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you'd be helping kids with asthma or saving babies."
But on the flip side, he said, in former smokers, using an e-cigarette could trigger the urge to smoke again.
The other big concern is children using e-cigarettes.
"More and more middle and high school kids are using e-cigarettes," Tindle said. "Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e-cigarette doubled in just a year. We could be creating new nicotine addicts. We don't know what the addictive properties of e-cigarettes are," she added.
Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.
Here's what you need to know about e-cigarettes:
What is an e-cigarette?
The U.S. Food and Drug Administration (FDA) describes an e-cigarette as a battery-operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.
How does an e-cigarette work?
"Nicotine or flavorings are dissolved into propylene glycol usually, though it's hard to know for sure because they're not regulated," explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. "Then, when heated, you can inhale the vapor."
The process of using an e-cigarette is called "vaping" rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called "vapers" rather than smokers.
Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don't exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.
"Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying," Strauss said.
Where can e-cigarettes be used?
"People want to use e-cigarettes anywhere they can't smoke," Strauss said. "I sat next to someone on a plane who was using an e-cigarette. He was using it to get nicotine during the flight." But he noted that just where it's OK to use an e-cigarette -- indoors, for instance? -- remains unclear.
Wherever they're used, though, he said it's unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e-cigarette.
Can an e-cigarette help people quit smoking?
That, too, seems to be an unanswered question. Tindle said that "it's too early to tell definitively that e-cigarettes can help people quit."
A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e-cigarettes to quit smoking, she said. It compared nicotine-containing e-cigarettes to nicotine patches and to e-cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.
"E-cigarettes didn't do worse than the patch, and there were no differences in the adverse events," she said. "I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy."
Strauss noted that "although we can't say with certainty that e-cigarettes are an effective way to quit, people are using them" for that purpose. "Some people have told me that e-cigarettes are like a godsend," he said.
Former smoker Elizabeth Phillips would agree. She's been smoke-free since July 2012 with the help of e-cigarettes, which she used for about eight months after giving up tobacco cigarettes.
"E-cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking," Phillips said. "I consider my e-cigarette experience as a baby step that changed my life."
Are e-cigarettes approved or regulated by the government?
E-cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e-cigarettes as a tobacco product.
The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e-cigarettes are being marketed to children; some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e-cigarettes have not been well-studied, especially in children.
Are e-cigarettes dangerous?
"It's not the nicotine in cigarettes that kills you, and the nicotine in e-cigarettes probably won't really hurt you either, but again, it hasn't been studied," Strauss said. "Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it's hard to imagine anything worse. But, it's a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you'd be helping kids with asthma or saving babies."
But on the flip side, he said, in former smokers, using an e-cigarette could trigger the urge to smoke again.
The other big concern is children using e-cigarettes.
"More and more middle and high school kids are using e-cigarettes," Tindle said. "Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e-cigarette doubled in just a year. We could be creating new nicotine addicts. We don't know what the addictive properties of e-cigarettes are," she added.
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