Let’s face it… Pap Smears aren’t fun. The only test to sample tissue for cervical cancer just happens to be one of the most embarrassing and awkward but it can be one of the most life saving and simple.  So what is it and how does it work?  Here’s your questions answered.

What is the cervix and what is cervical cancer?

The uterus looks similar to a light bulb.  The larger top portion being where the fetus develops, and the bottom, narrower area, the cervix.  The cervix thins and dilates during childbirth, as you’ve heard in the movies “she’s only 7 cm!” and then after childbirth becomes narrow again.  It affects nearly 13,000 and kills 4,100 women each year, rising each year.  It can affect women of any age but is more common between 20 and 50.

What causes cervical cancer?

The most common cause is HPV (Human Papillomavirus), especially HPV-16 and HPV-18.  This is acquired through unprotected sex, so condom use is encouraged. Thus it's one of the most preventable causes of cancer.  Additionally, there are 3 vaccines for HPV currently approved by the FDA, Gardasil, Gardasil 9, and Cervarix.

What are the symptoms of cervical cancer?

Early cervical cancer may not be symptomatic but as it develops it may cause an odor, pain with urination, pelvic pain and bleeding. This bleeding may occur after sex, a pelvic exam, or intermittent bleeding not associated with a menstrual cycle.

Is cervical cancer treatable?

Yes. Early detection is key and can be done by a Pap Smear, explained below.  Multiple treatments are available including surgery, chemotherapy,  radiation therapy, and targeted therapy such as Bevacizumab (Avastin®) which prevents new blood vessel growth that can feed a tumor.

Who should get screened for Cervical Cancer?

The USPSTF (United States Preventive Services Task Force) recommends the following:

Screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.

What is a Pap Smear?

It is the cytology (cell analysis) of the cervix.  Years ago, a cytobrush would collect the cells and the medical provider would “smear” it onto a slide, place fixative, and then send it to the laboratory for the pathologist to analyze it.  Now ThinPrep® Pap tests are used more commonly as the cells from the brush are placed into a container with fixative, and this vial is sent to the pathologist to spin down and analyze.

In order to obtain the cells from the cervix, the medical provider needs to use a speculum to open the vaginal canal and allow access to the uterus.  A woman may be in the lithotomy position…lying on one’s back on the exam table with her feet in stirrups and knees bent. During the speculum exam, the medical provider may take cultures to test for common vaginal infections such as yeast, bacteria vaginosis, or sexually transmitted illnesses such as gonorrhea and chlamydia.  After the speculum exam, the provider may perform a pelvic exam with her gloved hand to examine the uterus and ovaries, evaluating for tenderness, shape, size and masses.

How is an HPV test done?

An HPV test can be done with the cells obtained during the Pap Smear. The laboratory evaluates the cells to see if the HPV virus that causes cervical cancer is present.

In summary the thousands of deaths that occur each year to cervical cancer can be prevented with simple testing, such as the Pap Smear. Discuss with your medical provider when cervical cancer screening is best for you.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Breast cancer affects thousands of men and women each year and screening is unfortunately overlooked all too often.

Many women find mammograms painful and embarrassing hence hesitate when urged to get screened.

And some men may not realize they too have breast tissue and are at risk for breast cancer.

October is Breast Cancer Awareness Month and #ShirtsOff reminds us to examine ourselves, get screened, and look for changes in our breasts.

Signs of breast cancer include

• A lump inside the breast or under the arm
• Breast pain
• Change in breast shape
• Dimpling
• Nipple discharge
• Nipple bleeding
• Rash
• Sore on the breast
• Discoloration
• Change in skin texture

How common is breast cancer?

1 in 8 women will develop invasive breast cancer over the course of their lifetime. According to the American Cancer Society, an estimated 266,120 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,960 cases of non-invasive breast cancer, a rise from last year.

40,920 women and 480 men are expected to die this year of breast cancer.

What are the risk factors for breast cancer?

Risk factors for breast cancer include:

• Age greater than 50
• Family History
• BRAC1 and BRAC2 genetic mutations
• Alcohol use
• Never been pregnant or becoming pregnant for the first time over 35 years old
• Early menarche at age 11 or younger
• Obesity, especially after menopause
• Dense breasts
• Lack of physical activity
• Use of oral contraceptives
• Previous “precancerous” tumors such as atypical hyperplasia
• DES exposure
• Previous radiation therapy

How is breast cancer staged?

Breast cancer is staged based on size of the tumor, if lymph nodes are affected and whether the cancer has spread to distant areas of the body.  Prognosis varies greatly on the stage.

IMAGE ABOVE FROM JOHNSTON HEALTH

Is family history a huge factor?

85% of breast cancer cases occur in women with NO family history.

Screening of breast cancer

Mammograms are the first line screening tool for breast cancer and are currently recommended biennial for women aged 50-74.  However for those at higher risk, mammogram screening should start earlier, with possible follow-up ultrasound, and be performed more regularly.

3-D MAMMOGRAM IMAGE

3-D Mammograms use some of the most sensitive technology in screening.

Dr. William Boren, owner of West Valley Imaging in Las Vegas, Nevada, states “3-D Mammograms reportedly find up to 40% more cancers, allowing a topographic view of the tissue.”

Dr. Boren also recommends to “not leave big gaps between screening.  If you start screening at age 40, then continue yearly screens.”

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Celebrities such as Julia Louise-Dreyfus, Olivia Newton-John, Christina Applegate and Cynthia Nixon have revealed their breast cancer diagnoses, helping raise awareness for the most common cancer to affect women.  It’s the second most common cause of cancer death in females.

How common is breast cancer?

1 in 8 women will develop invasive breast cancer over the course of their lifetime. According to the American Cancer Society, an estimated 266,120 cases of invasive breast cancer are expected to be diagnosed in women in the US with 63,960 cases of non-invasive breast cancer, a rise from last year.

40,920 women and 480 men are expected to die this year of breast cancer.

What are the risk factors for breast cancer?

Risk factors for breast cancer include:

• Age greater than 50
• Family History
• BRAC1 and BRAC2 genetic mutations
• Alcohol use
• Never been pregnant or becoming pregnant for the first time over 35 years old
• Early menarche at age 11 or younger
• Obesity, especially after menopause
• Dense breasts
• Lack of physical activity
• Use of oral contraceptives
• Previous “precancerous” tumors such as atypical hyperplasia
• DES exposure
• Previous radiation therapy

How is breast cancer staged?

Breast cancer is staged based on size of the tumor, if lymph nodes are affected and whether the cancer has spread to distant areas of the body.  Prognosis varies greatly on the stage.

IMAGE ABOVE FROM JOHNSTON HEALTH

Is family history a huge factor?

85% of breast cancer cases occur in women with NO family history.

Screening of breast cancer

Mammograms are the first line screening tool for breast cancer and are currently recommended biennial for women aged 50-74.  However for those at higher risk, mammogram screening should start earlier, with possible follow-up ultrasound, and be performed more regularly.

3-D MAMMOGRAM IMAGE

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

For some yes, as new cancer screening guidelines suggest swapping the embarrassing procedure with HPV only tests. These HPV only tests can even be done in the privacy of one’s home.

The US Preventive Services Task Force (USPSTF) suggest women between the ages of 30-65 may be screened for cervical cancer by testing for the HPV virus, high risk strains, every 5 years without undergoing a concurrent Pap smear. This is opposed to the “co-testing” recommended up until now. Women can, however, if desired, choose to have Pap smears every 3 years. These guidelines do not pertain to those who have cervical cancer or symptoms that could suggest a malignant process such as pain, bleeding and weight loss.

However one concern many physicians have is the lack of other testing being done during a “Pap Smear” visit.  Pelvic exams evaluating for gynecological pathology, breast exams, counseling and preventative health recommendations are often done during a woman’s physical and extending the testing intervals to twice a decade could put one at risk of another illness being missed.

Moreover, would an at home HPV test be sufficient enough to screen for cancer?  Smoking may also predispose one for cervical cancer so testing for the HPV virus alone may not be enough.

What is the cervix and what is cervical cancer?

The uterus looks similar to a light bulb.  The larger top portion being where the fetus develops, and the bottom, narrower area, the cervix.  The cervix thins and dilates during childbirth, as you’ve heard in the movies “she’s only 7 cm!” and then after childbirth becomes narrow again.  It affects nearly 12,000 and kills 4,000 women each year.  It can affect women of any age but is more common between 20 and 50.

HTTP://WWW.WEBMD.COM/WOMEN

What causes cervical cancer?

The most common cause is HPV (Human Papillomavirus), especially HPV-16 and HPV-18.  This is acquired through unprotected sex, so condom use is encouraged. Thus it's one of the most preventable causes of cancer.  Additionally, there are 3 vaccines for HPV currently approved by the FDA, Gardasil, Gardasil 9, and Cervarix.

What are the symptoms of cervical cancer?

Early cervical cancer may not be symptomatic but as it develops it may cause an odor, pain with urination, pelvic pain and bleeding. This bleeding may occur after sex, a pelvic exam, or intermittent bleeding not associated with a menstrual cycle.

Is cervical cancer treatable?

Yes.  Early detection is key and can be done by a Pap Smear, explained below.  Multiple treatments are available including surgery, chemotherapy,  radiation therapy, and targeted therapy such as Bevacizumab (Avastin®) which prevents new blood vessel growth that can feed a tumor.

Who should get screened for Cervical Cancer?

The USPSTF (United States Preventive Services Task Force) recommended the following:

What is a Pap Smear?

It is the cytology (cell analysis) of the cervix. Years ago, a cytobrush would collect the cells and the medical provider would “smear” it onto a slide, place fixative, and then send it to the laboratory for the pathologist to analyze it. Now ThinPrep® Pap tests are used more commonly as the cells from the brush are placed into a container with fixative, and this vial is sent to the pathologist to spin down and analyze.

TEK IMAGE/SPL / GETTY IMAGES

In order to obtain the cells from the cervix, the medical provider needs to use a speculum to open the vaginal canal and allow access to the uterus.  A woman may be in the lithotomy position…lying on one’s back on the exam table with her feet in stirrups and knees bent. During the speculum exam, the medical provider may take cultures to test for common vaginal infections such as yeast, bacteria vaginosis, or sexually transmitted illnesses such as gonorrhea and chlamydia.  After the speculum exam, the provider may perform a pelvic exam with her gloved hand to examine the uterus and ovaries, evaluating for tenderness, shape, size and masses.

How is an HPV test done?

An HPV test can be done with the cells obtained during the Pap Smear.  At home tests require the patient to swab their vagina (female) or urethra (male) or rectum and then mail the swab to the lab.  The laboratory evaluates the cells to see if the HPV virus that causes cervical cancer is present.

In summary the thousands of deaths that occur each year to cervical cancer can be prevented with simple testing, such as the Pap Smear.  Discuss with your medical provider when cervical cancer screening is best for you.

----

Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

A study has found those who grill meat on charcoal, wood, or coal have a 12% increase risk of suffering a heart attack, stroke or heart failure.

Researchers from the University of Oxford studied 341,000 people in China, measuring their exposure to cooking mediums and their risk of heart death (8,300 died of heart disease unrelated to smoking and other factors). They additionally found that for every decade after one switched to cooking with gas or electric, their risk factor lowered by 5%.

Study authors suggest if one would switch to a gas or electric grill, the risk could be reversible.  Daily Mail reports the following:

PEOPLE WHO HAD SWITCHED 10 OR MORE YEARS AGO SAW THEIR RISK SINK BACK TO LEVEL WITH PEOPLE WHO HAD ALWAYS USED ‘CLEAN’ ENERGY.

PROFESSOR ZHENGMING CHEN ADDED: ‘SWITCHING TO ELECTRICITY OR GAS WEAKENED THE IMPACT OF PREVIOUS SOLID FUEL USE, SUGGESTING THAT THE NEGATIVE ASSOCIATION MAY BE REVERSIBLE.’

Last Spring, scientists found grilling may increase one’s risk of high blood pressure.  In this study, reported by medical xpress, they found high blood pressure risk to be:

• 17 PERCENT HIGHER IN THOSE WHO GRILLED, BROILED, OR ROASTED BEEF, CHICKEN OR AND FISH MORE THAN 15 TIMES/MONTH, COMPARED WITH LESS THAN 4 TIMES A MONTH.
• 15 PERCENT HIGHER IN THOSE WHO PREFER THEIR FOOD WELL DONE, COMPARED WITH THOSE WHO PREFER RARER MEATS.
• 17 PERCENT HIGHER IN THOSE ESTIMATED TO HAVE CONSUMED THE HIGHEST LEVELS OF HETEROCYCLIC AROMATIC AMINES (HAAS) – CHEMICALS FORMED WHEN MEAT PROTEIN IS CHARRED OR EXPOSED TO HIGH TEMPERATURES – COMPARED TO THOSE WITH THE LOWEST INTAKE.
• Standing NEXT to a Grill Can Increase Cancer Risk

Chinese researchers find the smoke released during grilling to expose one to cancer- causing chemicals.

As we head into the summer, grilling burgers, hotdogs, and steaks are a favorite pastime.  But a small study published in the journal Environmental Science & Technology suggests PAHs (polycyclic aromatic hydrocarbons), produced during grilling, are inhaled and absorbed through the skin, potentially causing genetic mutations that may cause cancer.

The study, out of Guangzhou, China, found those consuming the grilled meat had the highest exposure to PAH’s. Next came those exposed through skin, and finally those inhaling the smoke to be at next greatest risk.

Clothing provided some protection, but once smoke saturated, should be removed to lessen exposure.

The average person is considered safe if they grill in moderation, but excessive exposure could put them at higher risk of PAH-induced cancers such as lung, bladder and skin cancers.

For more on the study read here.

The heating of foods to high temperatures can cause chemical reactions among the amino acids, fats and sugars in foods, producing toxic substances.  Acrylamide, as discussed below, can be formed when heating starches such as potatoes, to high levels.

What is acrylamide?

Acrylamide is a chemical used in many industrial products that produce plastics, adhesives, food packaging and the treatment of drinking water.  It can also be produced when foods are heated, fried, baked, or roasted to above 120 degrees Celsius (248 degrees Fahrenheit).  In 2002 reports came out regarding acrylamide in french fries, and in 2013 the FDA issued guidance to the food industry on how to minimize producing the chemical.

Roasting coffee requires the beans to be heated to close to 450 degrees Fahrenheit. This heat produces a chemical reaction between the amino acid asparagine and sugars resulting in the formation of acrylamide.

The amounts however are miniscule. Much smaller than other modes of acrylamide exposure such as cigarette smoking and exposure at work when working in industries that use acrylamide such as plastics, food processing, mining, paper, agriculture and construction.

What can acrylamide do?

In rodents, acrylamide was found to increase several types of cancer. But the doses were 1,000-10,000 times greater than what the average human is exposed to.

According to the American Cancer Society, most of the studies done so far have not found an increased risk of cancer in humans. For some types of cancer, such as kidney, ovarian and endometrial cancer, the results have been mixed, but there are currently no cancer types for which there is clearly an increased risk related to acrylamide intake.

How do I decrease exposure?

As noted earlier, acrylamide can be in a variety of products we use throughout the day.  Large quantities, however, can be consumed through cigarette smoke, hence avoiding smoking is key.  Moreover, avoiding frying foods, especially starches, greater than 120 degrees Celsius/248 degrees Fahrenheit if possible. Frying and or toasting to a light gold, rather than crispy dark brown color, may limit your exposure as well.

But keep in mind, numerous studies have found coffee drinkers to lower their risk of cancer, especially liver, uterine, prostate and mouth cancer. However 4-6 cups had to be consumed in order for researchers to notice a benefit.

More research still needs to be done on all fronts when it comes to grilling mediums, crispiness of our cooking and coffee. So while we wait for the verdict let’s kick back with something safe…..I guess a cup of water??

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Legendary conservative maverick John Sidney McCain III died today from complications to brain cancer. His family announced just yesterday that McCain would no longer receive treatment for his cancer. Like many, I assumed that meant his passing was near but I was still shocked to hear of his death not even 24 hours later.

McCain has been in politics for 40 years first as a Navy liaison, then in the House and then a six time elected Senator. He was mainly an old school “war hawk, small government” Republican but at times cast surprising votes as he did in the July 25th, 2017 American Health Care Act vote but for the most part he, like most other politicians towed the party line. Initially, he even supported Donald Trump, albeit tepidly although in the past several months McCain has been incredibly critically vocal against the sitting president. McCain has laid low at home since December battling cancer, but he has still been active on social media and has only harsh words for the sitting President, basically agreeing with Hillary Clinton that Trump is a Putin puppet.

McCain has even been planning his funeral for months and has made it explicitly clear that President Trump is not invited. In fact, Senator McCain asked that former Presidents Obama and Bush give the eulogy. It reminded me of a few times during his failed 2008 Presidential run where he defended Obama against hostile crowd members. How many modern politicians can you name that have the guts to stand up to their own voters and defend a rival? The only two I can think of are Senator John McCain and President Barack Obama.

Anyway. Much has been written about and by him. He has multiple memoirs and there are thousands of tributes to him all over the internet. I will leave it to you to seek them out. Love him or hate him, Senator McCain was a very important figure in the United States and he fought a lot of good fights.

I doubt we will see anyone like John McCain in the Senate, especially on the Republican side of the aisle - any time soon.

I leave you with a touching tribute from his daughter, Meghan McCain. Her tweet this morning:

After being diagnosed with a brain tumor a little over a year ago, Senator John McCain has chosen to end treatment for the deadly cancer.

The 81-year-old Vietnam veteran and former POW was diagnosed with a primary glioblastoma in the summer of 2017. Since then he has bravely fought the malignant brain tumor.  His family reported this week the following:

Last summer, Senator John McCain shared with Americans the news our family already knew: he had been diagnosed with an aggressive glioblastoma, and the prognosis was serious. In the year since, John has surpassed expectations for his survival. But the progress of disease and the inexorable advance of age render their verdict. With his usual strength of will, he has now chosen to discontinue medical treatment.

Our family is immensely grateful for the support and kindness of all his caregivers over the last year, and for the continuing outpouring of concern and affection from John’s many friends and associates, and the many thousands of people who are keeping him in their prayers. God bless and thank you all.

Although still politically vocal, Senator McCain has not been in Washington since December.  He’s been at his home in Arizona with his family.

What is Primary Glioblastoma?

Primary Glioblastoma Multiforme is a type of brain tumor that arises in the brain and spinal cord and is very aggressive in nature. “Primary” suggests the tumor is not secondary to another cancer, such as the melanoma Senator McCain successfully battled.

In 1993, 2000 and 2002, McCain had three malignant melanoma lesions removed, and the 2000 lesion was close to his left temple.

Those diagnosed with a glioblastoma may have a poorer prognosis compared to other cancers as the 5-year survival rate is only 10%. Its median survival is less than 15 months.

In 2017, doctors were optimistic as his lesion had been removed, and chemotherapy and radiation were set to immediately begin once his incision had healed.

However many may choose to end cancer treatment early due to side effects or the desire to spend their remaining weeks with family devoid of medical procedures and hospital trips.  It's understandable and gutsy.  Our prayers are with him and his family during this difficult time.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Last year we learned that some patients, who were evaluated for a stroke or transient ischemic attack when they had come to the ER complaining of recurrent “temporary blindness” after checking their smartphone in the dark were suffering from a phenomenon, known as ‘smartphone blindness.’ This has also been experienced by many of us when we have the sensation of dimmed vision or poor visual acuity, feeling punished for peeking at our email when we should be sleeping.

But now we have a study suggesting vision loss could be permanent due to the blue light being emitted from our smartphones or laptops.

Researchers from the University of Toledo found blue light will react with retinal, an active form of Vitamin A, that can damage the nearby cells they are designed to stimulate when creating sight.

Researcher Kasun Ratnayake states, “If you shine blue light on retinal, the retinal kills photoreceptor cells as the signaling molecule on the membrane dissolves,” and since these cells do not regenerate they are gone for good.

Although a blue-light induced retinal activated cell could prove useful when fighting cancer, this finding is worrisome as millions of people, including children, look at their smartphone and tablet in the dark, depending on the blue light more and more to see their screens.

What is blue light?

Sunlight is made up of the spectrum of colors including red, orange, yellow, green, blue and purple.  Blue light is a light along the spectrum that has shorter wavelengths and more energy than red, which has longer wavelengths. We receive most of our blue light exposure from the sun but we can be exposed as well through our smart devices, LED lights and CFL (compact fluorescent light) bulbs.

IMAGE FROM PREVENTBLINDNESS.ORG

Smartphone use linked to retinal detachment

Studies surfaced a few years ago where great lengths of smartphone use can cause retinal detachment.  In these cases the layer of the retina which focuses images, detaches from the back of the eye, causing serious vision loss. Though there are treatments, if not treated early can cause permanent blindness in the affected eye since the retina loses its blood and oxygen supply when detached. A woman from China had been using her smartphone for 2-3 hours in the dark each night when this occurred.

Smartphones have also been linked to myopia, near-sightedness, and sleeping disorders as the blue light emitted from the screen can disrupt melatonin production.

A recent study found that 30% of adults spend more than 9 hours a day using their smartphone. Physicians recommend avoiding extended use, adjust settings to black text on white background, and with this recent case study, use both eyes to look at the screen when using the phone at night.

Smartphone, Street Lamp Blue Light May Increase Risk of Cancer

A study from the University of Exeter and Barcelona Institute for Global Health finds blue light exposure at night-time to increase the risk of breast and prostate cancer.

Blue light is emitted from artificial lighting, such as LED’s and smart devices, and has been linked in the past to cancer, heart disease, diabetes and obesity. Why?  Scientists believe the blue wavelengths in the light disrupt our circadian rhythm, or our body’s biological clock, by suppressing the secretion of melatonin. Poor sleep, and unpredictable body cycles, can affect our metabolism, hence our weight, diabetes risk and cancer risk.

In this study, published in the journal Environmental Health Perspectives, researchers reviewed data of more than 4000 patients, between the ages of 20 and 85, from 11 different geographical regions. They found exposure to blue light at night doubled the risk of prostate cancer in men, and increased breast cancer risk in women by 1.5.

The Sun reports study author Dr. Alejandro Sánchez de Miguel is urging to reduce exposure to outside street lights and use orange wavelength light rather than blue.

“The take-home message is: Use warm orange lights where possible, and shutters and blinds to block street light.

“Also, our findings suggest reducing your night-time exposure to smartphones and tablets could help cut cancer risk.

How to protect your eyes by minimizing blue light exposure

The recommendation to not use your smart device at night may not be very practical for many.  So here are some additional tips:

Increasing the size of the font helps your eyes since they don’t need to strain as much to read.  Try to look at your smartphone with a distance of 1 1/2 feet. Blinking often helps rest the eyes as well and keeps them lubricated and moist.

Screen time should be limited in the evenings.  Avoid computer/phone screens at least 2-3 hours before bed.

Although LED light bulbs are more energy-efficient, bedroom lighting may need to be swapped for softer bulbs.

If the weather permits, getting some night air and watching the stars may help stimulate one’s melatonin, allowing him/her to get sleepy.

Blue-blocking glasses may help limit exposure if night computer work cannot be avoided.

Additionally there are apps that allow a blue light filter on one’s phone screen.

Finally its good to use the 20,20,20 rule.  After every 20 minutes of use, look away at something 20 feet away for 20 seconds.  This may help avoid eye strain from excessive smartphone use.

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Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Although it's been long known that flight attendants are at higher risk of breast cancer and melanoma, new research has found an increase risk in the following additional cancers:

• non-melanoma (basal cell and squamous cell)
• thyroid
• cervical
• uterine
• gastrointestinal

Researchers from Harvard T. H. Chan School of Public Health, led by research associate, Irina Mordukhovich, surveyed over 5000 flight attendants as part of the Harvard Flight Attendant Health Study (FAHS) and found a four-fold risk in non-melanoma skin cancer, a two-fold risk in melanoma, and a 51% greater risk of breast cancer, among other malignancy risks.

Those flight attendants with three or more children had even a higher risk of breast cancer.

TIME Magazine reported the following:

“Flight attendants are considered a historically understudied occupational group, so there is a lot we don’t know about their health,” says Mordukhovich. “What we do know for sure is the exposures that both pilots and flight attendants have—the main one being high radiation levels because of cosmic radiation at altitude.” That exposure may not be concerning for people taking individual flights, but for people whose jobs involve flying, that risk may have a negative effect on their health, as the study results suggest.

A 2007 study found an increase risk of heart attacks, respiratory illness, poor sleep, depression and anxiety in cabin crew.

What’s surprising is the average flight attendant does not smoke and maintains a healthy weight, hence thought to live a healthier lifestyle, decreasing heart and cancer risk.  So….

Why are flight attendants at increased risk?

Multiple factors can affect those who work high in the skies. These include:

• cosmic ionizing radiation (radiation coming from outer space with higher levels in the upper earth’s atmosphere)
• solar radiation from sun flares
• disruption of their sleep cycle, circadian rhythm (long linked to cancer)
• exposure to chemicals such as jet fuel, flame retardants and other chemicals.
• constant exposure to pathogens and communicable diseases (link to cancer not yet determined)
• not being able to maintain regular hydration and diet

How can flight attendants protect themselves?

It’s difficult for those who staff airlines to alter their schedule, diet or uniform.  But what’s recommended is the following:

• wear sunscreen
• wear long sleeves and skirts/pants
• maintain good hydration and a regular diet
• try to ask for regular shifts that allow one to sleep regular cycles
• if at higher genetic risk for some cancers (BRCA1 and BRCA2 gene mutations) see your medical provider about recommended screening.

The CDC recommends the following:

• Try to reduce your time working on very long flights, flights at high latitudes, or flights which fly over the poles. These are flight conditions or locations that tend to increase the amount of cosmic radiation the crewmembers are exposed to. You can calculate your usual cosmic radiation exposures. The FAA’s CARI program website allows you to enter information to estimate your effective dose from galactic cosmic radiation (not solar particle events) for a flight.

• If you are pregnant or planning a pregnancy, it is important to consider your work exposures, including cosmic radiation. If you are pregnant and aware of an ongoing solar particle event when you are scheduled to fly you may want to consider trip-trading or other rescheduling actions if possible.

• For flight attendants, a NIOSH study found that exposure to 0.36 mSv or more of cosmic radiation in the first trimester may be linked to increased risk of miscarriage.

• Also, although flying through a solar particle event doesn’t happen often, a NIOSH and NASA study found that a pregnant flight attendant who flies through a solar particle event can receive more radiation than is recommended during pregnancy by national and international agencies.

• Regarding solar particle events:

• NIOSH has estimated that pilots fly through about 6 solar particle events in an average 28-year career.

• Avoiding exposure to solar particle events is difficult because they often happen with little warning. You can find out whether a solar particle event is currently active through these sources:

• The National Aeronautics and Space Administration (NASA) Nowcast of Atmospheric Ionizing Radiation System (NAIRAS) is being developed to report potentially harmful flight radiation levels to flight crews and passengers.

• NAIRAS: current radiation dose rate forecast.

• A space weather app for the iPhone offers current information on solar activity

• The National Oceanic and Atmospheric Administration (NOAA) Space Weather Prediction Center’s Aviation Community Dashboard includes a forecast for solar particle events.

Are travelers at risk?

Experts have suggested that those who are frequent fliers are still at low risk of being exposed to “too much radiation”.  Traveller.au.com writes: Overall, the amount “is really inconsequential,” said Dr. Edward Dauer, director of radiology at Florida Medical Center in Fort Lauderdale, adding that medical CT scans result in a much higher dose.

Read more:

Flight risk: how much radiation do planes expose you to?

Therefore medical professionals may suggest flying “in moderation” and checking in for regular check ups.

How can I check my radiation dose?

The American Nuclear Society provides a calculator, based on where one lives, how many x-rays, and how many hours one flies, here.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.

Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day.  They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml.   That dose would be commonly consumed by many humans who vape.

They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

• Formaldehyde (human carcinogen)
• Acetaldehyde (carcinogen related to alcohol drinking)
• Acrolein (highly irritating and toxic)
• Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
• Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.