TIME Drugs

It’s Easy to Overdose on Tylenol, Study Warns

Tylenol Pills Spilling Out Of Bottle
Shelley Dennis—Getty Images

A new analysis from Consumer Reports calls out the Food and Drug Administration (FDA) for inconsistent and potentially dangerous labeling of acetaminophen painkillers

The rise in prescriptions and non-prescription use of painkillers in the U.S. is no secret – in the past decade, prescriptions for opioids have skyrocketed by 300%, making them the most prescribed drugs in the country.

And the consequences of that spike can be deadly, according to the latest report from Consumer Reports: nearly 17,000 people die each year from overdosing on painkillers.

Equally alarming is the rise in other popular painkillers that also have over-the-counter (OTC) versions. Acetaminophen, which includes Tylenol and other generic brands, causes more than 80,000 emergency room visits each year because people often aren’t aware they’re taking too much. The drug is found in more than 600 over-the-counter and prescription medications, such as allergy and cold remedies and sleep aids.

To address the potential for accidental overdose of acetaminophen, the FDA asked physicians earlier this year to stop prescribing more than 325mg of acetaminophen to patients, noting that there isn’t evidence that higher doses provide any additional benefit for relieving pain and that high levels of the drug are linked to liver damage. But the warning did not apply to OTC versions of the drug, which account for 80% of acetaminophen use in the U.S., and are still available in higher doses.

MORE: Tylenol and Panadol Prove No Better Than Placebo at Helping Back Pain

The Consumer Report authors also say that OTC drugs have inconsistent advice about how much acetaminophen is too much for people to take in a day. “We found recommendations varying from 1,000mg per day in some nighttime pain relievers to 3,900 milligrams in some products that combine acetaminophen with allergy drugs or cold and flu drugs. We think the labeled daily limit should be no more than 3,250 milligrams,” they write.

Regarding opioids, the authors call for the FDA to reconsider its December 2013 approval of Zohydro ER, a long-acting version of hydrocodone, over concerns that longer-acting forms are more likely to be misused and abused and don’t show any clear pain-killing benefit over shorter-acting medications. They advise doctors to consider starting their patients who need pain relief with short-acting opioids first, to better gauge whether these forms can provide enough pain relief.

For consumers, the report urges people taking opioids or acetaminophen to ask for and expect regular monitoring of their pain and other symptoms. If the pain isn’t going away, then continuing to take the medications isn’t going to help, and will only expose you to potentially harmful side effects.

TIME behavior

This Blood Test Can Predict Suicide Risk, Scientists Say

Researchers report encouraging advances toward a blood test that can pick up genetic changes linked to suicide

Behaviors can’t be reduced to your genes – they’re far too complicated for that. But genes can lay the foundation for making people more or less likely to respond and act in certain ways, and suicide may be the latest example of that.

In a paper published in the American Journal of Psychiatry, researchers led by Zachary Kaminsky, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, found reliable differences in the activity of a specific gene among those who had committed suicide and those who had not. They conducted a series of tests to verify their result. First, they studied brain samples of mentally ill people and those not affected by mental illness, and revealed that a gene, SKA2—which is most abundant in the prefrontal regions of the brain that are involved in inhibiting negative thoughts and corralling impulses—was less active among those who ended up committing suicide than among those who had not. If there isn’t enough of SKA2, or if it isn’t working properly, then receptors that pull the stress hormone cortisol into cells to put a brake on the stress response also don’t work. That can lead to unchecked negative thoughts and impulsive behaviors, like a runaway car without brakes.

MORE: U.S. Special Ops Are Soldiers Committing Suicide in Record Numbers

The scientists also compared amounts of SKA2 among people with suicidal thoughts or those who had already attempted to kill themselves. Based on levels of the gene’s products in the blood, they could predict with 80% to 90% accuracy whether a particular participant had had suicidal thoughts or had tried to commit suicide.

The differences Kaminsky and his colleagues found isn’t a genetic mutation, but a change in how active the SKA2 gene is. Environmental exposures and life experiences can affect how and when genes are turned on or off. That’s what is happening with SKA2 in those who commit suicide; their gene is inhibited from doing its job of controlling their stress response and modulating it properly.

The work is just the first step in potentially developing a blood test for identifying people at highest risk of harming themselves, says Kaminsky. “We are not going to recommend screening everybody,” he says. “I don’t think that makes sense.” But among those at high risk of suicide, knowing that they also have a possible genetic tendency to react negatively to stress may help to them to get consistent support and more aggressive mental health services to help them cope with their stress and avoid more tragic outcomes.

TIME Pregnancy

The Connection Between Parks and Healthier Pregnancy

Trees can do a lot of good for your health, from lowering stress to encouraging you to spend more time outdoors exercising. But can it help expectant moms have healthier babies?

What mother-to-be doesn’t do her best to nurture her still-developing baby so he or she can be ready for the world after nine months? Eating right, exercising, and avoiding extreme amounts of stress are just some of the ways that expectant mothers can cocoon their babies in the healthiest environment possible. And now scientists say there’s another thing pregnant women can do to help their babies to emerge from the womb at a healthy weight.

Living near green spaces – parks, gardens, and even cemeteries – is associated with fewer low birth weight babies, according to a study published in the journal Occupational & Environmental Medicine. An international group of researchers analyzed data from nearly 40,000 singleton births in Tel Aviv, Israel from 2002 to 2006 and matched the mother’s address at the time of delivery with satellite images of the landscape to assess their relative “green-ness.” Women who lived in areas with more access to parks or gardens or green spaces were less likely to have children with low birth weight, a risk factor that can contribute to respiratory conditions, intestinal disorders and bleeding in the brain as well as more long term health issues such as diabetes, heart disease, bone disorders and possibly autism.

Because greener regions tend to be associated with higher socioeconomic status and more maternal education, both factors that also affect the rate of low birth weight, the researchers also adjusted for the effect of socioeconomic status, and still found an effect of the greener environments. But they did find a stronger association between less green space and more low-birth-weight babies among those in lower socioeconomic groups, which could reflect the influence of other factors, such as less healthy behaviors in those populations and greater exposure to air pollution, stress and other environmental factors that can influence pregnancy outcomes.

So living near parks alone can’t prevent low-birth-weight babies, but the findings suggest that it couldn’t hurt. And the authors note that other studies hints at why – being near parks may encourage physical activity and promote more social interactions that can provide support to relieve stress and depression. Green spaces also tend to have lower levels of pollution and other potentially harmful environmental compounds that have been linked to poor fetal development.

TIME Infectious Disease

Here’s What You Need to Know Now About the Ebola Crisis

After a passenger brought Ebola to Africa’s largest city, health officials are on alert for signs of the infection among passengers. Here's the latest

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The Ebola outbreak has already led to more than 670 deaths in West Africa, but a man who became ill on a flight from Liberia to Lagos, Africa’s largest city, has raised alarms for public-health officials after he later died of the virus.

Liberia has closed most of its borders, and airports in Nigeria are now screening passengers arriving from foreign countries for Ebola’s symptoms, which include fever, headache, joint pain, lack of appetite, difficult breathing and sore throat. In its advanced stages, Ebola leads to diarrhea, vomiting and internal bleeding. While the airport screenings are meant to ease travelers’ minds, the reality is that the Ebola virus can’t be detected soon after infection — the first signs of the virus are red eyes and a rash, which could be caused by many different things. Plus, outgoing flyers are not being tested and its unclear at this point if over countries will follow suit. People have recovered from infection with the virus, but the mortality rate ranges from 50% to 90%.

(MORE: Here’s What It Will Take to Contain the Worst Ebola Outbreak in History)

Who can spread the virus?

The virus takes anywhere from two to 21 days to incubate and start causing symptoms, but Dr. Stephan Monroe, deputy director of the National Center for Emerging and Zoonotic Infectious Diseases at the U.S. Centers for Disease Control and Prevention (CDC), said during a telebriefing Monday that infected patients only spread the disease when they have symptoms. Because the virus is transmitted through direct contact with fluids like saliva or blood from infected patients, airport officials are essentially looking for passengers who might have severe vomiting, diarrhea or other bodily secretions that could reach other travelers.

Are Nigeria’s airport screenings enough?

Nigeria is screening incoming passengers for such symptoms and may also take passengers’ temperature. Nigerian officials have also created holding rooms to isolate patients or passengers who are suspected of being infected, so they can be triaged to further medical care.

But because some of the early symptoms of Ebola mirror those of other ailments, including malaria, CDC officials say the strongest way to contain spread of infectious diseases is by instituting travel restrictions at the source. That’s why Liberia has closed all its borders except for three land crossings where travelers can be screened and treatment services provided if needed.

Dr. Marty Cetrone, director of the division of global migration and quarantine at the CDC, said during the briefing that officials can also try to contain the outbreak by using questionnaires asking travelers at these checkpoints about their recent travel history as well as their potential exposure to the virus through friends or other close contacts.

How did this outbreak get so bad?

Health officials aren’t sure why this particular outbreak has led to a historic number of deaths, but note that social and cultural practices may be driving spread of the virus. In many of the communities where the virus remains active, there is still denial about the disease, and stigma associated with getting ill, which discourages patients from getting early hydration and nutrition that can help them to overcome the infection. While there is no treatment for the virus, these measures can lower the death rate for some. Funeral practices that involve touching the deceased may also help the virus move from host to host.

How at-risk are Americans?

Monroe says the risk of Ebola for U.S. citizens who haven’t traveled to West Africa remains low. There are no restrictions on travelers entering the U.S., but the CDC has issued a Level 2 travel advisory for people traveling to Guinea, Liberia or Sierra Leone, recommending that they avoid contact with blood or other bodily fluids that might contain the virus, and use the proper protective equipment to avoid infection. The advisory applies mostly to health care or humanitarian aid workers, who so far make up the largest group of people affected by Ebola. “[Transmission] involves not only touching the contaminated body fluid but introducing it through some mucous membrane or cut on the skin,” said Monroe.

For anyone who has recently traveled to those countries or might have been exposed to someone who was ill in that area, health officials are advising a 21-day fever watch to ensure that no active infection is occurring.

What if an infected person flies into the U.S.?

The CDC is also preparing for the remote possibility that a passenger from the region who is ill boards a plane and lands in the U.S. and starts infecting residents. The agency is informing its network of physicians in state and local public-health facilities about how to look for signs of Ebola. “We are sending Health Alert Network notices about the importance of taking steps to prevent spread of the virus,” said Monroe. That includes procedures on asking patients about their recent travel history, as well as using the proper personal protective equipment, such as masks, gloves and gowns if they suspect an Ebola infection.

They’re confident that these measures will be effective, since infection with a virus related to Ebola, Marburg, was successfully contained in the Netherlands with isolation and barrier procedures. No health care workers contracted the virus from that patient. Health officials hope that with the proper preparation and education, that record can apply to Ebola as well, if it makes it beyond the heavily affected countries in West Africa.

TIME diabetes

Having The Right Kind of Fat Can Protect Against Diabetes, Study Says

Brown tissue, also known as brown fat
Brown tissue, also known as brown fat Getty Images

People with more "brown fat" were better able to keep blood sugar under control and burn off fat stores

Not all fat is created equal, it seems. When we’re born, we have larger amounts of brown fat, so-called because it contains more dark mitochondria, the cell’s energy factories that pull in glucose and use it as fuel to drive cellular functions. Like a hard-working battery, however, brown fat releases heat as it performs its functions, which is helpful to keep newborn infants warm but gets less useful for adults as we’re better able to regulate our body temperature. So as we get older, this brown fat is gradually lost.

But in a report published in the journal Diabetes, scientists led by Labros Sidossis, professor of internal medicine at University of Texas Medical Branch at Galveston, found for the first time that adults who retained more amounts of brown fat were better able to keep blood sugar under control and burn off fat stores. Previous studies have linked brown fat to better weight control, but these results also hint that the tissue may be important for managing diabetes.

MORE: How Now, Brown Fat? Scientists Are Onto a New Way to Lose Weight

The researchers measured the brown fat in a small group of healthy men and also tracked how much energy they used while resting, how well they metabolized glucose, and their sensitivity to insulin, which breaks down and controls blood sugar. Because brown fat tends to be activated under cold temperatures, the scientists also measured these factors after the men sat at room temperature, and again after they sat at 65 degrees to 70 degrees F for five to eight hours.

The men who had higher amounts of brown fat – about 70g on average – increased their metabolic rate by 15%, meaning they burned more calories when they were exposed to slightly cooler temperatures, compared to the men with little or no brown fat. That alone, says Sidossis, contributed to burning 300 more calories for these men.

Those with higher brown fat were also able to break down more sugar, leading to less of it in their blood, something that hasn’t been shown before in human studies. If the subjects sat in the cooler room for 24 hours, the researchers found, that would lead to a reduction of 25g of sugar in the blood thanks to their brown fat alone. “That’s significant because if you consider people who have diabetes, they only have about 2g to 3g more sugar in the blood,” says Sidossis.

MORE: Study: Scientists Find a Way to Trigger Fat-Burning Fat

Interest in brown fat has exploded in recent years, and investigators found that adults retain more brown fat than previously thought, on either side of the base of the neck. Activating this fat store has become a popular area of research; so far, cold temperatures are the only reliable way to stimulate it, but others are exploring ways to transform white fat into brown fat. As of yet, experts haven’t found a reliable way to turn brown fat on or off in a reliable and metabolically useful way. Genetics may determine how much brown fat people are born with, but if early research is validated, it may also be possible to modify that amount, either with drugs or by transforming white fat.

MORE: Turn Down the Thermostat, Drop a Few Pounds?

If the results of the current study are confirmed, the need to do so might become more urgent. “Our data suggest that brown fat may function as both anti-obesity and anti-diabetic tissue in humans,” says Sidossis. “And that makes it a therapeutic target in the battle against obesity and chronic disease. Anything that helps in this area, we need to pursue and make sure that if there is potential there, we exploit it.”

TIME Mental Illness

Schizophrenia Linked to 108 Genes

In a groundbreaking study, researchers reveal a host of new genes involved in schizophrenia, making it possible to develop desperately needed treatments

It took 80,000 genetic samples, seven years and the work of 300 scientists from around the world, but scientists now have the most complete dossier on schizophrenia ever.

In an historic paper published in the journal Nature, the Schizophrenia Working Group of the Psychiatric Genomics Consortium identified 108 new regions on the genome linked to the psychiatric disorder, which is associated with hallucinations and psychotic episodes and affects about 1% of people worldwide.

The genetic clues are the most dramatic hints that experts have gotten so far about what causes that mental illness. Schizophrenia has had a rocky history in the psychiatric community, with some doctors early on not even recognizing it as a disorder, and others debating whether its origins were biological or caused by traumatic events or other experiences. Now, by comparing the genomes of people with and without the disorder, it’s clear that at least some of the psychotic symptoms can be traced to changes in the genes.

“For the first time, we are starting to see the underlying biological basis of the disease, and that can lay the foundation for understanding the disorder, and eventually developing treatments,” said Eric Lander, founding director of the Broad Institute of MIT and Harvard, where about one third of the DNA samples were sequenced.

MORE: Older Fathers Linked to Kids’ Autism and Schizophrenia Risk

The study used genome wide association, a technique that sequences the genomes of affected and unaffected individuals, and then compares where they differ. Those DNA differences may be hints about why people develop schizophrenia in the first place, and therefore lead to new drugs or treatments.

The 108 genetic regions aren’t all located in specific genes, nor is it known yet if this is what actually causes schizophrenia. But, like evidence at a crime scene, they may point to certain molecular pathways that are responsible for the mental illness. It’s already known that some of the identified regions, for example, are involved in how adaptable or plastic the brain is, and in regulating the immune system, a connection that experts have previously not investigated before. Other genes may also reveal new ways to potentially treat the disease, a significant improvement over the existing therapies, which only address one brain system, involving dopamine. “Thorazine was approved in 1954 as the first anti-psychotic medication, and every antipsychotic since then has relied on the same fundamental mechanism of action,” Steve Hyman, director of the Broad Institute’s Stanley Center for Psychiatric Research and professor of stem cell and regenerative biology at Harvard University said. “And their efficacy has plateaued since the 1960s.”

MORE: Most Common Psychiatric Disorders Share Genetic Roots

Having a greater suite of potential areas of inquiry, the researchers hope, will attract pharmaceutical companies back to the field of mental illness. “We now have more than 100 genes pointing to distinct pathways – calcium channels, glutamate, the immune system – this is concrete stuff, and it means that the pharmaceutical companies who left [this area of drug development] because they didn’t have anything concrete to work on, are beginning to get their toes in the water, and are thinking of jumping back in the water,” says Lander.

The genetic windfall can also help scientists piece together how genetic changes may work in tandem to cause symptoms of psychoses. They warn that these advances, and new treatments, may not come in the next year, but they may be able to provide better answers to questions about which drugs may work better in which patients, and in finding ways to detect and hold off symptoms of schizophrenia earlier, before they become debilitating. All of the genetic information released in the paper will be deposited in a public database for researchers to access and advance the understanding of the disorder.

TIME Diet/Nutrition

Yogurt Could Lower Your Blood Pressure: New Study

The latest study links certain probiotics with better blood pressure control

Bacteria aren’t the first allies we turn to for staying healthy – there are enough strains that can cause serious illness, after all – but there’s growing evidence that certain strains of the bugs can actually be good for your health, and may even relieve symptoms of inflammatory conditions, allergies and possibly even obesity.

In the latest report on these microbial allies, researchers add one more possible benefit of probiotics – the live concoctions of bacteria contained in foods like yogurt. In an analysis of nine studies that looked at probiotic use and blood pressure, the report in the journal Hypertension found that people using probiotics tend to have lower blood pressure compared to those who didn’t eat them. The effects seemed to be stronger among those with higher blood pressure to begin with, and among those consuming multiple probiotic strains and in higher doses.

What do bacteria have to do with blood pressure? The researchers say that the micro-organisms could be helping to address hypertension in a variety of ways, from lowering cholesterol levels, which can contribute to less fatty buildup in the vessels and therefore reduce the chances of developing hypertension, to controlling blood sugar and keeping the enzymes and proteins that control blood flow and fluid volumes in check.

The results aren’t exactly a prescription for treating hypertension — at least not yet. But they raise the interesting possibility of incorporating a probiotic regimen into blood pressure management. The study authors admit, however, that more questions still need to be answered, such as which micro-organisms might be associated with the strongest effect on blood pressure, as well as which combinations of bacterial strains work best. The formulation of the probiotic may also be important, they say – in the studies they reviewed, participants consumed probiotics primarily from yogurt, but also from cheese, sour milk and supplements (liquid or capsules). Hitting the right threshold of microbes also seems to be important, and figuring out that volume is also essential before any advice about using probiotics to lower blood pressure is given.

TIME HIV

Researchers Find New Way to Kick Out HIV From Infected Cells

Scanning electron micrograph of HIV-1
Scanning electron micrograph of HIV-1 Getty Images

The technique addresses the problem of hidden reservoirs of HIV in the body, and could herald a new way of battling the viral infection

Once HIV invades the body, it doesn’t want to leave. Every strategy that scientists have developed or are developing so far to fight the virus – from powerful anti-HIV drugs to promising vaccines that target it – suffers from the same weakness. None can ferret out every last virus in the body, and HIV has a tendency to hide out, remaining inert for years, until it flares up again to cause disease.

None, that is, until now. Kamel Khalili, director of the Comprehensive NeuroAIDS Center at Temple University School of Medicine, and his colleagues took advantage of a new gene editing technique to splice the virus out of the cells they infected – essentially returning them to their pre-infection state. The strategy relies on detecting and binding HIV-related genetic material, and therefore represents the first anti-HIV platform that could find even the dormant virus sequestered in immune cells.

MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be

Even more encouraging, they also used the system to arm healthy cells from getting infected in the first place, by building genetic blockades that bounced off HIV’s genetic material. “It’s what we call a sterilizing cure,” says Khalili.

His work was done on human cells infected with HIV in cell culture, but, he believes the results are robust enough to move into animal trials and eventually into testing the idea in human patients.

The key to the strategy is the gene editing technique known as CRISPR, a way of precisely cutting DNA at pre-specified locations. CRISPR acts as a customizable pair of molecular scissors that can be programmed to find certain sequences of DNA and then, using an enzyme, make cuts at those locations. Because HIV is a retrovirus, its genetic material comes in the form of RNA; the virus co-opts a host cell’s genetic machinery to transform that RNA into DNA, which it then inserts into the cell’s genome. HIV’s genes, which it needs to survive, then get churned out by the cell.

MORE: David Ho: The Man Who Could Beat AIDS

Khalili designed a CRISPR that recognized the beginning and end of HIV’s DNA contribution, and then watched as the enzyme snipped out HIV from the cell’s genome. “I’ve been working with HIV almost since day 1 [of the epidemic] and we have developed a number of molecules that can suppress transcription or diminish replication of the virus. But I have never seen this level or eradication,” he says. “When you remove the viral genes from the chromosomes, basically you convert the cells to their pre-infection state.”

The advantage of the system lies in the fact that CRISPR can recognize viral genes wherever they are – in infected cells that are actively dividing, and in infected cells in which the virus is dormant. Current drug-based strategies can only target cells that are actively dividing and releasing more HIV, which is why they often lead to periods of undetectable virus but then cause levels of HIV to rise again. That’s the case with the Mississippi baby, who was born HIV positive and given powerful anti-HIV drugs hours after birth and appeared to be functionally cured of HIV when the virus couldn’t be detected for nearly four years, but then returned.

MORE: Rethinking HIV: After Five Years of Debate, a New Push for Prevention

Khalili admits that more work needs to be done to validate the strategy, and ensure that it’s safe. But it’s the start, he says, of a potential strategy for eradicating the virus from infected individuals. That may involve excising the virus as well as bombarding it with anti-HIV drugs. “We can get into cells, eradicate the viral genome, and that’s it,” he says.

TIME sexual abuse

Childhood Sexual Abuse Raises Heart Disease Risk In Adulthood

Researchers link early sexual abuse to greater risk of developing blocked heart arteries

Sexual and physical abuse during childhood can have long term effects on both mental and physical health, and previous studies have linked childhood sexual abuse to a greater risk of heart attack and other heart events—but it has been unclear exactly why. New research published Thursday in the journal Stroke adds to the case, showing thatwhether or not women had other risk factors for heart problems, a history of childhood sexual abuse remained a strong potential contributor to their atherosclerosis.

“What was a surprise was that when we controlled for [heart disease] risk factors, such as smoking and obesity, the association didn’t go away. We just couldn’t get rid of the association,” says Rebecca Thurston, director of the Womens’ Biobehavioral Health Laboratory at the University of Pittsburgh, who led the research with a team of colleagues.

MORE: Viewpoint: Why a Mandatory Child Abuse Reporting Law Could Backfire

More than 1,000 middle-aged women of various ethnic backgrounds from across the U.S. had yearly clinical exams beginning in 1996 for 12 years. At the end of the study, they also answered questions about sexual and physical abuse and had an ultrasound of their carotid arteries. About a quarter of the women reported being sexually abused as a child, and a similar percentage reported the experience as an adult.

When Thurston compared the women’s answers to their ultrasound, she found that those who reported childhood sexual abuse showed higher rates of plaque buildup in their arteries. They also had hearts and vessels that looked about two to three years older than those of women who hadn’t been abused.

MORE: Psychological Abuse: More Common, as Harmful as Other Child Maltreatment

Thurston’s findings suggest that whether or not the women had other risk factors for heart problems, their history of childhood sexual abuse remained a strong potential contributor to their atherosclerosis.

Thurston plans to continue the work by studying women who have had heart events – in this study, only women without heart disease were included – to see if the correlation still holds. She also wants to better understand how the early abuse affects women in later life. There is some evidence that traumatic experiences may change the stress response system in lasting, and possibly permanent ways.

While none of the women had signs of heart disease at the start of the study, Thurston says the results hint that physicians should be considering childhood experience, particularly traumatic ones, as part of comprehensive heart care for women. If the results are validated, then they might lead to ways of intervening with stress reduction or other psychological techniques to hopefully slow down the hardening of the arteries and lower their risk of heart disease.

TIME Breast Cancer

Removing Both Breasts May Not Improve Survival From Breast Cancer

The latest study adds support to the data suggesting that in some cases, less may be more in treating breast cancer

Researchers at the University of Minnesota confirm that when it comes to treating some forms of breast cancer, drastic surgery to remove breast tissue may not help in improving survival from the disease.

Reporting in the Journal of the National Cancer Institute, the scientists describe a model for calculating life expectancy based on recent rates of recurrent cancers among women with stage 1 or stage 2 disease. Although previous studies found that among women diagnosed with breast cancer in one breast, removing the other breast can lower risk of breast cancer in that breast by up to 90%, few studies have documented whether that also translated into greater survival of breast cancer, which can recur in other organs.

According to the researchers’ model, the overall difference in survival at 20 years after diagnosis for both women who had their opposing, unaffected breast removed and those who did not, was less than 1%.

The data confirm recent findings from a study of women with metastatic disease, which also showed that women who received additional surgery to remove lymph nodes and their breasts did not survive any longer than those who were treated with chemotherapy only. As TIME wrote about that study,

Researchers from Tata Memorial Hospital in Mumbai, India, recruited 305 women between 2005 and 2013, all of whom had metastatic breast cancer and had responded to six cycles of chemotherapy. The women were split into two groups. One group of 173 women received additional surgery and radiation treatment, and 177 did not. The women who received surgery had partial or total removal of their breasts and lymph nodes followed by radiotherapy.

After just over two and a half years, the scientists found no overall difference in survival between the two groups; in fact, there was a slight, but not significantly significant, increase in risk of death for the women undergoing surgery and radiation. The lack of difference remained strong even after the scientific team adjusted for the types of breast cancer the women had, and the extent to which their cancer had spread to other organs. The findings should provide more confidence to both doctors and patients who choose not to go under the knife or receive radiation in an effort to prolong their lives, since the evidence suggests that the added measures don’t provide significant benefit, and may only expose the women to more complications.

In the current study, the researchers note that survival is only one factor that women may take into account when debating whether to remove an unaffected breast. In an accompanying editorial, other researchers echoed the distinction, saying that quality of life and peace of mind factors may be important reasons for supporting the continued use of prophylactic mastectomy surgery.

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