TIME Cancer

Breast-Cancer Drug Has a Surprising New Application, Study Finds

An early study shows that gel-based tamoxifen may be as effective as the oral drug, and have fewer side effects

Tamoxifen is a mainstay of breast cancer treatments: it blocks the effects of the female hormone estrogen on the breast, inhibiting estrogen’s tendency to encourage breast tissue to grow uncontrollably. Now, Dr. Seema Khan, professor of surgery at Northwestern University Feinberg School of Medicine, reports in Clinical Cancer Research that putting the drug in a gel, and applying it directly to the breast tissue, where it needs to work, may have merit.

Doctors generally prescribe tamoxifen for women diagnosed with early breast cancer, including very early-stage ductal carcinoma in situ (DCIS), to prevent recurrent growths. But the drug has also been linked to an increased risk of stroke, blood clots and cancers in other tissues, including the uterus. That’s why more women, including those who have not yet had cancer but are at high risk for the disease could benefit from the drug but are reluctant to take it.

MORE: Why Mammograms Are Less Effective Among Breast Cancer Survivors

Dr. Khan’s study was small—only 26 women—but it provides proof that the principle of applying tamoxifen directly on the breast may be worth investigating. All of the women were diagnosed with DCIS, which generally does not spread. But 30% of DCIS can recur even after surgery and proper treatment, so most women are prescribed tamoxifen. In the current study, about half of the women in the study were randomly assigned to take the oral form of the drug, while the other half were given doses of a tamoxifen gel to apply directly to the breast tissue for six to 10 weeks before their surgery. Khan analyzed the breast tissue after surgery to study markers for tumor growth, and conducted blood tests for levels of tamoxifen metabolites as well.

At the end of the study, the women in both groups showed similar decreases in tumor-related proteins, but blood levels of tamoxifen were five times lower among the women using the gel than those taking the oral pill. That, says Dr. Khan, suggests that the major side effects of the drug, which occur in the blood and other reproductive organs, may be largely avoided if women use the gel.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

“Our study showed that applying the drug through the breast skin leads to high concentrations in the breast and low concentrations in the rest of the body,” she says. “The biological effect on the breast is consistent with the benefit of oral tamoxifen, so for that reason, we hope that this kind of approach would make preventive medication more acceptable to women with non-invasive breast cancer and how may be at high risk of developing breast cancer.”

Dr. Khan says that the breast may be uniquely designed for such transdermal therapy, since it is essentially an appendage of the skin, with its own internal lymphatic circulation. That may keep things applied to the breast skin within the breast tissue, and could explain the higher concentrations of tamoxifen metabolites she and her team found after the gel applications.

Still, she says that the small number of participants in the study means more research is needed to confirm the results. Right now, the gel version is not available. The company that provided the experimental doses for the study stopped making that formulation, so Dr. Khan is studying a related, similar metabolite called endoxifen that may have similar cancer-fighting effects on breast tissue.

If the strategy proves effective, it’s possible that cancer treatments, or at least breast cancer treatments, may become useful in preventing cancer as well, as more women at high risk who have yet to be diagnosed with the disease take advantage of them. Applying a gel with relatively few side effects may help more women to eliminate small tumors before they have a chance to grow. And if other types of drugs can be used on the skin as well, that could significantly broaden the therapies available to women looking for ways to prevent the disease.

“For high-risk women who need better prevention strategies, delivering the drug to the breast is a very desirable solution,” says Dr. Khan.

TIME Brain

To Prevent Alzheimer’s, Diet and Exercise Are Effective, Large Study Shows

In a groundbreaking study that looked at how diet, exercise and other non-drug interventions affect cognitive decline, researchers see some hope for relatively easy dementia-fighting strategies

+ READ ARTICLE

No one believes that a disease as complicated as Alzheimer’s can be warded off by an apple a day or by faithfully hitting the weight room. But a breakthrough study presented Sunday at the Alzheimer’s Association International Conference shows that after just two years, people who underwent lifestyle interventions showed improvements in their mental functions, including in memory, executive function and speed tests of their cognitive skills.

Dr. Miia Kivipelto from the Karolinska Institute in Sweden knew that several studies have linked some lifestyle behaviors, such as exercise and a healthy diet, as well as being more socially active, to less cognitive decline and stronger scores on memory and organizational tests. But it wasn’t clear whether people who ate better, exercised more and had more friends also shared something else in common that could explain their ability to slow down dementia symptoms.

So Kivipelto conducted one of the first studies to randomly assign 1,260 older individuals at high risk of developing Alzheimer’s to a lifestyle intervention or to normal health care, to see if the behaviors linked to better brain health actually helped to stave off intellectual decline. “We were surprised that were able to see a clear difference already after two years,” says Kivipelto. She was especially pleased to see the effect since the control group also received adequate and appropriate health care. “We thought that two years may not be enough, but the multi-domain approach seems to be an effective way of doing something to protect memory.”

MORE: New Understanding on Understanding Alzheimer’s

All of the participants, part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, had some risk factor for developing dementia, including their age, education, and poor heart-health profile. Half were randomly assigned to get an intensive lifestyle makeover, with both group and individual nutrition advice, an exercise trainer, and a nurse or physician who made sure they took their medications. In addition, these volunteers benefited from a social support system. The other half received appropriate health care, but not at the intensive level the intervention group did, and without the social support of their fellow participants.

MORE: New Criteria May Change Alzheimer’s Diagnosis

After just two years, the group that group that got the lifestyle makeover were in much better shape.

MORE: Study: Brain Scans Help Predict Alzheimer’s Disease Early

She and her team plan to continue following up with the participants in another seven years, to see if the effect remains. But she is aware that sticking with a lifestyle plan like the one in the study is a challenge, and says that any such program needs to incorporate ways of keeping patients motivated to comply. That’s why social support may be an important part of any such plan; in this study, for example, if participants missed exercise sessions, others called to find out why they were absent, cementing a pact to adhere to the new behaviors.

Kivipelto also recognizes that genetic factors can play a role in cognitive decline and risk of memory loss, but she says there may be a role for lifestyle interventions in helping people who may be at high risk of developing dementia or Alzheimer’s disease—before their symptoms start.

“These findings show that prevention is possible, and that it may be good to start early,” she says. “With so many negative trials for Alzheimer’s drugs reported lately, it’s good that we may have something that everyone can do now to lower their risk.”

 

TIME fitness

Sitting All Day Isn’t As Bad If You Do This

African American businessman using laptop
Jetta Productions/Blend Images RM/Getty Images

Getting to the bottom of sitting on your bottom: the latest study shows that fitness matters

There’s a growing drumbeat to get all of us out of our chairs and off our bottoms. Some studies, including the most recent analysis, suggest that something about being sedentary can lead to poor health outcomes, including heart disease and things like obesity, diabetes and overall “fitness”—which, in technical terms, is a measure of how strong the heart and respiratory system are. Those studies found that even people who exercised weren’t immune to the dangers of sitting—though exercise did help.

But were the effects of sitting actually independently lowering fitness and causing health problems, or was the sitting just a reflection of the fact that people who sat more spent less time being active?

MORE: Sitting Can Increase Your Risk of Cancer By Up to 66%

Kerem Shuval, a research specialist in nutrition and physical activity at the American Cancer Society, and his colleagues wanted to address that question. So they turned to the Cooper Center Longitudinal Study, an ongoing trial of white men that measures how lifestyle behaviors affect disease and longevity. They asked the men about how many hours they spent in a car or watching TV (the sedentary part) and then put them on a treadmill to record their fitness levels, as well as tested their blood for cholesterol and blood sugar. The scientists also calculated the participants’ body fat percentage, their waist circumference and their body mass index (BMI).

When they adjusted for the amount of physical activity that the men reported, they found that those who spent more hours each week in a car or watching TV showed higher triglyceride levels, a higher BMI, waist circumference and more body fat compared to those who reported less than nine hours a week of sedentary behavior.

MORE: An Hour of Exercise Can Make Up for a Day of Sitting Down

But when Shuval then factored in the mens’ fitness levels, he found that most of the interaction with negative health outcomes went away. “Once we controlled for fitness, the effects of sedentary behavior were a lot less pronounced on health outcomes,” he says.

So there’s no question that people who are fit, which means they are physically active, and those who exercise regularly, enjoy better health. The question is whether you can get fitter not just by becoming more active, but also by sitting less. “The jury is still out in my mind about what to do about decreasing sitting,” says Shuval, who published his results in Mayo Clinic Proceedings.

There are some studies that follow people over time that found that more sitting time is linked to a higher risk of early death. But that could be due to the fact that people who sit more are less physically active, so sitting is displacing exercise. Shuval found, for example, no strong association between how much time people spent sitting and their risk of metabolic syndrome – the constellation of risk factors connected to heart disease – nearly nine years later. That suggests that physical activity, and not something unique about sedentary behavior, may be the driving factor in that syndrome.

MORE: Now There’s Another Reason Sitting Will Kill You

That’s supported by a study published in PLOS ONE in January 2014 in which researchers from the U.S. and Australia found that when they included all levels of physical activity – not just moderate or vigorous activity, but even the light forms that make up most of what people do during the day – the negative effect of sitting on adverse health measures like blood pressure, cholesterol levels, blood sugar and waist circumference disappeared. In other words, how active people are – and the more active they are, the less they sit – likely has the strongest effect on health.

Shuval, however, admits that his results likely aren’t the definitive ones that will resolve the question of how sitting affects our health. The men in the Cooper study, for example, were only asked about the time they spent in their cars or watching television; they didn’t account for time spent sitting at their jobs, for instance, so the sedentary time could have been underestimated. They also only asked about sedentary habits once, so the study couldn’t account for any changes the participants had in the amount of time they spent in chairs.

The uncertainly probably explains why there aren’t yet any guidelines about healthy and unhealthy amounts of sitting time, as there are for physical activity. “We haven’t established yet by how much we need to reduce sedentary behavior and how to do it,” says Shuval. But one thing is clear – sitting less means you are probably more physically active. And there is plenty of evidence suggesting that’s good for your health.

 

TIME Sex

The Strange Social Science of the Color Red

Women walking
Getty Images

There's plenty of research connecting the color with sex. Here's why

When it comes to sex and women, red is the first color you think of, right? Red lips, red lingerie, red dress. Studies show men perceive women who wear red on dating profiles as both sexier and more open to a sexual encounter.

Red, it seems, sends a very clear message—about sex. And now scientists add to the scarlet sex literature with this piece of data, which we reported on earlier, in the Personality and Social Psychology Bulletin – turns out it’s not just men, but women too who see women who dress in red as more overtly sexual and open to having sex. Not only that, women perceive other women who sport red clothing as sexual rivals (i.e. after their mates), which raises their competitive instincts and leads them to think negatively about their ability to maintain relationships and be loyal.

What? Does that mean every time I grab the red dress my female friends see me as a romantic threat who is about to move in on their partners? “I don’t think it’s the case that women who wear red are always advertising sexual interest,” says Adam Pazda, a social psychologist at University of Rochester who led the study. “But there is evidence that people make judgments about other people in general based on clothing. You can see how color might easily fit into that.”

MORE: The Science of Dating: Wear Red

Pazda says that studies have also shown that people who view pictures of female news anchors in loose or tight-fitting clothing perceived those wearing the form-fitting outfits as less competent, possibly some derivation of the idea that they were dressing for sex and therefore somehow less able to do their jobs.

One thing to remember about that study, and Pazda’s as well: You probably react differently to strangers you pass on the street than those you’re confronted with in a lab setting, where the questions the scientists are asking can’t help but be leading.

If someone sticks a picture of a news anchor wearing a loose top in front of you, asks you to rate her competence, you’re going to grasp at any possible clue to make your decision, because you have to make a decision, or a judgment. You have no other information on the anchor—you don’t know her, you don’t know her background, and you certainly don’t know her experience, which would be more reasonable measures of her competence. Instead, you’re making a snap judgment and for that, you tend to rely on your cultural experience.

And when it comes to the color red and women, that cultural background tells you that red equals sex. In Pazda’s study, he ran three experiments, one to test whether women perceived other women dressing in red as more sexually receptive than those clothed in the same outfit but in white; another to determine if that perception of being more open to sex implied sexual promiscuity, and a final experiment to test whether another color (green) and outfit changed the results.

Each participant was shown either the red-clothed image or the white- or green-clothed one, and then asked to rate, on a sliding scale, the woman’s openness to sexual encounters and her promiscuity. But since they knew nothing else about the women in the pictures. They couldn’t hear their voices, or watch their behaviors. With no other information to go on what were the participants basing their decisions on?

They were likely relying on deeply ingrained, and even unconscious biases connecting the color red to sex. “When we asked, ‘Is this person interested in sex,’ or how seductive or flirtatious is this person, they are drawing on whatever cues are available to make judgments about them,” says Pazda. “One of the only cues is using the dress or shirt color.”

That may only play a small part in people’s first impressions of others in real life, however, where they have facial expressions, behavior, conversations and other information on which to base their decision. Pazda admits that “people aren’t always making judgments about others automatically. But if we stop and make a judgment, color may influence how that judgment is processed.”

TIME Pain

Achy Back? Don’t Blame the Weather

Changes in the weather don’t cause back pain, say researchers.

Some people insist they know when it’s going to rain because they can “feel” it in their bones. Or their knees start aching. Or their back. Their explanation? They’re more attuned to changes in air pressure, precipitation, and the like. But a new study reveals that might be nothing more than magical thinking.

Researchers in Australia put to the test the idea that weather triggers back pain. They recruited 993 people who saw doctors because of low back pain and matched those visits to national meteorological data on temperature, humidity, air pressure, wind direction and precipitation. They also checked the same weather parameters one week and one month before the patients reported their pain. It turns out there was no statistically significant correlation between weather changes and back pain.

MORE: This Is the No. 1 Cause of Disability Worldwide

“We had an open mind on the issue,” Daniel Steffens, from the George Institute for Global Health at the University of Syndey, told TIME in an email. “We had heard many patients attribute their worsening pain to the weather, but we also knew there was limited research. In our very rigorous study we found no evidence that weather is associated with an increased risk of back pain.”

One of the strengths of the study, published in the journal Arthritis Care & Research, involved the fact that the same participants were evaluated during stable and changing weather, meaning that most of the other variables that could affect pain, such as people’s lifestyles, behaviors and genetics, remained the same.

MORE: Aching Back? Try Massage for Chronic Pain

So why do so many patients believe that weather affects their joints? Some studies have found an association between cold or humid conditions and people’s symptoms of chronic pain, but the reason for the link from a physiological point of view isn’t known.

Steffens and his colleagues aren’t discounting the potential role that weather could play. They admit that Sydney, where the study was conducted, is blessed with relatively temperate conditions.

But for now, it looks like back pain sufferers can’t blame the weather. Steffens notes that other factors, including the way people move and lift heavy objects, as well as stress and fatigue, may be more important for triggering aching backs.

TIME Smoking

This Is The New Best Way to Quit Smoking, Study Finds

Combining varenicline and the nicotine patch was more effective in helping smokers quit after six months than the drug alone

Quitting smoking can be a frustrating challenge, and no single therapy works dramatically well. Nicotine replacement strategies – the patch, gum or lozenges—can help wean smokers off nicotine gradually, but don’t often work in keeping smokers abstinent over the long term. The prescription drug varenicline, or Chantix, which curbs smoking by occupying and blocking the same nicotine receptors in the brain used by the nicotine in cigarettes, makes nicotine less pleasurable. But studies show that it’s only about 33% effective in keeping smokers off cigarettes after 12 weeks.

Researchers in South Africa, however, report in JAMA that combining varenicline with the nicotine patch boosted that quit rate to 49% among a group of 435 smokers who were randomly assigned to take either the pills and the patch or the pills and a placebo patch. Smokers on the pills and patch were nearly twice as likely to be abstinent after six months than those who took the pills alone with a dummy patch.

MORE: Nicotine Gum and Patch Don’t Help Smokers Quit Long Term

“The efficacy of combining the two drugs cannot be readily explained,” Dr. Coenraad Koegelenberg, lead author of the study from Stellenbosch University in Cape Town, wrote in an email response to questions about the findings.

It’s possible that the timing of the pills and the patch worked in the smokers’ favor. While both varenicline and the nicotine patch target the same nicotine receptors in the brain, they have different effects; the nicotine from the patch activates the nicotine receptors and provides the same pleasurable sensations that cigarettes would, while varenincline is designed to bind and block the effects of nicotine on the brain. Varenincline is more effective at binding to these receptors, while nicotine from the patch is slower to activate, so starting on the patch may wean smokers from nicotine, and the varenicline may have helped them to drop cigarettes completely.

MORE: Hope for Quitters? Scientists Devise a New Nicotine Vaccine

Interestingly, the one-two punch didn’t work by lowering craving for nicotine. They also did not find a significantly increased risk of side effects, including depression or nausea, in the varenicline group. The U.S. Food and Drug Administration in 2009 added a black box warning alerting users to the potential for suicidal thoughts, although a 2013 study found no greater risk of depression among smokers with depression or who had had depression in the past.

The results raise important questions about how current smoking cessation treatments might be more effective if used in combination. Currently, varenicline is not recommended with other nicotine-replacement strategies; for that to change, other studies showing similar results to this one would be needed.

TIME Exercise/Fitness

An Hour of Exercise Can Make Up for a Day of Sitting Down

It's not just how much exercise you get, but also how much time you spend off your bottom that keeps your heart healthy

Another day, another study that confirms the dispiriting reality that sitting is bad for you. Fortunately, says that same study on heart health published in Mayo Clinic Proceedings, it doesn’t take much to offset the harmful effects of sitting.

Because exercise has a more powerful effect in helping the heart than sitting does in harming it, one hour of physical exercise could counteract the effects of sitting for six to seven hours a day, according to researchers led by Dr. Jarett Berry at UT Southwestern Medical Center.

(MORE: It’s Lack of Exercise — Not Calories — That Makes Us Fat, Study Says)

The data Berry and his team reviewed came from the National Health and Nutrition Examination Survey, an ongoing series of health studies maintained by the Centers for Disease Control. The 2,223 participants between the ages of 12 and 49 wore accelerometers for seven days (except while showering or swimming) to measure their activity levels and sedentary behavior, and the result showed that sitting, regardless of the total amount of physical activity the people did, was linked to lower heart fitness.

But it also found that men and women who logged less time sitting had better fitness, as measured on a treadmill test, than those who spent more hours in a chair or on the couch. So instead of focusing on working out, those worried about their health might think instead about sitting less. “Even people who exercise regularly spend the vast majority of their time not exercising,” says Berry. “And it appears that what we do when we’re not exercising is relevant to our health. Understanding this has the ability to shift the paradigm of thinking about exercise more dramatically than anything else in the field of exercise.”

(MORE: Exercise Snacking: How to Make 1 Minute of Exercise Work Like 30 Minutes)

In general, Berry says, any movement, from walking to taking the stairs and even fidgeting if you absolutely have to be in a chair, is likely better than sitting relatively motionless. “Much more work needs to be done, to develop small scale trials to test the impact that lifestyle changes have irrespective of volitional physical activity,” he says. “We spend so much of our time sitting and doing non-exercise-related activities that it’s relevant for us to understand that better.”

 

TIME Breast Cancer

Why Statins Could Be the Next Treatment for Breast Cancer

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Photodisc—Getty Images

Research connects high cholesterol levels with increased risk of breast cancer.

Cholesterol and cancer may not seem to have much in common, but scientists are increasingly seeing some intriguing connections between the two. In the latest study on the topic, presented at the Frontiers in Cardiovascular Biology in Barcelona, Spain, researchers report on preliminary but strong evidence that women with high cholesterol levels had a 1.6 times greater risk of developing breast cancer over 14 years than women with lower levels.

While the association doesn’t prove that cholesterol can cause breast cancer, the strength of the study comes from its numbers – the data emerged from 664,000 women enrolled in an ongoing study in the UK.

MORE: The Serious Heart Risks That Come With Chemo

Earlier studies have suggested that obesity may be tied to an increased risk of breast cancer, but more recent trials raised the possibility that cholesterol was the driving factor in this correlation – animal studies found, for example, that lowering cholesterol can inhibit tumor cell growth.

So Dr. Rahul Potluri, from Aston University in the UK, decided to investigate the relationship with the database he had established known as the Algorithm for Comorbidities, Associations Length of Stay and Mortality (ACALM) study, focusing on a subset of data from among 1.2 million women in the UK between 2000 and 2013. And indeed, those whose records showed cholesterol levels of 200mg/dL or more were more likely to develop breast cancer. (In the U.S., recent changes to cholesterol guidelines by the American Heart Association and the American College of Cardiology mean that doctors no longer focus on target cholesterol levels but include cholesterol as part of a heart disease risk calculation that includes age, smoking history, blood pressure and diabetes. In previous guidelines, levels between 200mg/dL and 239 mg/dL were considered borderline high.)

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

“It’s a starting point for looking at the relationship in human populations,” says Potluri, who is cautious about overstating what the correlation means. He says that the database did not include information on medications, for example, so he and his colleagues could not adjust for other factors that could explain the association, such as whether the women smoked, or their exposure to other things that could increase their risk for breast cancer.

MORE: Treating Cancer With A Malaria Drug

Still, says Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan Kettering Cancer Center who was not involved in the study, “I think this is an important observation. It’s interesting when a big study like this supports some evolving basic science.”

Hudis suspects that the explanation for how cholesterol is involved in breast cancer – or potentially in other types of cancers – may be quite complex, and certainly requires deeper investigation. His own work, for example, explores how obesity and its related metabolic syndrome, which involves resistance to the effects of insulin and low levels of inflammation, could be activating some tumor triggers in breast tissue. Cholesterol is also part of the body’s steroid hormone pathways, which can play a role in certain cancers.

MORE: New Guidelines for Cholesterol Treatments Represent “Huge Change”

“The problem of obesity is going to have profound public health repercussions,” says Hudis; these results are just another reminder of how insidious the health effects of obesity can be.

 

 

 

 

 

 

 

 

TIME Stem Cells

Blockbuster Stem-Cell Studies Retracted Because of Fraud

Editors of Nature, which published two papers claiming to generate stem cells in a simplified way, are retracting both papers after data was “misrepresented.”

In an editorial published on Wednesday, editors at the scientific journal Nature announced their decision to retract two papers that received wide media attention, including by TIME, for apparently dramatically simplifying the process of creating stem cells. Genetically manipulating older, mature cells are the only confirmed methods for reprogramming them back to their embryonic state, but in the Nature papers, Japanese scientists claimed to have accomplished the feat by physical means, using an acidic bath or physical stress.

Several months after the papers were published, one of the co-authors, from the RIKEN Institute, called for their retraction, saying “I’m no longer sure that the articles are correct.” RIKEN’s own probe determined that the studies’ lead author, Haruko Obokata, was guilty of misconduct.

At the time, Nature launched its own investigation into concerns that some of the figures in the paper contained errors, and that parts of the text were plagiarized. The journal now says that “data that were an essential part of the authors’ claims have been misrepresented. Figures that were described as representing different cells and different embryos were in fact describing the same cells and the same embryos.”

MORE: Stem-Cell Scientist Guilty of Falsifying Data

While scientific journals have peer-review processes to check researchers’ work, they rely on the fact that the scientists are presenting their data in their entirety and without any biases—something that didn’t occur in this case.

Nature’s editors say they are reviewing their review process and intend to improve on the way they select articles to ensure that such mistakes are minimized.

TIME Environmental Health

Potent New Weed-Killer Could Be Sprayed Near Schools, Says Environmental Group

The Environmental Protection Agency (EPA) is considering approval of a new herbicide that could pose health risks to school children, says the Environmental Working Group

The EPA is open to public comments until June 30 about approving Enlist Duo, a new combination of 2,4-D and glyphosate, which is the main ingredient in Monsanto’s popular RoundUp weed killer. A majority of soybean and corn crops are now resistant to glyphosate alone, which is why Dow AgroSciences created the new formulation, designed to work on genetically modified seeds the company has developed that are supposed to be more resistant to weed growth.

But in a new analysis, EWG says more than 5,000 schools are located within 200 feet of fields that could potentially be sprayed with the chemical, if it’s approved. According to the environmental advocacy group, the compounds in Enlist Duo have been linked to harmful health effects, including immune and reproductive issues as well as certain cancers and Parkinson’s disease. EWG says the EPA analysis of the herbicide doesn’t sufficiently consider the potential health harms, especially if inhaled, which would be the primary way people would be exposed to it. The agency, for its part, says it “confirmed the safety of the use for the public, agricultural workers and non-target species.”

In its analysis, EWG found that Michigan contains the highest number of schools—658—located within 200 feet of corn and soybean crops that could be sprayed with Enlist Duo, followed by Missouri, South Dakota, Pennsylvania and Wisconsin. For an interactive map of schools within 1000 feet of such fields, click here.

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