TIME

Is the Menstrual Cup Going Mainstream?

Lily Cup menstrual cup
Courtesy of Lily Cup

This Kickstarter cup got funded at 4,000% of its goal

Not a whole lot seems to have changed in the menstrual market since the 1970s, when you no longer had to wear a belt to keep a pad in place.

Lily Cup menstrual cup
Courtesy of INTIMINA

But an innovation in period care—a collapsible menstrual cup called the Lily Cup Compact—was just successfully crowdfunded at more than 4,000% its goal on Kickstarter.com. The campaign, led by Swedish brand Intimina, which has five physicians on its board, aimed for $7,800. After the campaign ended Sunday, backers gave more than $325,000 to help make the Lily Cup Compact real.

Menstrual cups have existed in some form since the 1930s, though earlier iterations were nothing like the Keeper, Softcup and the Diva Cup, to name a few modern models. Still, American women have been slow to adopt them. “The very first time I heard about [menstrual cups] was a year and a half ago,” says Taraneh Shirazian, MD, assistant professor of obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City. “When I talk to my patients about it, none of them are using it, and very few people know about it.”

Menstrual cups are flexible, goblet-shaped devices usually made of silicone or latex that are folded and then inserted like a tampon. Once inside, it opens up and forms a seal to stop menstrual blood from escaping from the uterus into the vagina. Other menstrual cups—the Keeper and the Diva Cup—are currently on the market, though they are not collapsible. The Lily Cup also comes with a carrying case, making it more convenient and discreet to tote around.

A 2011 survey found that 91% of women who tried a menstrual cup said they would switch to one—and recommend it to friends. The study also found that the cost of buying tampons for a year, approximately $37, was about equal to the price of a single menstrual cup, which can last for a decade. Menstrual cups come with other advantages. They can be left inside the body for 10 hours; tampons need to be changed every 8 hours to prevent the growth of the bacteria Staphylococcus aureus, a cause of toxic shock syndrome (TSS). According to a different 2011 study, women who used the Softcup saw no changes in their vaginal flora and no growth of that dangerous bacteria.

Still, the rate of menstrual cup use in the U.S. is still low, partly due to squeamishness and worries about their cleanliness. Menstrual cups need to be washed with soap and water after being removed. Because they don’t come from a package, though, fears of not getting the cup “clean enough” are one of the main reasons Shirazian’s patients don’t use it, she says. “I think there’s this misconception about sterility versus clean,” she says. “The vagina itself is not clean…things can be clean and be introduced and you’ll be fine. You won’t increase your risk of infections.”

The first menstrual cup with lasting power in the U.S. market, the Keeper, was introduced in 1987, and it’s no stranger to confronting the ick factor. “You can tell a woman about it and her first reaction’s going to be ‘Gross,’ or ‘Oh God, no way,’” says Elizabeth Moore, general manager of The Keeper Inc. “It had to come through the midwives and doulas and vegans.” But there’s evidence that the mindset is changing, particularly among young women. Most of the Keeper’s customers are 18-25 years old, Moore estimates. And they’re less shy about getting informed. “Ninety percent of the questions were done via email early on, and now we’re seeing more and more phone calls coming in,” she says. “That’s showing that women are more comfortable talking about it.”

“I think women are tired of having only two options,” says Intimina’s Amandine Pranlas-Descours. The Lily Cup Compact campaign closed with 8,530 backers.

TIME Diet/Nutrition

Lunch Brought From Home is Unhealthier Than Cafeteria Food

The Image Bank—Getty Images

Lunch boxes are light on veggies and packed with sodium

Most lunches brought from home don’t meet the nutritional guidelines set by the National School Lunch Program (NSLP), finds a new study.

Over the last few years, school lunches have undergone a makeover in hopes of curbing adolescent obesity and helping kids get healthier. Schools now provide more fruits, vegetables, whole grains and low-fat milk. Soda and sugar-sweetened beverages have been dismissed and vending machines restocked with healthier snacks. Even breakfast options are better for young people.

But the lunch revolution hasn’t yet reached the home front. Researchers Karen Cullen, a professor of pediatrics and nutrition at Baylor College of Medicine, and Michelle L. Caruso of the Houston Department of Health and Human Services discovered that kids who are bringing their lunches from home are nutritionally much worse off than those who are buying school lunches.

“We were in the schools doing other observations and noticed the lesser quality of meals from home, so we decided to look closer and actually measure it,” explains Cullen.

To figure out what exactly what’s being packed at home, Cullen and Caruso looked at the brought-from-home lunches of 242 kids at eight elementary schools and 95 kids in four middle schools in the Houston area over a two month period. They calculated the nutritional content of the home lunches compared to the NSLP guidelines, as well as how much the home lunches cost.

They found that lunches brought from home had more sodium, fewer servings of fruit, fewer vegetables, fewer whole grains and less milk. Perhaps the most staggering finding was that around 90% of the lunches from home had a sweetened beverage, snack chips and dessert in them. None of those items are permitted in school lunches.

“We saw a lot of pre-packaged meals, pouches of sweetened beverages, and popular chip products,” says Cullen.

And among the elementary school kids, lunches from home were more expensive than the school lunch offering. For middle school kids, that wasn’t consistently the case. Still, Cullen and Caruso say more research is needed in a larger population size to see just how great the disparities are between home and school lunches.

The study couldn’t conclude whether students or parents packed the lunches, but either way, Cullen and Caruso think that parents have a role in teaching their kids what’s healthy for lunch. “Parents need to involve their children more in planning meals and learning what makes them healthy,” says Cullen. “Food at home needs to be a joint collaboration.”

TIME

When the Heart Stops Beating, Advanced Care Might Not Be Better

Heart with coronary vessels
Getty Images

To restart a heart, a high-tech response doesn't mean better results

When emergency medical responders receive a call that someone’s heart has stopped, standard practice is to send the best help available: a truck equipped with a team trained in provide everything needed for advanced life support, from administering an IV drip to inserting a breathing tube down a person’s airway to get air into their lungs.

But in a study published in JAMA Internal Medicine, researchers led by Prachi Sanghavi, a PhD candidate in health policy at Harvard University, found that the more advanced teams and trucks didn’t always lead to better outcomes for patients. In fact, when people whose hearts had stopped received care from basic life support—oxygen via masks and life-support interventions like chest compressions with automatic defibrillators—they survived more often after getting to the hospital than those receiving advanced life support. Sanghavi and her colleagues, who included physicians at Massachusetts General Hospital, found that those receiving basic life support were 43% more likely to survive and be discharged from the hospital than those getting more advanced care by emergency teams. That pattern held even after 90 days.

MORE: Cardiac Arrest Patients Need CPR, Not Hospitals, Doctor Says

People who got basic life support also showed fewer effects on brain function compared to those who received the more sophisticated care. Only 21% of those admitted after getting basic life support showed poor brain functioning on tests of brain injury, compared to nearly 45% among those getting the higher tech services.

Why does the more advanced care lead to worse outcomes? Sanghavi says that the study, which looked at Medicare claim data for people having out-of-hospital cardiac arrest, did not collect data on the experience levels of the emergency medical responders, but they did account for potential influences such as the patients’ previous heart health history. She notes that the data involved only patients whose hearts had stopped, and not those who had a heart attack, in which blocked vessels may cause the heart to beat irregularly but continue to function.

MORE: New CPR Rules: Pump First, and Save the Breaths for Later

Researchers found that basic life support teams might be able to bring patients to the hospital more quickly because they aren’t equipped to do much in the way of treating patients in the field. “One argument is that the time it takes to provide interventions in the field isn’t worth it when the hospital is not far away,” says Sanghavi. The study looked only at urban or suburban areas where hospitals are relatively close by.

Data also shows that hospital staff may be more experienced at performing advanced life support techniques like inserting breathing tubes and setting IVs, so fewer complications may arise. Some previous studies found that emergency responders only perform about one intubation a year, a procedure that may require more practice to be performed well. “It’s the kind of thing you want to keep up with, and do all the time to be good at,” says Sanghavi.

MORE: New CPR Guidelines: Hands Only

Advanced life support teams are able to provide more potentially lifesaving drugs to patients, including those that may open up blockages or restart the heart. But using such drugs properly requires knowing exactly what caused the heart to stop, something that’s not always obvious to those working in an emergency situation in the field. “There are treatments that would get at the underlying cause of cardiac arrest that we would never provide in the field,” Sanghavi says.

Based on their data, Sanghavi’s team believes that the priority for patients whose hearts have stopped should be to transport them as quickly as possible to a hospital. For that, an advanced life support team—which is more expensive and may even end up doing more harm than good—may not be necessary. “We believe the priority should be to provide basic life support principles of rapid transport, because it doesn’t seem like advanced life support is doing any better,” she says.

TIME Infectious Disease

Salmonella in 10 States Linked to Raw Sprouts

(WASHINGTON) — Raw sprouts are linked to dozens of cases of food poisoning — again.

The Centers for Disease Control and Prevention says 63 people from 10 states concentrated on the East Coast fell ill with salmonella linked to bean sprouts from a supplier in New York City. The CDC says the supplier, Wonton Foods Inc. of Brooklyn, has agreed to stop production for now.

The outbreak is one of three recently linked to raw sprouts. Two listeria deaths and three listeria illnesses were linked to consumption of mung bean sprouts in the Midwest over the summer, and 19 E. coli illnesses were linked to raw clover sprouts in mostly Western states in May.

Raw sprouts are a frequent culprit in foodborne illness because of the moist, warm conditions in which they are grown; there have been more than 30 outbreaks associated with different types of raw and lightly cooked sprouts since the mid-1990s. Federal regulators have warned against eating them at all, advising consumers to always cook them thoroughly and to ask that raw sprouts be left off their plate at restaurants.

The CDC said that 78 percent of those interviewed in the current outbreak reported eating bean sprouts or items containing bean sprouts in the week before they became sick. The CDC and Food and Drug Administration found that Wonton Foods was a supplier to many of the restaurants where those who became sick had eaten.

Wonton Foods “has verbally agreed to voluntarily stop the production and sale of their bean sprouts while they take steps to prevent Salmonella contamination,” the CDC said.

A person answering the phone at Wonton Foods said the company had no comment and declined to give their name.

The illnesses were reported from the end of September to the beginning of November, according to the CDC. People were sickened in 10 states: Connecticut, Maine, Massachusetts, Montana, New Hampshire, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. The one ill person from Montana likely became ill on a trip to the East Coast, the CDC said.

Salmonella illness usually develops 12 to 72 hours after infection and can cause diarrhea, fever and abdominal cramps. The illness lasts around 4 to 7 days, and most people recover without treatment.

TIME Research

Study: Brain Abnormalities Found in 40% of SIDS Cases

Brain, artwork
Science Photo Library/Corbis

A quirk in the brain may be causing unexplained deaths in babies

The unknown cause of Sudden Infant Death Syndrome (SIDS) could be a brain abnormality, a new study suggests.

A team of researchers reported that around 43% of infants who died of SIDS shared a brain abnormality that affects the area of the brain called the hippocampus, which is responsible for basic functions like breathing and heart rate, in study published in the journal Acta Neuropathologica.

The team from Boston Children’s Hospital, Harvard Medical School, the San Diego County Medical Examiner’s office, and Baylor College of Medicine in Houston looked at sections of the hippocampus from 153 infants who underwent an autopsy in San Diego. All of the infants had died suddenly between the years of 1991 and 2012. Some of the infants’ deaths could be explained; those that could not be explained fell were ruled as SIDS. Eighty-three of the cases were classified as SIDS.

MORE: Don’t Count on Smart Baby Monitors To Prevent SIDS

Within the infants with SIDS, the researchers found an abnormality in a part of the hippocampus called the dentate gyrus. Specifically, at some parts of the dentate gyrus, it contained a double layer of nerve cells instead of the typical single layer. It’s possible that this abnormality interferes with the brain’s regulation of breathing control and heart rate while a child is sleeping. This abnormality was found in 43% of the SIDS cases.

Researchers believe that there might be a variety of factors that influence the risk of SIDS, which is why the researchers say not all of the cases had the brain abnormality.

It’s also possible that when a child is sleeping in an unsafe position or environment (it is recommended that infants sleep on their backs), the abnormality is triggered. More research is needed to conclude how exactly this quirk in the brain plays out.

TIME Mental Health/Psychology

Suicide Risk Drops 26% After Talk Therapy

Suicide is a problem with few concrete preventive solutions, but a new study in Lancet Psychiatry finds that intervening with talk therapy after a suicide attempt seems to have some amazing long-term effects.

Researchers from Johns Hopkins Bloomberg School of Public Health looked at data from about 65,000 people who had attempted suicide between 1992-2010 in Denmark. The country opened suicide clinics in 1992 and provided them nationwide in 2007, and some of the people had gone to one of these clinics and received 6-10 sessions of talk therapy. The rest of the people did not.

When the researchers analyzed the data after a 20-year follow-up, those who had received the talk intervention fared much better. They repeated acts of self-harm less frequently and had a lower risk of death by any cause, including death by suicide.

After five years, there were 26% fewer suicides in the group who received therapy than in the other group. About 145 suicide attempts and 30 suicides were prevented in the talk therapy group, the researchers estimated.

“People who present with deliberate self-harm constitute a high-risk group for later suicidal behavior and fatal outcomes, so preventive efforts are important; yet, implemented specialized support after self-harm is rare,” the researchers wrote in the study.

Though the study had a long follow-up period and population size, it was not a randomized controlled trial, but such an intervention would be ethically impossible, the study authors write. “These findings might be the best evidence available and provide a sound basis for policy makers who wish to limit suicidal behavior and fatal events in an accessible high-risk group, which, in many countries, receives little support.”

 

TIME Aging

Taking Care: An Intimate Look at How Parkinson’s Disease Has Changed 1 Family’s Life

“Taking Care” is a series intimately covering the lives of caregivers and the people they care for. This month’s edition is on Parkinson’s Disease

When Eleanor Copeman was diagnosed with Parkinson’s disease, an incurable condition that gradually attacks the nervous system and impairs even simple movements, family life for the Copemans changed forever. The vibrant, joyful matriarch who loved cooking for her family became dependent on her husband Douglas and daughter Tammy for everything from preparing meals to getting dressed.

Now, almost a decade later, Eleanor also has dementia, which strikes 50-80% of people with Parkinson’s. The physical and emotional burdens of caretaking fall to the family.

Eleanor Copeman sweeps the porch outside the family home as her daughter rides her horse toward the house in Elkins, West Virginia, on July 14, 2012. Abby Kraftowitz

“Physically, taking care of someone with Parkinson’s is intense—you have to be on 24/7,” Tammy Copeman tells photographer Abby Kraftowitz, who has been documenting the Copemans’ lives since 2012. “I think it’s just a whole different level of love and loving your family.”

Douglas says he chose to take care of Eleanor at home to honor a promise he made to her 51 years ago when they first married.

Kraftowitz’s work offers a deep look into life inside one household touched by this chronic disease.

Abby Kraftowitz is a photographer based in New York City. You can follow her on Twitter @abbykraftowitz.

TIME mental health

Women in Positions of Power Show More Signs of Depression Than Men

A study found that women in the workplace experience more symptoms as they gain job authority, while the opposite is true for men

Symptoms of depression become more prevalent for women as they obtain job authority but less prevalent for men, a new study from the University of Texas at Austin suggests.

Researchers looked at 1,300 middle-aged men and 1,500 middle-aged women for the study, “Gender, Job Authority and Depression,” which appears in the December issue of the Journal of Health and Social Behavior. Women with the ability to affect pay and fire and hire others had more symptoms of depression than women without such authority. Men with similar authority at work had fewer symptoms of depression than those without, the study reports.

“What’s striking is that women with job authority in our study are advantaged in terms of most characteristics that are strong predictors of positive mental health,” said sociologist Tetyana Pudrovska. “These women have more education, higher incomes, more prestigious occupations, and higher levels of job satisfaction and autonomy than women without job authority. Yet, they have worse mental health than lower-status women.”

One explanation is that women face more stressors at work when in positions of power because they are faced with overcoming more stereotypes and resistance to their leadership. Men, on the other hand, don’t appear to face such obstacles.

“Men in positions of authority are consistent with the expected status beliefs, and male leadership is accepted as normative and legitimate,” Pudrovska said. “This increases men’s power and effectiveness as leaders and diminishes interpersonal conflict.”

TIME Exercise/Fitness

Your Lungs: A User’s Manual

lung xray
Getty Images

Better workouts, less coughing and wheezing, even a longer life? Yep. Here's your guide to open airways

Inhale. Exhale. You take 15 to 20 breaths a minute—more than 20,000 breaths a day. With each one, oxygen travels through your bloodstream, fueling your body’s cells. Trouble is, we bombard our lungs with pollutants and irritants such as secondhand smoke and fumes from household cleaning supplies. “Still, lungs are resilient,” says Ravi Kalhan, MD, director of the Asthma/COPD Program at Northwestern University Feinberg School of Medicine. “Keep them healthy and they will protect you into old age.” Read on, and start breathing easy.

GET FIT
While exercise doesn’t increase lung capacity per se, “it strengthens heart muscles so your heart is better able to pump oxygenated blood through your body,” says Doreen Addrizzo-Harris, MD, associate professor of pulmonology at the NYU Medical Center. “Your lungs then don’t have to work as hard.” You’ll exercise more efficiently and feel less winded.

HEALTH.COM: How to Become an Exercise Addict

Exercise can also trim belly fat, which is linked to a higher risk of asthma. “We think the excess fat associated with obesity increases inflammation in the body, which affects the lungs,” says Neil Schachter, MD, a pulmonologist at the Icahn School of Medicine at Mount Sinai in New York City. To see results, you need consistent exercise, raising your heart rate for 20 to 30 minutes most days of the week, says Jason Turowski, MD, a pulmonologist at the Cleveland Clinic. If you’ve got asthma, it might be hard to maintain an intense workout, but lower-key activities may help reduce airway inflammation. In one study, asthmatic adults who walked for 20 to 30 minutes three times a week at a moderate pace reported improvement in their symptoms. Swimming is another option, especially during the frigid winter months. The warm, moist air at an indoor pool is asthma-friendly. (But don’t swim in a pool that’s strongly chlorinated; irritation from the fumes can counteract the benefits.)

HEALTH.COM: 27 Mistakes Healthy People Make

EAT SMART

“An anti-inflammatory diet helps decrease airway inflammation, which has been linked to respiratory diseases such as COPD and asthma,” notes Melissa Young, MD, an integrative medicine specialist at the Cleveland Clinic. Fill up with these foods:

Fruits and veggies: They’re packed with antioxidants, which can help repair damage from air pollution. It doesn’t matter what kind, as long as you eat plenty of them.

HEALTH.COM: 13 Veggies You Only Think You Don’t Like

Flaxseeds: They contain high levels of omega-3 fatty acids, which are believed to be connected to a lower risk of asthma.

White wine: Vino drinkers—especially those who sip white—have healthier lungs. (Researchers theorize it’s due to wine’s high antioxidant capacity.)

Olive oil: It has monounsaturated fatty acids, which can help reduce inflammation, and alpha-tocopherol, a form of vitamin E associated with better lung function.

A cup of joe: Caffeine has a similar effect as the drug therophyllin, which opens up the airways,” Dr. Turowski says.

Tomato sauce: Research suggests that lycopene—the antioxidant famously found in tomatoes—may protect you against exercise-induced asthma.

HEALTH.COM: 14 Foods That Fight Inflammation

CLEAR THE AIR

Air pollution claims more than 3.2 million lives worldwide every year, according to the 2013 Global Burden of Disease Study. Why? The tiny particles penetrate the lungs, causing cancer and other respiratory illnesses. We don’t expect you to flee L.A. for Idaho, but there are precautions that everyone should take.

Check the forecast: You can find the Air Quality Index (AQI) at airnow.gov. On days that the AQI in your area is high (over 150 if you have no lung issues, over 100 if you’ve got a breathing problem), consider taking your workout indoors. If you do exercise outdoors, avoid routes near traffic.

HEALTH.COM: Burn Calories This Summer

Don’t idle your car: It releases as much pollution as a moving vehicle, and you’re in the middle of the mist. Turn off the ignition if you’re waiting more than 10 seconds, and warm up your engine by driving. (Your car and its engine warm up faster when you drive.)

Make a P.M. pit stop: As you fill your tank, gas emissions evaporate and form ozone, a component of smog. Hit the pump after dark to keep the sun from turning those gases into pollutants.

REHAB YOUR HOME
Air pollution in your house may be worse than what’s festering outdoors. Here’s how to clear the air, stat.

Go electric: Your home heating and AC system should ideally operate on electricity, not oil, since the latter releases more particulates. Most homes built after 2000 do, but if you’re living in an older home that uses oil, consider installing a home air-filtration system for a few thousand dollars.

HEALTH.COM: 9 Ways to Detox Your Home

Get tested: Every two years, your home should be tested for radon—an odorless natural gas that’s found in one in every 15 homes in the U.S. and is the second leading cause of lung cancer. You can hire a certified company to do it, or buy a test kit for $15 to $25 at a hardware store or throughsosradon.org/test-kits. If radon concentrations exceed 4 picocuries per liter of air (pCi/L), you’ll need to install a radon reduction system (up to $1,500).

Keep humidity low: A too-damp environment is a breeding ground for mold, a common allergen. The EPA recommends keeping humidity under 60% in the summer and between 25 and 40% in winter. You can measure humidity with a hygrometer ($20 to $40 at a hardware store). If the air is too dry, use a humidifier. It it’s too wet, try a dehumidifier.

HEALTH.COM: Your 12 Worst Allergy Mistakes

Trade in your fireplace: The particulate matter in wood smoke can damage your heart and lungs. Switch to a cleaner-burning gas or wood stove certified by the EPA, or put in an electronic fireplace or gas insert (about $1,000 to $3,000) for fewer emissions. To learn more, go to epa.gov/burnwise.

STAY SAFE FROM THIRDHAND SMOKE
You know not to smoke and to keep away from secondhand smoke. But there’s something called thirdhand smoke—residual tobacco fumes that adhere to walls and furniture and then off-gas slowly into the indoor environment. This stuff isn’t just smelly: It reacts with indoor pollutants, such as ozone and nitrous acid, creating compounds that lock onto your cells’ DNA and cause potentially cancer-causing damage, according to research presented at the American Chemical Society’s 2014 meeting. While the risk is higher for babies and toddlers (as they crawl around the house, they may stir up and inhale these compounds), pretty much anyone is susceptible.

HEALTH.COM: 30-Day Countdown to Quit Smoking

When traveling, insist on smoke-free hotel rooms, and avoid homes of friends who smoke (even if they’re not lighting up in front of you, their furniture can reek). If you inherit the home of a smoker, remove affected items like sofas and carpets, repaint and bring in a professional to thoroughly clean the air-ventilation system.

DID YOUR DUVET GIVE YOU ASTHMA?
You’ve never had asthma before, but lately you’re constantly short of breath. What gives? “It’s not uncommon for a 40-something woman to suddenly complain of asthmalike symptoms,” Dr. Addrizzo-Harris says. A typical trigger: being exposed to an allergen you haven’t faced in years, such as feather bedding or mold. “I can’t tell you how often I’ve seen a patient who reports symptoms starting as soon as she moves into a new house,” Dr. Turowski says. “Usually a moldy basement is the culprit.”

HEALTH.COM: 20 Ways to Stop Allergies

A WOMAN’S PROBLEM?
How the three P’s of womanhood can mess with your breathing.

You’re about to get your period: Up to 40% of women with asthma report that their symptoms worsen immediately before their period. “During this time, estrogen levels drop, and we think that these fluctuations somehow activate an inflammatory response in a woman’s airways,” Dr. Kalhan says. As a result, you’re more likely to cough, feel short of breath and wheeze. Talk to your doc about increasing asthma meds on these days; research also suggests that taking birth control pills (to ward off hormone rises and dips) may help.

HEALTH.COM: 15 Ways Smoking Ruins Your Looks

You’re pregnant: In the first few weeks of pregnancy, an increase in the hormone progesterone causes you to breathe more often, which may make you feel like you’re short of breath when you really aren’t. (The hormone expands your lung capacity, allowing your blood to carry large quantities of oxygen to your baby.) This sensation disappears, then re-emerges around your third trimester, when your uterus begins to press on your diaphragm, making it harder for your lungs to fully expand. But there’s relief soon: During the final month of pregnancy, your baby will “drop” into your pelvis, taking pressure off your lungs.

HEALTH.COM: 10 Tips for Getting Pregnant

You’re going through perimenopause: As you approach menopause, estrogen levels ride a veritable roller coaster, and those dramatic peaks and drops can trigger inflammation that sets off an asthma attack. Research has shown that menopausal women are twice as prone to severe asthma as similarly aged men. If you notice your wheezing getting worse, talk to your gyno about going on the pill or using hormone therapy to help ease you through the transition. The good news is that once your ovaries have closed up shop, your asthma should improve.

This piece originally appeared on Health.com.

TIME Cancer

The Hidden Dangers of Medical Scans

medical scans
Getty Images/Flickr RF

Medical imaging tests are exposing more of us to potentially cancer-causing radiation. Here's when you really need that scan—€”and when you should just say no

Over the past ten years, Jill Nelson, 52, a health coach, personal trainer and counselor in Chicago, has received at least seven computed tomography (CT) scans and close to 30 sets of X-rays for a variety of health ailments—from two separate disk fusions in her spine to a worrisome-looking spot on her lung. That’s on top of the 10 or so mammograms she has had since age 35, plus dozens of dental X-rays. “With all that radiation, I’m surprised I don’t glow,” she says. “It makes me a little uneasy—in trying to get my health problems diagnosed, did I increase my risk of cancer?”

Jill’s concern is shared by a growing number of doctors and medical organizations, who are worried about the soaring use of medical imaging tests that rely on ionizing radiation. This radiation can damage your cells’ DNA, which may, over time, lead to cancer. The more you’re exposed to, the riskier it is. And thanks to the increase in CT scans—which typically emit far higher doses of radiation than traditional X-rays or even other imaging tests like mammograms—exposure has risen dramatically. In 1980, only about 3 million CT scans were performed in the United States. By 2013, that number had skyrocketed to 76 million.

Exactly how dangerous are all those zaps? In 2009, National Cancer Institute researchers estimated that the 72 million CT scans performed in 2007 could lead to as many as 29,000 future cases of cancer. And a couple of years ago, when the Institute of Medicine looked broadly at the environmental causes of breast cancer, it concluded that one factor that’s strongly associated with risk of developing the disease is ionizing radiation.

HEALTH.COM: 9 Everyday Sources of Radiation

That sounds scary—and it is. “Limiting exposure to medical radiation should be on every woman’s cancer-prevention list,” says Rebecca Smith-Bindman, MD, professor of radiology, epidemiology, biostatistics and health policy at the University of California, San Francisco. Yet the tests are widely overused, research finds. “About a third of CT scans are clinically unnecessary or could be avoided by using conventional X-rays or an imaging test that doesn’t use radiation, like ultrasound or MRI,” says David J. Brenner, PhD, director of the Center for Radiological Research at Columbia University Medical Center.

The challenge is figuring out whether the CT your doctor wants you to have is essential or not—a judgment call that is difficult for the average person to make. CT scans can, in fact, be lifesaving. “They’ve revolutionized medicine in almost every area you can imagine, including helping prevent unnecessary exploratory surgeries and diagnosing and treating cancers, heart disease and stroke, ” Brenner says. Price and time can also be a factor since CT scans are cheaper and faster than an MRI. (For a cost comparison of common imaging tests, go to health.com/scan-costs.)

Understanding the risks of medical radiation—as well as the real benefits—will better prepare you to make the best decision no matter when you’re faced with it. Here’s what you must know to avoid unneeded radiation.

Weighing the rewards and risks

When you receive a traditional X-ray, a small amount of radiation passes through your tissues in order to create a two-dimensional image of your insides in shades of gray. Air is black because it doesn’t absorb any X-rays, while bones are white because they absorb a lot, and organs are somewhere in between.

HEALTH.COM: 15 Diseases Doctors Often Get Wrong

CT scanners, on the other hand, rotate around the body, sending numerous X-ray beams (and multiple times the amount of radiation) from a variety of angles. A computer processes the data to create three-dimensional pictures, providing a far more detailed view. “CTs allow us to see behind and around structures in the body in three dimensions with exquisite resolution,” Brenner says. As a result, they’re an indispensable tool in diagnosing all sorts of frightening health problems, such as finding small, early cancers (particularly in the lungs, liver and kidneys) or spotting internal injuries after a serious accident.

“They can detect differences between normal and abnormal tissue about 1,000 times better than a traditional X-ray,” says Richard Morin, PhD, professor of radiologic physics at the Mayo Clinic in Jacksonville, Fla. “Before CTs, if we suspected cancer in the abdomen or internal organs, we had to cut the patient open and do exploratory surgery, which could mean a weeks-long hospital stay. Now with a single scan we can confidently make the call in minutes, and the patient walks out the door afterward. If it’s an appropriately ordered exam, the benefit is far, far greater than any radiation risk.”

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But the ease and accuracy of CTs has also fueled an alarming level of overuse. Have a headache that prompts a trip to the ER? Odds are good you’ll get a CT, even though current guidelines say that doctors shouldn’t perform imaging tests on patients with migraines or chronic headaches. Brain scans, whether a CT or an MRI, are worthwhile only if you have a headache with other worrisome symptoms, such as weakness or numbness on one side of your body, explains Brian Callaghan, MD, a neurologist at the University of Michigan. Even so, he and his colleagues recently found that about one in eight headache-related doctor visits result in a brain scan—and nearly half those patients are getting CTs, even though MRIs are more effective for peering into the brain.

“The goal isn’t to eliminate CTs but to use them more prudently,” Dr. Smith-Bindman says. “When my son did a head-dive out of a tree and was vomiting afterward, the ER doc recommended a CT scan to rule out a brain bleed, and I was happy to have the test. Five years later, when he hit his head skiing, it was pretty clear he just had a concussion, and the ER doc didn’t think a CT was necessary, so we didn’t get it. Doctors and patients need to step back a little and say, ‘Yes, this is a great test, but is it really necessary?’ If you have a CT when it’s not necessary, it won’t do any good—which means it can only do harm.”

The radiation equation

X-rays and CT scans use so-called ionizing radiation, which contains enough energy to penetrate the body—and can damage DNA in your cells. Any damage that isn’t repaired can lead to DNA mutations, and those glitches in a cell’s programming center can, over many years, lead to cancer.

And we know that it does. “There’s not a single cancer-causing agent that has been studied more thoroughly than ionizing radiation,” Dr. Smith-Bindman says. Survivors of the atomic bombs in Hiroshima and Nagasaki who were exposed to even very low doses were more likely to get practically every type of cancer, from leukemia to lung cancer. Nursing mothers who were treated with radiation for breast infections—a common practice in the 1920s and ’30s—developed breast cancer at higher rates than those who weren’t. Those of us who’ve had more sunburns (caused by the sun’s ultraviolet radiation) are at higher risk of getting skin cancer. And the newest studies reveal that children who undergo CT scans of the head, abdomen or chest are more likely to develop brain cancer and leukemia over the next 10 years.

For reasons that are unclear, women seem to be slightly more sensitive to radiation than men. Children are more vulnerable than adults; not only do their growing bodies and rapidly multiplying cells put them at a higher risk, they also have far more years ahead of them during which they could develop cancer.

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However, it’s important to note that our bodies are able to repair damage done to our cells by low levels of radiation. “If they weren’t, everyone who goes out in the sun would get skin cancer,” points out James Brink, MD, radiologist in chief at Massachusetts General Hospital.
The poison is in the dose, says John Boice, ScD, president of the National Council on Radiation Protection and Measurements and professor of medicine at Vanderbilt University. And the effects of exposure might be cumulative. “What may happen is that our bodies repair damage from small doses, but at higher doses our repair mechanisms are overwhelmed,” Dr. Brink explains. “And after that, subsequent exposure to radiation may propel the damaged cells farther down the path toward cancer.”

The actual danger to an individual receiving a scan (or even two or three) is relatively low. The overall risk of the average woman getting cancer at some point in her lifetime is about 38 percent; getting a single CT scan raises that risk to perhaps 38.001 percent, Boice explains. But since no one knows who is most likely to be affected, there is an element of radiation roulette at play.

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What’s more, we’re marinating in low-level radiation every day. The average person in the United States receives about 3 millisieverts (mSv) of radiation per year (more if you live at a high altitude) from the sun and naturally occurring radiation in the environment, such as radon gas. To put medical radiation in that context, a dental X-ray is equivalent to about one day of natural radiation, while a single chest X-ray is equivalent to about 10 days. A mammogram adds up to about seven weeks of natural radiation—but even that level, doctors say, poses a relatively small risk, especially when compared with the danger of missing a malignant tumor already growing in your breast. A regular-dose chest CT, on the other hand, exposes you to about two years’ worth of natural background radiation, or 7 mSv. Some of the Japanese survivors of atomic bombs were probably exposed to between 5 and 20 mSv on the low end. The trouble is, we don’t fully know how much our bodies can handle.

What doctors don’t know can hurt us

The issue of medical radiation is now on most physicians’ and medical societies’ radars; just this fall, the American Heart Association called for doctors to learn about, and discuss with patients, the risks of radiation exposure from cardiovascular imaging tests. So it’s surprising—and concerning—how spotty regulations still are. For instance, dosages aren’t standardized across imaging centers, which means that one hospital or clinic may be delivering up to 50 times as much radiation as another facility, according to Dr. Smith-Bindman. “If machines are set too low, they provide blurry, unusable images, but the vast majority are set higher than they need to be,” she says. This is in part because it’s not a simple matter of pressing one button and lowering the dose. “There are formulas you need to use to set up a new protocol,” Dr. Smith-Bindman explains.

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And because most older machines, many of which are still in use, don’t have warning systems to alert technologists when radiation levels are set too high, mistakes can happen. The most publicized CT-related overdoses occurred between 2008 and 2010, when several hospitals in California and one in Alabama seriously over-radiated more than 400 patients. The problem was discovered after patients reported losing their hair. Since then, new technology has been created to alert technologists if the dose is too high—and new federal legislation is in the works that would require radiology centers to adopt modern imaging equipment standards by 2016.

Still, the more common problem is that too many scans are being done in the first place, particularly in the ER, where doctors sometimes order CTs before they’ve fully evaluated a patient, Dr. Smith-Bindman says. But doctors in general have come to rely heavily on these tests. One reason: Many MDs today have a lower tolerance for ambiguity than ever before and have learned to trust images to give them definitive answers, even when other methods, including a risk-free physical exam, can provide the information needed.

In addition, physicians in private practice may feel financial pressure to recoup the cost of expensive equipment. “Research has found that if a neurologist, say, owns a CT scanner, the percentage of patients getting scans is higher than what’s typically done in a radiology clinic and much higher than in similar doctors’ practices without scanners,” Morin says. Add to the mix the possibility of being sued over a misdiagnosis, and you have a recipe for overuse.

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Making scans safer

Avoiding unnecessary medical radiation starts with speaking up and being your own best advocate (see 5 Questions to Ask Before You Have That Scan, page 117). At the same time, multiple industry efforts are under way to lower exposures from CTs. One initiative, Choosing Wisely (choosingwisely.org), helps doctors and patients understand which procedures and tests—including imaging tests—are unnecessary or commonly overused. Radiologists are leading the charge to make scans safer: Image Wisely, a program created by the American College of Radiology (ACR) and the Radiological Society of North America, is focused on optimizing the amount of radiation used in imaging studies and eliminating inessential CTs and other scans. The ACR has also created the Dose Index Registry in an effort to compare dosage information across facilities. About a third of the 3,000 or so scanning facilities in the U.S. are members, which means they get updates on the dosages other centers are using for similar tests, explains Morin, who was the founding chair of the registry. (For more on finding the best place to get a scan, go to health.com/safe-scan.)

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Meanwhile, companies that manufacture scanners are developing new technology to lower the radiation doses. “They’ve fine-tuned the equipment so you can produce high-quality images with lower doses,” Morin says. Even so, when you need to get a CT scan, it’s always a good idea to ask if they can scan using the lowest dose possible, Dr. Smith-Bindman says. If you’re smaller or thinner, technicians can often get a clear image at a lower dose. (The bigger your body, the more radiation you require, since fat absorbs some of the beams.) Avoid unnecessary radiation from even low-level sources, like dental X-rays, which you probably don’t need every year unless you have ongoing problems with tooth decay.

The idea is not to refuse all medical radiation but to do your best to discriminate between what’s essential and what’s not. “I always tell my friends to say to their doctors who recommend CTs, ‘I’m happy to have the test, but I’d like you to help me understand why I really need it,'” Dr. Smith-Bindman says. “Medicine often doesn’t change until patients start asking questions. And when it comes to medical radiation, it’s time to start asking.”

5 Questions to ask before you have that scan
“When a doctor prescribes a medication, she always talks about the risks and benefits,” says Rebecca Smith-Bindman, MD. “Now we need to start having that same kind of discussion about medical imaging.” In addition to the obvious “Why do I need this test?” ask these key questions—especially if your doc suggests a CT scan.

1. “Will the outcome of the test change the treatment I’m likely to receive?” If the answer is no, the test may not be necessary, Dr. Smith-Bindman points out.

2. “Are there alternatives without radiation, like ultrasound or MRI?” In some cases, such as many abdominal CT scans, other scans work as well or better, Dr. Smith-Bindman says.

3. If you’ve just had a scan at another facility, ask, “Is there a reason to repeat the scan I just had?” Notes John Boice, ScD: “It doesn’t make sense to do tests twice, yet it does happen.”

4. If a CT scan is crucial, ask, “Is there a way to minimize the dose?” Doctors may be able to use a lower-dose technique, particularly if you’re petite.

5. After a CT scan, ask, “How much radiation was I exposed to?” Write it down so you have a record.

You probably don’t need a CT for… Question your doc if she recommends a CT for these health problems.

Concussion: Concussions can be diagnosed by symptoms alone. But it’s valid to do a CT if the doctor suspects a skull fracture or brain bleed, says Robert Cantu, MD, clinical professor of neurosurgery at Boston University School of Medicine.

Sinus infection: This everyday health problem can generally be diagnosed through symptoms and a physical exam, says the American Academy of Allergy, Asthma & Immunology.

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Headache: If you do need a scan, MRI is the test of choice, unless a doctor suspects a stroke or brain hemorrhage, according to the American Headache Society.

Appendicitis in children: It’s best to use ultrasound first, then follow up with a CT if the ultrasound is inconclusive, according to the American College of Radiology.

Back pain: Most cases improve on their own within a month, so it doesn’t make sense to expose yourself to unnecessary radiation. If the pain continues, ask your doctor about an MRI.

How much radiation you get from…
Airport backscatter scan: .0001 mSv
Bone-density scan: 0.001 mSv
Dental posterior bite-wing X-ray series (two to four images): 0.005 to 0.055 mSv*
Two days in Denver: 0.006 mSv
Panoramic dental X-rays (standard single image): 0.009 to 0.024 mSv*
Cross-country flight: 0.04 mSv
Single chest X-ray: 0.1 mSv
Digital mammogram: 0.4 mSv
Average yearly dose from the sun and other environmental sources: 3 mSv
Chest CT: 7 mSv
Virtual (CT) colonoscopy: 10 mSv

PET/CT (often used to diagnose cancer): 25 mSv

Smoking a pack a day for a year: 53 mSv

*Dose can vary based on the type of machine used.

Your anti-radiation diet
Antioxidants from food can sop up the free radicals that cause DNA damage. And some research has hinted that what you eat may shield your body from radiation’s harmful effects. A 2009 study of airline pilots, who tend to be exposed to elevated levels of ionizing radiation, found that those with diets highest in vitamins C and E, beta-carotene, beta-cryptoxanthin (found in pumpkin, papaya and red peppers) and lutein-zeaxanthin (in leafy greens, egg yolks and squash) had fewer biomarkers of cumulative DNA damage.

Researchers in Toronto have recently shown that taking antioxidants before a scan can reduce the number of DNA breaks caused by the radiation. Published results are expected within the next six months. Says researcher Kieran Murphy, MD, professor of radiology at the University Health Network Toronto: “In light of what we’ve found, making sure you have a diet rich in antioxidant-packed fruits and vegetables could be beneficial.”

This post originally appeared on Health.com

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