TIME Cancer

You Asked: Is Sunscreen Safe — and Do I Really Need It Daily?

Is sunscreen bad for me?
Illustration by Peter Oumanski for TIME

Tons of you Google it. Our experts have the answer

Google sunscreen and toxic and see what you find. Claims that titanium dioxide is hazardous? Claims that you need vitamin D, and a little unprotected sun can give you that? Claims that chemical sunscreen can turn boy fish into girl fish? Let’s settle this for once and … for now, at least.

First thing’s first. There are two kinds of sun blockers — the physical kind, like zinc and titanium dioxide, and the chemical kind, like oxybenzone and its many cousins. They work in vastly different ways, the former blocking or “scattering” the sun’s rays (literally), and the latter causing a chemical reaction that is said to prevent damage from the sun’s UVA and UVB rays.

Start looking into it and two topics tend to come up again and again. The first surrounds titanium dioxide or zinc oxide — but only in their nanoparticle form — which means ultra-fine specs of material used in sunscreens to block or “scatter” the sun’s rays. Some scientists have voiced concern that nanoparticles may be small enough to slip past your skin’s defense barriers and into your bloodstream. Those concerns have grown louder since a recent study — albeit in rodents — found that mice injected with titanium dioxide nanoparticles developed inflammation, a marker of cell distress that has been linked to lots of terrible things that happen in the body, including aging — and cancer.

These concerns do not extend to sunscreens that contain titanium dioxide and zinc in non-nano form—although those are becoming harder to find.

The second source of concern involves other nonnano sunscreen chemicals, which work by absorbing the sun’s ultraviolet radiation as opposed to reflecting it. More animal studies have hinted at ways in which some of these chemicals could cause damage to a person’s endocrine — hormone — system. That’s the worrisome news and if you want to avoid risk, many experts contend, you are better off with nonnanoparticle forms of the physical sun blockers.

The good news: there just isn’t much hard data showing that applying these chemical sunscreens to your skin can lead to health problems, says Dr. Henry W. Lim, chairman of the Dermatology Department at Henry Ford Health System in Detroit.

Lim points out that many of the animal studies at the root of sunscreen concerns involve injecting or inhaling the chemicals, not rubbing them on your skin. “As of today there are no recorded health issues associated with sunscreen’s proper use,” he says.

But, in almost the same breath, Lim says there may still be reasons to worry about sunscreen. Specifically, he says spray-on sunscreens could present some unique dangers. That’s because, unlike lotions spread on the skin, spray-ons can be inhaled. “That could lead to very different types of risks not associated with creams,” he says, adding that the FDA is in the process of investigating the potential dangers of spray-on products. (The FDA is also, after much delay and pressure, investigating the introduction of new sunscreen ingredients that have been on the market in Europe for some time. Stay tuned for more on the bill that could change that.)

Looking past the possible dangers of sunscreen use, the benefits are far less nebulous: 1 in 3 cancers diagnosed worldwide is a skin cancer, according to the American Cancer Society. And up to 95% of malignant melanomas are caused by excessive sun damage, found research from the International Agency for Research on Cancer. “The risks associated with sun exposure are well mapped and well understood, and we have proof that using sunscreen lowers these risks,” Lim stresses.

“Sunburns are bad. There’s just no way around it,” says Kerry M. Hanson, a chemist at the University of California, Riverside, who has studied sunscreens extensively and has also worked with sunscreen manufacturers. “Protecting oneself from sunburn is critical to prevent skin cancers later in life,” she says. And to protect against sunburn, Hanson says sunscreen is proved to be effective — if it’s applied properly.

A recent study from the University of Queensland in Australia found people who followed proper sunscreen-application practices on a daily basis developed roughly 50% fewer melanomas than those who were left alone to use (or not use) sunscreen as they saw fit. Similar research efforts have uncovered proof of sunscreen’s effectiveness at blocking the development of squamous-cell and basal-cell cancers as well.

Unfortunately, Lim says many people don’t rub on nearly enough of the stuff to protect themselves. You need to spread on 1 oz. — or about the amount that would fill a shot glass — to safeguard your whole body for just a couple hours, he says. And that’s assuming you’re not sweating or swimming, in which case you need to apply more frequently.

In the end, he says the greatest danger of sunscreen may be that it provides people with a false sense of security against the sun’s dangers. “Just because you rub some on in the morning doesn’t mean you’re safe spending all day in the sun,” he says.

TIME Research

The Link Between 9/11 and Cancer Still Isn’t Entirely Clear

National 9/11 Memorial Museum
People visit the National 9/11 Memorial Museum in New York City on May 25, 2014. Cem Ozdel—Anadolu Agency/Getty Images

A number of complicating factors and delayed data make conclusions difficult to draw

The New York Post reported Sunday that the number of cancer cases among 9/11 first respondents had more than doubled in the past year, from 1,140 to over 2,500. However, to scientists who specialize in analyzing such data, the number of cases cannot ever tell the full story.

Dr. Roberto Lucchini is an epidemiologist and director of the World Trade Center Health Program Data Center at Mount Sinai Hospital, which treats and researches the police officers, construction workers, sanitation workers and iron workers who were among the first respondents on 9/11. To Lucchini, the number of observed cancer cases among these patients cannot be significant until compared to the number of expected cancer cases.

“I don’t think there’s a double of cases one year to the other,” Lucchini told TIME. “When you compare one year to the other, you have to be careful and try to understand what you are comparing. If you don’t compare correctly, you can come up with information that is not exactly true.”

“I don’t think they compared like-with-like which is what you normally do in epidemiology,” adds Dr. Billy Holden, a deputy director of the data center. “I don’t know how they came to the conclusion that there was a doubling.”

Mount Sinai has a record of 1,646 confirmed cancers from 2002 to present-day among the over 30,000 first respondents that they oversee. The hospital’s cases are reviewed and certified by the National Institute of Occupational Safety and Health (NIOSH). Meanwhile, the public registry—which also collects data on these cases—has confirmed 1,172 cancers among Mount Sinai patients, but the registry’s number only represents data through the year 2010, which may account for the difference.

“That’s the latest that we have in reliable data that we can use,” Holden says. “The delay is coming from the registries themselves. It takes them a long time to get the data.”

According to a press release from Mount Sinai, “analysis of available data through 2010 shows that there is an approximately 20% increase in cancer incidence in 9/11 rescue and recovery workers compared to the general population, with a particular increase in thyroid cancer, prostate cancer, myeloma, and leukemia.”

This elevated incidence rate could result from the high exposure to carcinogens that many first respondents endured. However, even this number is subject to question due to a number of complicating factors, including over-diagnosis of certain cancers—such as thyroid and prostate—and questionably reliable data for the general population.

“Over-diagnosis means you’re just screening for cancers, and you pick up cancers that in the normal course of things would never cause symptoms and would never cause death,” Holden says. “The screening for thyroid and prostate cancer is picking up these really non-malignant cancers that don’t do anything.”

Another complicating factor is the continued aging of the first respondents. Epidemiologists would expect the number of observed cancer cases among this population to increase over the coming years regardless because everyone’s risk of cancer rises with time. “Numbers are interesting, but they’re not revealing because we have to look at the rates,” Holden says. “Looking at numbers themselves doesn’t mean anything. You have to put them in a certain context.”

The search for a similar context alone can result in frustration for researchers. As so many residents of New York need not be reminded, 9/11 is an event that stands alone in our history.

“There’s nothing like this in the whole history of the world,” Lucchini says. “We can think about Chernobyl or Fukushima, but this is a totally different situation here… So for us to compare this to other studies and other experiences is quite difficult.”

Lucchini adds, “We are doing as much as we can.”

When it comes to the men and women who first responded on that fateful day, the question remains of how much can ever be enough.

TIME Cancer

House Passes Bill to Update Sunscreen Review Process

The first of its kind in more than a decade

The U.S. House of Representatives on Monday passed a bill that will streamline the process for reviewing and approving ingredients in sunscreen products.

The Sunscreen Innovation Act (H.R. 4250) was created in cooperation with the Food and Drug Administration and is the first major update to the review process since the 1990s.

The act won’t change the level of scientific review required for FDA approval, only some of the procedural steps that can draw out the review process.

If it becomes a law, the Sunscreen Innovation Act would only apply to sunscreen products that have been marketed outside the U.S. for at least five years. Most of the ingredients pending approvals could have their reviews completed within the following year, according to the American Cancer Society, whose advocacy wing the Cancer Action Network supports the bill.

“Educating people about good sun safety behaviors is only half of the story,” ACS CAN President Chris Hansen said in a statement. “American consumers should have access to the broadest choice of sunscreens — including those in use for years in other countries — once they are shown to be safe and effective.”

TIME Breast Cancer

Promising Cancer Drug Fails to Slow Breast Cancer

NEXAVAR
Nexavar Bayer Pharmaceuticals Corporation

Researchers had hoped to add breast cancer to the list of cancers for which the drug is already approved

A Phase 3 trial of cancer drug Nexavar in patients with advanced breast cancer failed to delay progression of the disease, according to the drug’s makers, Bayer and Onyx Pharmaceuticals, Inc., an Amgen subsidiary.

The study, called Reslience, evaluated Nexavar in combination with capecitabine, an oral chemotherapeutic agent, in patients with HER2-negative breast cancer.

The drug is approved to treat certain types of liver, kidney and thyroid cancer and works by targeting signalling pathways that tumor cells use to survive. Researchers hoped that Nexavar would have the same tumor-stalling effect on breast growths.

“We are disappointed that the trial did not show an improvement in progression-free survival in patients with advanced breast cancer,” Dr. Joerg Moeller, Member of the Bayer HealthCare Executive Committee and Head of Global Development, said in a statement. “While the primary endpoint of this trial was not met, the trial results do not affect the currently approved indications for Nexavar. We would like to thank the patients and the study investigators for their contributions and participation in this study.”

Data from the study will be presented at an upcoming scientific conference.

TIME U.S.

Little Boy Battling Cancer Receives 30,000 Birthday Cards

He said all he wanted for his birthday were cards with his name on them -- and the world responded

Today, Danny Nickerson turns six. It’s been a tough year for him, as he was diagnosed with terminal brain cancer last fall and had to stop going to kindergarten, ABC News reports. The Boston area boy told his family that all he wanted for his birthday were cards with his name on them — and it looks like his wish has definitely been granted.

When people around the U.S. — and even around the world — heard about Danny’s story and his one birthday wish, they began to flood his family’s P.O. box. Danny’s mom told ABC News that she received messages from far as Switzerland, Germany, Australia, California, Alaska, Norway and Sweden, all asking how to send Danny a card or package.

The Nickerson family has been posting about the influx of mail on Facebook:

By the time Danny reached his birthday on July 25, he’d received more than 30,000 cards, Boston.com reports. In the meantime, the local post office is preparing for many more. If you want to send Danny a belated birthday card, here’s the address his family provided:

Danny Nickerson
PO Box 212
Foxboro, MA 02035

TIME Cancer

HPV Test vs. The Pap Smear: Which Detects Cancer Better?

New studies are supporting the role that HPV tests can play in detecting cervical cancer.

When it comes to detecting cervical cancer, the Pap test has been the gold standard for more than 60 years. But as the role of human papillomavirus virus (HPV) in contributing to the cancer has emerged in recent years, screening for HPV has started to rival the Pap. And last week, a study of more than one million women added to HPV test’s utility; it found that the HPV test was more successful in assessing cervical cancer risk than the Pap smear.

With a Pap smear, health care providers scrape cells from the surface of the cervix and analyze them under a microscope for abnormal ones that could turn in to cervical cancer. The HPV test, on the other hand, detects the presence of two strains of HPV, which is responsible for about 70% of cervical cancer cases.

In the recent study, published in the Journal of the National Cancer Institute, women with a negative HPV test had half the risk of developing cancer over three years as women who had a negative Pap test, and similar rates to women who were negative on both tests (known as a co-test). Because most cases of cervical cancer are caused by an infection with HPV, women who don’t show signs of the virus are at a very low risk of developing the cancer –even lower than women who have a negative Pap test.

For that reason, says the study’s lead author Julia Gage of the division of cancer epidemiology and genetics at the National Cancer Institute, “We think that HPV primary screening might be a viable alternative to Pap screening as well as co-testing.”

The potential role of HPV testing as a first line screening tool for detecting cervical cancer is also supported by an April study published in the Lancet that looked at four randomized controlled trials in Europe and concluded that the HPV test was the superior screening method. Other studies in rural populations have also been able to cut down on advanced cervical cancers and deaths using just HPV screening.

That’s why in April, the Food and Drug Administration unanimously approved an HPV DNA test developed by Roche as a primary screening tool for cervical cancer for women ages 25 and older. The test screens for the strains most commonly linked to the cancer — HPV 16 and HPV 18 — as well as for others. Along with the approval, the FDA offered guidelines for how the test should be used, advising that women who test positive for HPV 16 or HPV 18 should have a colposcopy, or a procedure that magnifies the cervix so physicians can take a better look at abnormal cells and take biopsies if needed. If women test positive for other strains of HPV, they should have a Pap test as a follow-up to determine the state of their cells.

Still, while the data appears to be showing that the HPV test is a more accurate predictor of cervical cancer, it’s unlikely it will replace the Pap smear any time soon. “There’s not enough evidence accumulated to have a guideline revision at this point,” says Gage. There’s concern, for example, that HPV tests could lead to more unnecessary and invasive procedures, since just the presence of the virus doesn’t always mean cancer will follow; many cases of infection resolve on their own.

And many physicians have relied on the Pap for so long, that implementation will not be prompt. “I understand that something that’s gospel one year may not be gospel the next, but I still tend to lean towards doing the Pap smear than just an HPV test alone,” says Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine.

Most health groups have adopted a similar wait-and-see approach, relying on a combination of Pap and HPV tests. In 2012, for example, the U.S. Preventive Services Task Force (USPSTF) released updated guidelines for cervical cancer screening, advising Pap testing for women between the ages of 21 to 65 every three years, or co-testing with a Pap smear and HPV test every five years for women ages 30 to 65 with normal screening results. Younger women, experts believe, may be more likely to clear HPV infections so wouldn’t benefit as much from regular HPV testing.

Now that studies are suggesting that HPV may be a useful addition, if not replacement, for Pap testing, doctors and their patients may be able to better exploit opportunities to detect and prevent cervical cancer and keep rates of the disease as low as possible.

TIME Cancer

It’s Unlikely Tobacco Company Will Pay $23.6 Billion

Based on the industry's track record, the second-largest tobacco company probably won't pay the billions in damages it owes to a Florida widow

Big Tobacco took a hit on Friday when a court ordered the second-largest tobacco company in the U.S. to pay damages to a Florida widow who had sued them for her husband’s smoking-related death. However, it’s unlikely that the company will pay full price for its negligence.

Although the verdict will likely stand, tobacco company R.J. Reynolds says it plans to appeal the $23.6 billion that the jury determined it owed widow Cynthia Robinson. Based on the industry’s track record, that will likely result in them paying far less.

Robinson’s husband, Michael Johnson, began chain-smoking when he was 13-years-old and died at the young age of 36 in 1996. A decade after her husband’s untimely death, Robinson took the cigarette-makers to court, saying they were not forthcoming about the extremely harmful effects of their product, suing them for not informing the public that smoking was addictive. And almost another decade later, she proved her case.

Unsurprisingly, R.J. Reynolds, whose holding company Reynolds American Inc. recently announced a $27 billion deal to buy out rival Lorillard, contested the verdict. “Regardless of the rhetoric surrounding this case, the damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice president and assistant general counsel for R.J. Reynolds Tobacco Company in a statement sent to TIME. “We will file post-trial motions with the trial court promptly, requesting that the verdict in the case be set aside. We are confident that the law will be followed and the punitive damages verdict will not be allowed to stand.”

Raborn is probably right.

“It is quite likely, bordering on certainty, that the amount of punitive damages will be reduced, though it is unclear how much,” says John Banzhaf, a law professor at George Washington University known for his successful litigations against the tobacco industry. There’s not a lot of dispute among the legal community that the verdict will be reduced–probably substantially. Prior verdicts against Big Tobacco demanding billions in court have been reduced to millions–something the industry, which spends about $23 million on cigarette marketing each day, can pay off rather comfortably. In 2009, Phillip Morris failed to overturn a $79.5 million punitive-damages ruling in the U.S. Supreme Court, and business continued as usual.

“This doesn’t set a legal precedent, but the result of this verdict has people asking how much money will it take to deter tobacco companies? Previous verdicts against tobacco companies have been treated as just the cost of doing business,” says Richard Daynard, a law professor at Northeastern University who specializes in tobacco control. So far, no verdict has changed the economic fundamentals of the industry. But this time, the industry might being feeling less confident.

“I think this is the first time in many years that tobacco companies are going to have to start thinking about really doing something different,” says Daynard. After all, it’s likely we will see many more cases like Robinson’s land similar verdicts in Florida, and it’s possible that similar lawsuits will start to pop up nationwide.

Robinson’s case is one of thousands of lawsuits referred to as an “Engle progeny,” which was developed after a $145 billion verdict in favor of a class action lawsuit led by Dr. Howard A. Engle, a Miami Beach pediatrician. The award was voided in appeals court, under the finding that individual smokers could not make up a class. Though the tobacco industry did not have to pay the award, which was the largest punitive damages payment decided by a jury, the decision opened the floodgates for individual cases to head to Florida court with the support of the Engle case, which proved that the tobacco industry knew cigarettes were addictive, and failed to warn the public.

“The [Robinson] case indicates that juries, when a case is properly presented, are willing to sock it to tobacco companies,” says Banzhaf. “They are angry as hell at these tobacco companies, and when an attorney presents a strong case, they are willing to hit them, and hit them hard.”

Banzhaf says the case will likely motivate attorneys in other states that are less gung-ho to take on Big Tobacco. Lawyers in states like New York, California, and Washington with good tobacco control track records, he said, are likely “salivating” at the future possibilities.

Banzhaf believes that the public is finally grasping the health implications of smoking and is now willing to punish those that profit from it. The numbers seem to support this claim: smoking rates are down 2.8% since 2005 according to CDC data, and smokers can be charged up to 50% more under Obamacare. “Clearly the public is angry. But the courts have to allow damages that are substantially higher than ordinary damages,” says Banzhaf.”Hitting them with $16 million is pocket change.”

It will be no surprise if the final bill for R.J. Reynolds is significantly lower than what the Florida jury determined to be sufficient, but it’s encouraging for the pending cases. “About 70% of Engle cases that have gone to verdict have gone in favor of the plaintiff,” says Daynard. “There are thousands more of these cases pending. Any of them could produce a jury verdict like this because it’s the same misbehavior.”

Unfortunately, the tobacco industry can also produce the same appeals solution they’ve achieved successfully in the past.

TIME Syria

Cancer Wages Its Own War Against Syrian Refugees

A higher rate of cancer among Syrian refugees is forcing doctors, patients and humanitarian organisations to make difficult decisions about who does, and does not, receive care

+ READ ARTICLE

It was just before Syrian civilians started rising up against their government in 2011 that Fayhaa al-Dahr, 22, from the northern city of Raqqa, noticed a strange swelling in her neck. Doctors advised surgery to excise the tumors growing on her vocal chords, but even though Syria has one of the best government-subsidized medical systems in the Middle East, the operations and the follow-up treatment would be expensive.

To pay for al-Dahr’s care, her father sold some land than had been in the family for generations. When another tumor appeared, he sold more land. By the time the third tumor was taken care of, there was no more land to be sold, and the uprising had turned into a war that made it impossible for al-Dahr to travel to the capital for her chemotherapy appointments. When a rocket destroyed her home in December, al-Dahr and her family saw no choice but to take refuge in neighboring Lebanon. At least there, they believed, al-Dahr could continue her treatments. They were wrong.

Lebanon is host to some 1.1 million Syrian refugees, part of an exodus of 2.9 million seeking shelter from a war that has claimed more than 160,000 lives and has wrought untold damages to the middle-income country. Unlike refugees fleeing conflicts in Africa, where diseases of poverty such as diarrhea, malaria or cholera take their toll, Syrian refugees are afflicted with chronic and costly illnesses like diabetes, heart disease and cancer. The international humanitarian agencies that provide for refugees the world over simply do not have the funds to treat these diseases, leaving many, like al-Dahr, without access to proper medical care. Her cancer has metastasized, and she now has a tumor in her upper thigh so excruciating, she says, “I am living on painkillers.”

A recent study published in The Lancet Oncology journal documented a high demand for cancer treatments among refugees from the recent conflicts in Iraq and Syria, with host countries and refugee organizations struggling to find the money and the medicines to help. Cancer, writes Dr. Paul Spiegel, Chief Medical Expert at United Nations High Commissioner for Refugees (UNHCR), is likely to play a much greater role in refugee care going forward. “Cancer diagnosis and care in humanitarian emergencies typifies a growing trend toward more costly chronic disease care. Something that …. is of increasing importance because the number of refugees is growing.”

As it is, the UNHCR warned on July 3 that the organization had received only 30 percent of its $3.74 billion budget for Syrian refugee programs for this year, a shortfall that would see many vital programs, including health care, slashed.

Al-Dahr’s doctor in Damascus had warned her of the consequences of missing chemotherapy appointments, and when she first arrived in Lebanon, she did try to continue her treatment. But the costs—$1,900—were twice what she paid in Damascus. Her family was able to borrow enough cash to pay for one round in January, but when her Lebanese doctor called a few weeks later to remind her of her follow up, she knew she couldn’t afford another session. “He was very worried about me, and called several times to beg me to come, but there was nothing we could do and nothing he could do.” The doctor may have been willing to volunteer his time and expertise, but the drug and hospital costs are immutable.

“It’s a sad story,” says Dr. Dr. Elie Bechara, an oncologist in Beirut who works with other doctors to treat refugees pro-bono. “We are overwhelmed by these cases from Syria. Sometimes we are standing still, watching, and we are not able to help them. It is frustrating.”

Lebanon boasts some of the finest medical facilities in the Middle East, but nearly 90% are privately run, and most of them are for profit. UNHCR has spent tens of millions of dollars on treatment for refugees at private hospitals, but funds are limited. With the rising number of refugees — 1.5 million, a third of the Lebanese population, are expected to have registered by the end of the year — costs too will rise, forcing UNHCR to choose between funding emergency care and primary health clinics that can save thousands of lives and spending thousands of dollars to save one life.

Last year UNHCR covered medical treatment for 41,500 refugees in Lebanon, but each of those cases was judged on specific criteria: the cost of the intervention against the chances of a positive outcome. “It’s a horrible decision to have to make,” says Spiegel. “If there is a poor prognosis, we can’t go that route. It doesn’t mean the patients won’t get treatment—they may search elsewhere, and sometimes embassies or private donors step in—but we can’t afford to help where there is no hope.”

Palliative care, at least, is not that expensive, adds Spiegel. “We never say, ‘There is nothing we can do, go away.’ We just say we can’t treat the cancer but we will treat the consequences.” Al-Dahr falls into that category. Instead of chemotherapy, she gets painkiller injections at her local pharmacy, and she tries not to dwell on her illness. “When you don’t know what is going to happen, it is better to stay in the present,” she says. “Thinking about the future only brings more problems.”

Given the funding shortages, cases like al-Dahr’s are likely to become more common, says Spiegel. “Syria is our biggest and most expensive operation to date, and there is a question of how long donors will continue supporting it as things get worse. If we continue like this, there will be more like this woman who will not be able to receive treatment.”

Like a cancer patient with a poor prognosis, Syria is starting to look like a hopeless cause, and thus less likely to receive aid.

With reporting by Hania Mourtada / Anjar, Lebanon

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 health

Lessons From a Sun Worshipper

Jane Green Ian Warburg

A chance encounter led best-selling author Jane Green to her diagnosis of malignant melanoma.

As far back as I can remember, I have worshipped the sun. My skin is fair, but as the years have gone by, it has toughened and darkened. I now turn a rich golden brown every summer, but only after the first day of burning. I am relatively careful these days. I wear a sunscreen with at least SPF 30, even though I may not apply it as regularly as I could. And as for staying out of the sun during the hottest part of the day? That’s prime suntanning time.

Three weeks ago, my friend Sophie gave me two CDs by a singer named Eva Cassidy. I had never heard of this singer with an angelic voice, so I Googled her. I learned that years ago, when she was 30, she had had a small, dark mole removed from her back. It was a malignant melanoma, said the doctors, but they had caught it early and removed everything with surgery. Three years later, after experiencing pain in her hip, they found that the surgery had not removed everything; the melanoma had spread, and cancer was everywhere. She died at 33.

Some might call this a God moment. Had Sophie not given me those specific CDs, had I not been inclined to look up this singer, I wouldn’t have been thinking about moles. I would not, that night, have noticed, quite by chance, a small mole almost at the rear of my left calf, which seemed somehow not quite right.

It wasn’t very big, but it was uneven, and in the middle was a black splatter, like paint.

I went to my dermatologist, who expressed no concern, but her face had a grave intensity as she removed it to send off for a biopsy, and I knew the news wouldn’t be good.

She phoned three days later. I was on a train on my way home from a breakfast in New York. “Do you have time to talk?” she asked. “Cancer. Malignant melanoma.”

The good news is it’s a thin melanoma, under 1 mm, and it’s Stage I.

The bad news is that my thin melanoma has something called mitosis, which means the cancer cells are dividing and multiplying even as I write. My thin melanoma has already spread outside of the tumor and into the deep layers of skin. Without the mitosis, it’s a slam dunk. The mole is removed, and with it the cancer. With the mitosis, it becomes a slightly different beast, one that has brought sleepless nights filled with endless Internet searches, one that has a less predictable outcome.

I am under the best care at Memorial Sloan-Kettering, where surgery will remove the tissue and a lymph-node biopsy will reveal if it has spread, if in fact my Stage I cancer might be Stage III. Although unlikely, that possibility brings a level of uncertainty that is unfamiliar and frightening.

Melanoma is not the most common of skin cancers, but it is the most dangerous if not found in the early stages. Melanoma causes 80% of skin-cancer deaths. According to the Melanoma Research Alliance, more than 76,000 people in the U.S. are diagnosed with it each year, ­one every eight minutes — and roughly 9,500 die from it, ­one every hour.

Despite all the advancements in the medical world, the death rate from melanoma has remained static for 30 years, and the incidence is rising — it is the fastest-growing cancer in the world. When it is caught early enough, the cure rate can be 100%. (For more information on how to spot dangerous moles, visit the Melanoma Research Alliance.)

As AIDS was in the 1980s, cancer has become the plague we are all living with today. Five years ago, one of my best friends was diagnosed with Stage IV breast cancer. She died seven months later, in September 2009. Another friend has recently emerged triumphant after battling non-Hodgkin’s lymphoma.

I am Superwoman. I am the author of 15 novels, including one about cancer. I am not, however, someone who gets cancer. I am a sun worshipper who never thought it could happen to me.

There will be a lesson in this. I’m just not yet sure what it is. Recognizing the grace, kindness and generosity of those around me, or my own resilience and strength, perhaps. We shall see.

In the meantime, after the tears, I have taken to heart what Winston Churchill once said: “When you’re going through hell, keep going.” I plan to keep going. Hopefully for a very long time.

Green is the author of 15 best-selling novels dealing with real women, real life and all the things in between. She writes a daily blog and contributes to various publications including Huffington Post, the Sunday Times, Wowowow and Self. Her most recent novel, Tempting Fate, was published this spring.

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