TIME Etiquette

How To Act Around Someone Who Was Just Diagnosed With Cancer

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The best thing someone did for me was to just be calm

xojane

This story originally appeared on xoJane.com.

I was diagnosed with thyroid cancer two years ago.

It was a confusing whirlwind where I felt more alive than ever, then flushed with the irony of that, became scared and isolated. And then I just wanted everything to go back to normal.

What I realized very quickly is that people don’t know what to say when something like this happens. And as someone who’s been on the other side, I thought I’d write a little bit about what helped me and what didn’t.

Listen and follow their lead.

When I wanted to talk about it, I talked about it. When I didn’t, I didn’t. If I’m not talking about it with you, I’ve made that choice.

There is a circling-the-wagons thing that happens with a cancer diagnosis, and the information and the fear and the mood swings can only be entrusted to the very top tier of one’s support system. If you are a friend of someone diagnosed with cancer and all they want to do is talk about work problems and good books they’ve read and this one brunch place they’re loving right now… let them. They’re not in denial and they don’t need you to brave the waters of talking about The Cancer. They need time off from The Cancer and the service you’re providing by letting them not talk about it is invaluable.

Prayers and good thoughts. Talismans and good luck charms. A stiff drink and nice big popcorn movie. Normalcy becomes the hottest commodity when one’s life has been hijacked.

Be ready for “weird.”

A cancer diagnosis feels like the most surreal thing in the world. It’s not an easy thing to process — if we can ever truly process it at all. You might not feel sick. You might not look sick. And now you’re being told there’s essentially a time bomb in your body… so you know, come back in a week and we’ll take some blood. NO! GET IT OUT RIGHT NOW?

And you have to make plans and keep showing up to work and follow orders and act like it’s not a big deal for your worried loved ones and be positive about it because you totally got it in time and what a blessing and all you can think about is going back to a time when you didn’t have cancer.

So you’re off. You know you’re off, too. You can’t get into the groove of things. And you want to keep apologizing, which, for me, comes out like, “I know I’m weird, just…” Because when you are a friend to someone who has been diagnosed, they aren’t going to know what’s happening either.

When you get a diagnosis, you’ve been told some crazy stuff about how your life is going to be in the coming months. It’s like the worst, most morbid Choose Your Own Adventure book ever. “Has your cancer spread to the lymph nodes? Turn to page 76!” Either you’re going to be fine or you’re… not. And that information hits you in waves.

You never know when it’s coming it’s just… you know when you think of some really embarrassing stuff you did back in the day? And that flush sweeps across your face? That’s what it feels like. The paralyzing fear.

So, let your friend be weird. They don’t know why they’re like that either.

Don’t preach.

Please don’t tell me that meditation really worked for you. Don’t tell me to marvel at trees because none of us knows how long we’re going to be here. Please don’t quote Eckhart Tolle and implore me to “find the joy.” Also, please don’t assume that I haven’t found my own ministry during this hard time.

Instead of trying to arrogantly educate me on what you’d do in the hypothetical, why don’t you listen to me about what I’m actually doing in the reality of it. Because you don’t have cancer. I do. So your platitudes about the evils of gluten and the wondrous qualities of kale sound so stupid to someone thinking about dying.

Please understand that there is a difference between what you expect from your life in the best of times and what I’m muddling through in the worst phases of mine. And I know. You read this article once where… I don’t care. I really don’t. I really don’t want to sit across a table from you and listen to what more you think I should be doing to fight for my life. Save it. It really is wildly tone deaf and most of all? Doesn’t help.

Complicated isn’t bad.

People really wanted me to be OK. Are you OK? I wonder if she’s OK.

Thing is, I wasn’t going to be OK right then. And that turned out to not necessarily be a bad thing.

Having cancer changed the course of my life. It made me think differently and live differently. On a cellular level. And that wasn’t an easy thing to excavate. It really was a trial by fire.

So, if your friend doesn’t seem OK? It’s complicated. It’s not necessarily a bad thing. It’s not something you think you need to talk to them about. They may not be “sad” — they could be thinking about their life and how they’ve lived it and how they want to live differently. Maybe they’re getting angry. That’s a good thing. Maybe they’re overwhelmed by the outpouring of love and feeling grateful. It’s all such a majestically beautiful, terrible Jackson Pollack painting.

Feelings are good. Feelings are messy. And feelings make us grow. Let your friend feel. Let your friend not be OK. Let your friend be comfortable in the not OK.

Talk about the right now.

It’s hard not to tell your friend that everything is going to be OK. We feel like we’re helping by shrugging off their worries and lightening the mood with “But you’re going to be fine!” It might not be. And also? It’s not all that fine right now.

The best thing someone did for me was to just be the calm flight attendant on the plane telling me where the exits are. They’re not fazed. They’re not worried. They’re hearing me, they’re providing copious amounts of tea and making sure that I have a blankie. They’re right here, right now. They’re pragmatic and sympathetic.

How was the appointment? Let’s talk about that. What’s up with that ham-fisted phlebotomist? Stay in the moment. Feel what’s happening now and talk about this moment on the checklist. Lighten the mood when you think it needs it or just listen and let them see your concern.

I think it’s actually the toughest tightrope to walk because it demands that you experience what’s happening in real time with your friend and most importantly understand that it’s not about you. By staying in the moment and not defaulting to a day when everything is going to be OK, you are telling your friend that you’re in this and moreover, you’re not going to be bringing your psyche to the party. This isn’t going to be about making you feel better. This isn’t going to be about acting fine so you don’t worry. This is just two people going through some scary stuff, making sure your seatbelt is buckled safely and that the drinks cart is on its way.

Also, don’t tell me I should start checking things off my Bucket List or Carpe Diem! Let’s not act like I have one foot in the grave.

Don’t get off on my drama.

You can sniff ‘em out on Facebook. You have suspicions. We all know them. The Drama Vampires.

There’s a part of you that actually thinks they’ll hold it together when your diagnosis comes down. They couldn’t make this about them… No? That’s… I mean, how… And then you’re sitting across from them and reassuring them and making sure they’re fine and making sure they’re taken care of during this trying time. THEIR FRIEND HAS CANCER, GUYS. Uh, yeah. You know. You’re the friend.

If you’re one of these people, it comes down to one simple question: Is the drama and attention you’re receiving worth more to you than the friend you are most certainly going to lose? Because cancer has a way of clarifying things. And a friend selfish enough to make your diagnosis about them is going to be the first one on the chopping block.

Furthermore, your friend’s cancer diagnosis is theirs to tell. Not yours. You should never divulge someone else’s diagnosis just so you can feel important or in-the-know. It’s a breach of trust. You’re not helping your friend; you’re feeding your own ego.

In the end, your friend is still your friend. And I think that’s the most important thing to remember: yes, this is a particularly challenging time but it’s not the only thing about them.

Make sure to let them be something other than A Person With Cancer. Help them remember this, because sometimes when you’re in the thick of it, that’s all you fear you are.

Liza Palmer is an author living in Los Angeles.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Aging

How to Talk About The End of Your Life

The toughest conversation might also be the most important

The video of Brittany Maynard, 29, describing her choice to move to Oregon for the right to end her life due to her terminal cancer has received well over 7 million views. It’s also left many people shocked, saddened and inspired by her decision.

“I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms,” Maynard wrote on CNN.com.

Talking about death—and the circumstances surrounding it—is uncomfortable for most people. But my colleague Lily Rothman, 28, just wrote her will. “My eventual death was something I’d been mentioning to lots of people, on Facebook and at engagement parties and at my high-school reunion,” she writes. “It wasn’t that I thought death was going to come any time soon or in any special way, it’s just that, as they say on Game of Thrones, all men must die.”

MORE: 5 Tips For Families Facing End-Of-Life Care

Many people argue that it’s time we had more conversations about the end of life and how we want to go. It’s a conversation that can become awkward, especially for adult children bringing it up to their parents, but it allows people to avoid having to make very difficult decisions at the most sensitive times. “It’s critically important for us to have these conversations at the kitchen table,” says Ellen Goodman, founder of The Conversation Project, a nonprofit organization that campaigns for the expression and respect of wishes for end-of-life care. “Too many people are not dying in the way that they choose, and we need to change that.”

Goodman, who had to make medical decisions for her dying mother that they had never discussed beforehand, also created the Conversation Starter Kit, which you can download for free. So far, people in 50 states and 176 countries have downloaded the kit. That’s great news, considering about 90% of Americans believe it’s important to talk about their end-of-life care wishes and those of their loved ones, but only 30% actually have those discussions, according to the Conversation Project. “We would hope that this really tragic story of [Brittany Maynard] has an outcome that will really help people talk about these issues,” says Goodman.

Here are some other preparations you might consider if preparing an end-of-life checklist, from the National Institute on Aging:

  • A living will, which records a person’s wishes for medical treatment near the end of life.
  • Designating a durable power of attorney for health care, which names a person, sometimes called an agent or proxy, to make health care decisions when a person can no longer do so.
  • Talking about a do-not-resuscitate (DNR) order, which instructs health care professionals not to perform cardiopulmonary resuscitation if a person’s heart stops or if he or she stops breathing. A DNR order is signed by a doctor and put in a person’s medical chart.
  • Writing a will—a document that indicates how a person’s assets and estate will be distributed upon death.
  • Naming a durable power of attorney for finances, someone to make financial decisions when the person no longer can. It can help terminally ill people and their families avoid court actions that may take away control of financial affairs.
  • Penning a living trust, which provides instructions about the person’s estate and appoints someone, often referred to as the trustee, to hold the title to property and funds for the beneficiaries. The trustee follows these instructions after the person can no longer manage his or her affairs.
TIME Cancer

Can Low-T Therapy Promote Prostate Cancer?

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New rat research raises health questions for researcher

“Low T” therapy is a fast-growing trend for men who want to jack up testosterone—which declines naturally with age but which can also be clinically low in some people—and the testosterone therapy industry is predicted to reach $5 billion by 2017. The long-term safety effects of supplementing with the hormone is still in question, however—especially in light of a study earlier this year that found double the heart attack risk in certain men after starting testosterone treatments. Other research suggested there was no meaningful increase in heart risk, adding to the confusion. But a new rat study published in the journal Endocrinology raises some alarming questions about the increasingly popular drugs.

Maarten Bosland, PhD, study author and professor of pathology at the University of Illinois at Chicago’s College of Medicine, devised an animal model to test the tumor-promoting effects of testosterone in rats. He exposed a group of rats to a carcinogen, which would put them at risk of developing cancer. He also gave some of the rats testosterone, but no carcinogen. In a third group, he administered both the carcinogen and the testosterone. Then, he measured tumor growth among the two groups.

None of the rats developed prostate cancer when they were just exposed to the carcinogen, but 10-18% of them did when they were just given testosterone. When the rats were exposed to the carcinogen and then given testosterone—even at very low doses—50-71% developed prostate cancer. “I was totally amazed about how strong testosterone can work to promote the formation of prostate cancer in these animals,” he says.

Of course, an animal model can’t determine what will happen in men, but Bosland thinks a similar effect is possible. “Absent of having solid human studies, we won’t be able to say that—it’s just an extra warning signal,” he says. “But I think it’s a clear indication that there is risk.”

TIME Cancer

Why Cancer Drugs May Work Better While You Sleep

The body doesn't process drugs in the same way throughout the day, so it's possible to time your doses to make anti-cancer meds more effective

It’s news to no one that your body works differently when you’re awake and when you’re sleeping. But could the different states also affect how your body processes certain life-saving drugs? Researchers, reporting Friday in the journal Nature Communications, found that when it comes to cancer drugs, the answer may be yes.

Researchers at the Weizmann Institute of Science discovered—by happy accident—that some of the body’s molecular functions during the day may interfere with the effectiveness of certain cancer medication. Specifically, they found that the normal day-time production of some steroid hormones in the body actually inhibited the work of epidermal growth factor (EGF) receptors—which are the proteins targeted by a class of anti-cancer drugs. Tumor cells plant these receptors on their surfaces to attract nutrients that help them survive and grow. Drugs, including the breast cancer agent lapatinib, can block these receptors on tumors, and such medications are a popular way to treat breast cancers expressing epidermal growth factor.

But Yosef Yarden, a professor in the department of biological regulation, and his team found that when the tumor cells simultaneously bind to something else—such as steroid hormones—the EGF receptors are less active, making drugs like lapatinib less potent.

The findings are still preliminary, but there is other evidence that the day-night cycle may be a potentially important factor in determining cancer treatment dosing in coming years. Some studies showed, for example, that when the 24-hour rest and activity cycle is broken metabolically, and the EGF receptors aren’t given enough time to be active, certain tumors in animals grow two to three times faster.

“The study developed out of a mistake. We accidentally omitted a synthetic steroid…from the medium in which we routinely grow mammary gland cells,” Yarden wrote in an email response to TIME. “And we noticed that the cells acquired a faster rate of migration when we followed them under a microscope.”

Intrigued, they turned to mice to answer some more questions. Knowing that steroid levels peak during the day and drop off during sleep, Yarden and his colleagues wondered whether the timing of anti-tumor drugs would affect tumor growth. So they gave a group of mice with breast cancer tumors lapatinib at different times over a 24-hour period and tracked any differences in the size and growth of the tumors.

Indeed, the mice given the drug while they slept showed significantly smaller tumors after seven days than those who received the drug during the day. Yarden suspects that the lower levels of steroid hormones circulating at night allows more of the EGF-targeting drug to hone in on its receptors on the tumor cells and inhibit their growth. Not only that, but the tumors in the mice taking the drug at night looked different; they showed less blood vessel infiltration which meant they were less robust.

Does that mean it’s better to get cancer therapy at night? So far, the results only apply to animal models, and to cancers driven by EGF. More work needs to be done, but if it’s validated, shifting therapies to just before bed “seems logical,” says Yarden. Especially since drugs like lapatinib come in pill form, so it would be relatively easy to take medications before turning in rather than in the morning.

TIME Cancer

Smoking and Drinking Raise Your Risk for Oral HPV

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Research sheds new light on HPV risk factors

Your favorite health vices—smoking and drinking—may pave paths to HPV, two new studies find.

A new study published in a research letter in JAMA looked at detailed health profiles from 6,887 participants in the National Health and Nutrition Examination Survey (NHANES). Those people with higher levels of biomarkers for tobacco exposure in their blood and urine also tended to have a higher prevalence of oral HPV type 16. That’s a strain that causes more than 90% of HPV-related oropharyngeal—or throat—cancers, says study co-author Dr. Gypsyamber D’Souza, associate professor at Johns Hopkins Bloomberg School of Public Health.

(By the way, you can only get oral HPV through intimate oral contact—not by sharing forks or kisses on the cheek, D’Souza says. It’s unclear whether French kissing, when you’re actually exchanging saliva, also does the trick.)

The main causes of throat cancers are tobacco, alcohol and HPV, she says, but since tobacco use has declined in the U.S., HPV is becoming an increasingly important player.

“HPV is the primary causal agent of HPV-related oral cancer,” D’Souza says, and most people clear the infections on their own. “But these results suggest that tobacco may make these infections less likely to clear, and therefore smokers may have a higher risk of eventually developing oropharyngeal cancers.”

The increased risk doesn’t only come from smoking cigarettes: the researchers found an association with oral HPV-16 and tobacco exposure in general, even at very low levels indicative of secondhand smoke. People who were current tobacco users had more cases of oral HPV-16 than former users or people who had never used it.

The good news is that the HPV vaccine protects against HPV type 16, and though it hasn’t been definitively shown yet to protect against oral infection, some data suggest that it does, D’Souza says.

In other HPV-related news, a separate questionnaire study on 1,313 men published earlier this month in BMJ found that men who reported drinking more alcohol tended to also have higher levels of HPV. In fact, the biggest drinkers in the study had 69% of HPV prevalence vs 57% among the men who drank the least. (For HPV types that may increase the risk of cancer, those numbers were 35% vs 23%.)

Neither study could definitively point to a cause or mechanism, but studies have shown that smoking and drinking have immunosuppressive effects, which can promote inflammation and infection.

“What this adds to the story is an understanding of one reason why people who have not had very heavy sexual history, people who’ve had one lifetime partner . . . develop these cancers,” D’Souza says. “This cross-sectional study suggests that in some people tobacco use might be an explanation.”

TIME Innovation

Five Best Ideas of the Day: October 2

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A global competition could prime the pump for development of disease-fighting treatments.

By James Surowiecki in New Yorker

2. Cancer detecting yogurt? New technology could make diagnosing colon cancer as simple as taking a pregnancy test.

By Kevin Bullis at the MIT Technology Review

3. Youth-targeted networks are leading a surge in LGBT-friendly television programming.

By Joanna Robinson in Vanity Fair

4. California’s massive expansion of teledentistry could revolutionize delivery of oral hygiene to underserved areas.

By Daniela Hernandez in Kaiser Health News

5. The climate change movement desperately needs diversity and corporate leadership.

By Caitlin Colegrove in conversation with M. Sanjayan in the Aspen Idea

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Opinion

How Celebrities Helped Me Get Through Breast Cancer

When I was diagnosed at 40, Betty Ford, Betsey Johnson and Sheryl Crow stepped in

If you’re diagnosed with cancer and you live, you’re graced with a label that’s meant as an honor: “Survivor.” And yes, surviving cancer is a powerful experience that can enrich and embolden the rest of one’s days. But what of people whose lives are taken by the disease? Anyone who has lost a loved one to cancer knows well that people who die of cancer commonly display extraordinary determination, clarity, and grace. We don’t have a fitting term for those people — “victims” is not exactly empowering — and yet, as Breast Cancer Awareness month begins, their experience is just as worthy of being honored.

I took a crash course in these issues when I was diagnosed with breast cancer, at age 40, in 2008. Part of what I learned during that time came from close connections, especially those I found in a national group called the Young Survival Coalition, which provides support and information for younger women facing this diagnosis. At the same time, I also found a community somewhere less expected: with celebrities.

Before connecting with others dealing with the disease, I could immediately turn to the famous women whose experiences I had watched throughout the decades before. I thought of Betsey Johnson, who’d been diagnosed in 2002. She had apparently come through more fabulous than ever; I’d interviewed her a few years before and found her insightful, buoyant, and laughter-filled. I thought of Minnie Riperton, a musician I’d loved all my life. Her candor about her diagnosis earned her a spokesperson position for the American Cancer Society in 1977 and the ACS’s Courage Award, presented by President Jimmy Carter, in 1978. She ultimately died of breast cancer, at 31, but I remembered the impression she’d made on me when I was a child by communicating in public about her illness with honesty and grace.

The list goes on: Sheryl Crow and Christina Applegate emerged from their breast cancer treatments determined to help others who face the disease. Edie Falco was diagnosed at 40, in 2003; she later said that the way long-held wishes came to the fore in her life after cancer treatment encouraged her to adopt her children. Robin Roberts came out about her sexuality after she was treated for a blood disorder that appears likely to have resulted from the chemotherapy she received for breast cancer five years before. I also thought of photographer Linda McCartney, diagnosed with breast cancer in 1995. In March of 1998, her face somewhat gaunt and her hair just growing back from chemotherapy, she nonetheless shone with pride at her designer daughter Stella’s fashion show. One month later, she died of the disease — but I will never forget the photos I saw of her that day and how she put herself, though very ill, in the public eye for an event she held dear, living on her terms till the end.

The impact these women can have on those fighting the disease out of the spotlight just goes to show how important it is that celebrities now feel free to speak out if they want to.

That’s where Shirley Temple Black comes in. When the former child star was diagnosed with breast cancer in 1972, it was not only common for women to keep the diagnosis a secret from others, but also for their doctors to keep secrets from them: Doctors often told women they were having a biopsy when in fact a mastectomy was planned; the thinking was that a woman would not be able to handle the news in advance. Black, one of the first women in this country to speak publicly about her breast cancer diagnosis, expressed outrage at this practice: “The doctor can make the incision; I’ll make the decision,” she wrote in McCall’s magazine.

Just two years later, First Lady Betty Ford was diagnosed, mere weeks after her husband took the oath of office. TIME reported that she received what was then the standard surgery for breast cancer: a “radical mastectomy” that “removed the entire right breast, its underlying pectoral muscle, and lymphoid tissue in the adjacent armpit.” Today, less invasive surgical options are far more common, even when a mastectomy is performed. (Ford went on to commit herself to many causes, most famously helping to erase stigma from another illness she faced: addiction.) Within weeks, Happy Rockefeller, the Vice President-designate’s wife, had decided to learn from Ford’s example and perform a breast self-exam. She found a lump in her breast and was diagnosed with breast cancer; Ford was publicly credited with leading Rockefeller toward the diagnosis and what proved to be successful treatment.

The First Lady’s decision to be open about what was still a taboo topic — a frightening illness in a private part of the body — had paid off immediately. And I can attest that the trend she helped start, of sharing a breast cancer experience publicly, continues to make a difference.

These days, of course, one needn’t even be a global celebrity to have a broad impact. In mid-2010, I discovered the writings of journalist Mary Herczog, who had also been treated for breast cancer. I loved her warm, witty writing style; and I loved that she had decided to pursue a doctorate after her initial cancer treatments. I wanted to meet this remarkable survivor — but was devastated to learn that Herczog had died of breast cancer a few months before, at age 45. In a blog entry about a month before her death, Herczog acknowledged her somewhat unusual refusal to despair over terrible medical news. “Either there’s a whole lot of unavoidable bad coming at me,” she said, “in which case I don’t see the need to rush up and greet it, or I feel pretty swell, and I roll out with cookies and good books.” Words to live by, from one whose legacy will continue to survive.

As for what to call those who, like Herczog, were not themselves survivors, one of my friends from the Young Survival Coalition has a suggestion: call them by their names. That goes for boldface names as well as the names of beloved friends.

Meanwhile, whatever term you want to use for someone who had cancer and now shows no evidence of the disease, that’s what I am. And I carry in my heart others who touched my life while they faced the disease — those who survived and those who didn’t — even if I only ever knew them from a distance.

Read TIME’s 2013 cover story about the impact of Angelina Jolie’s mastectomy, free of charge, here in TIME’s archives: The Angelina Effect

TIME Cancer

The New HPV Vaccine Could Be 90% Effective

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An even more effective vaccine against human papillomavirus (HPV), which can cause cervical cancer, may be on the horizon, according to new research published in Cancer Epidemiology, Biomarkers & Prevention. Merck announced that it’s investigating a 9-valent HPV vaccine that protects against nine total types of HPV—five more than the current one on the market.

The current vaccine, GARDASIL, also manufactured by Merck, is effective against 70% of cervical and other HPV-related cancers and protects against two of the main types that cause cancer—type 16 and 18—as well as two more that cause most cases of genital warts, types 6 and 11. The potential new vaccine, which isn’t named yet, will protect against approximately 90% of cervical cancers, says study author Elmar Joura, an associate professor of gynecology at the Medical University of Vienna in Austria (who received grant support, lecture fees and advisory board fees from Merck). It protects against the HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

MORE: HPV Vaccine Cuts Rates of Genital Warts 61%

Coverage against those extra strains could be good news for women worldwide, as some races are prone to different types of HPV. In East Asia, HPV 52 and 58 are more common than in the U.S. or Europe, Joura writes in an email to TIME. “The good thing is that the nine valent vaccine will equalize these differences,” Joura writes. “The grade of protection will be the same worldwide.”

In the study, Joura and his team analyzed data from 12,514 women and found that of those ages 15-26 who had precancers, 32% had more than one type of HPV—that number was 19% for women between the ages of 24 to 45.

MORE: There’s a Vaccine Against Cancer, But People Aren’t Using It

The FDA is currently reviewing the vaccine, and Joura expects them to reach a decision by the end of 2014. “The vaccine will hopefully be available soon after,” he wrote.

TIME Cancer

Waist Size Linked to Breast Cancer, Study Finds

Trading in smaller skirt sizes for bigger ones is linked to a higher risk of breast cancer, finds a new study published in BMJ Open.

But it’s what underneath the skirt—an expanding waist—that counts.

Research already suggests that gaining weight puts women more at risk for breast cancer, since fat tissue spurs the production of estrogen, which feeds the growth of breast tumors. The kind of fat around your waist seems to be especially telling: Some studies have found that waist circumference is better than BMI at assessing the risk for many conditions. In an attempt to give women an “easy to understand message,” researchers of this new study measured waist thickness by the number on their subjects’ skirt tags.

The study looked at data from about 93,000 mostly overweight, postmenopausal women in the U.K. Collaborative Trial of Ovarian Cancer. After gathering various kinds of health data from the women—like general health, cancer status, and, yes, skirt size—for about three years, they analyzed the results.

An increase in skirt size was the single most predictive measure of breast cancer risk, the study concluded. When women went up a single skirt size over a 10-year span between their mid 20s and mid 60s, they were shown to have a 33% greater risk of developing breast cancer after menopause. Buying two skirt sizes up during that same period was linked to a 77% increased risk.

The size of your skirt might seem like a silly stand-in for measuring belly fat, but skirt size “has been shown to provide a reliable and feasible estimate of waist circumference at the population level,” the study reads.

Don’t get too married to the results, though. The study acknowledges that skirt sizing probably varied over the years, as any woman who’s ever shopped at more than one store can tell you. Forget changing skirt size in a decade—you can change skirt size in a minute if you just try a different store, so it should take more than a sudden switch from a 4 to a 6 to freak you out.

TIME Cancer

Senate Passes Bill for Better Sunscreen

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A highly anticipated bill that could bring more sunscreen ingredients to market has passed

The Senate passed a bill Wednesday that requires the Food and Drug Administration (FDA) to respond to current pending sunscreen ingredients within a shorter period of time — an important factor in ensuring that people have the most up-to-date ways to protect their skin from cancer-causing UVA rays, proponents of the legislation have argued.

While skin cancer is the most common cancer diagnosed in the U.S., eight sunscreen ingredients have been pending in FDA backlog for years — some for over a decade — even while several of the pending ingredients have already been used in Europe and Asia for years.

As TIME reported in May, proponents for sunscreen modernization were optimistic that a bipartisan bill, the Sunscreen Innovation Act, would pass over the summer. The bill, which also requires the FDA to respond to all potential sunscreen ingredients in the future within a year and a half at maximum, moved along quickly through the summer months. A version of the bill was passed by the House in July. Now, the House and Senate will meet to agree on a final legislation of the bill. Once they reach consensus, it will go to President Obama to sign.

“The two bills are pretty darn similar, so we don’t anticipate the negotiation will be contentious,” says Michael Werner, policy adviser of the Public Access to SunScreens Coalition.

One of the reasons it takes so long for sunscreen ingredients to get approval in the U.S. is because of the regulation process that the FDA currently has in place. In Europe, ingredients are regulated as cosmetics, but in the U.S. sunscreens are go through a process similar to drug approval, which takes longer and has more safety requirements.

However, many ingredients had not received any feedback from the FDA, not even negative feedback, which prompted skin-care advocates and policymakers to question why the FDA had taken so long to respond, even given the excuse of a stringent system.

As the bill began to move through the voting process, the FDA started responding to some of the pending applications.

Read more of TIME’s coverage on the sunscreen bill here.

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