Whether or not robotic assisted surgery is currently cost effective, the technology is here to stay. The industry has grown at an incredible rate making this technology more accessible across Canada, the United States and across the globe. For example, in 2004 less than 25,000 da Vinci surgical procedures were performed worldwide. In 2009, a mere 5 years later, there were close to 200,000 da Vinci surgical procedures. That is over a 45 percent growth .
As clinical trials are done, the da Vinci will hopefully improve in technology, accessibility, and how it is used. Clinical trials will pin point the draw backs of using the da Vinci Surgical System and provide ways in which the technology can be improved. Competition between medical institutions and hospitals to provide the most innovative procedures will increase demand for the da Vinci making its training programs more accessible to surgeons and its surgeries more available to patients, including those seeing cancer treatment. Surgical procedures will hopefully also be refined, as technological improvements will allow surgeons to perform more complex surgeries.
Just imagine what possibilities this technology could bring. With the growing speed and access to wireless networks, it is theoretically possible to use the da Vinci wirelessly over long distances. A surgeon from Vancouver could perform a da Vinci laparoscopic prostatectomy on a patient in Ottawa as long as the console (in Vancouver), and the patient side cart (in Ottawa) were connected via wireless technology. This could provide all different types of surgical opportunities as medical facilities would not necessarily need to have both the da Vinci console and patient side cart on site at the same time. This could also reduce the cost required to spend on da Vinci equipment, as hospitals may not need to invent in both the surgical console and the patient side cart.
There is really no way to know where this technology may eventually take us. But like most new technology, it is expensive and somewhat controversial. Should we continue to invest in this technology when there is a lack clinical research to show that it is cost effective? Who should be responsible for investing in this technology? Here in Canada, we are fortunate to have a universal health care system. But as taxpayers, should we be investing in technology that may not be cost effective? These are very tough questions to answer especially for hospitals, medical practitioners and policy makers.
As it stands right now, the da Vinci surgical system has the potential to provide several short term benefits for those undergoing minimally invasive surgery. This includes a number of cancer surgeries such as laparoscopic prostatectomy, laparoscopic hysterectomy and laparoscopic nephrectomy. Clinical research, all be it limited, seems to suggest that the da Vinci Surgical System can reduce blood loss and transfusion exposure during the procedure while reducing post-operative pain, recovery time and hospital stay when compared to typical laparoscopic and open surgical techniques. These advantages provide cancer patients with less invasive surgical options and alternatives to other suggested measures of treatment.
In time, as more clinical evidence is gathered, the da Vinci may offer more advantages as the technology is improved and as surgical procedures are refined. But until then, it remains a very expensive piece of technology with a tremendous amount of potential.
Robotic Assisted Surgery and Canada
As it stands right now, the da Vinci Surgical System is not as widely available in Canada as it is in other parts of the world. The following Canadian locations have access to the da Vinci Surgical System :
• St. Michael's Hospital (Toronto, ON)
• Toronto General Hospital (Toronto, ON)
• Sir Mortimer B. Davis - Jewish General Hospital (Montreal, QC)
• Hopital du Sacre-Coeur de Montreal (Montreal, QC)
• Montreal General Hospital (Montreal, QC)
• Vancouver General Hospital (Vancouver, BC)
• Royal Alexandra Hospital (Edmonton, AB)
• University of Alberta Hospital (Edmonton, AB)
• Rockyview General Hospital (Calgary, AB)
• St. Joseph's Hospital (London, ON)
• Canadian Surgical Technologies & Advanced Robotics (London, ON)
Showing posts with label Posted by Jon Avery. Show all posts
Showing posts with label Posted by Jon Avery. Show all posts
Monday, March 14, 2011
Friday, March 11, 2011
Robotic Assisted Cancer Surgery: Robotic Surgery vs. Laparoscopic Surgery
As noted previously, robotic assisted surgery was developed to improve laparoscopic surgery. Laparoscopic surgery is a common surgical technique to treat several types of cancers including prostate, colon, kidney and ovarian cancers as well as cancer of the throat and esophagus. Given the ergonomic advantages of a laparoscopic surgery using the da Vinci surgical system, which technique – traditional or robotic – provides the most successful surgeries when treating cancer?
In general, robot-assisted surgery has been associated with reduced blood loss, reduced transfusion exposure, fewer complications, reduced post-operative pain, shorter hospital stays, and reduced recovery times as compared to typical laparoscopic and open surgical techniques . But, given the relatively recent introduction of robotic assisted surgery, there is a lack of substantial medical proof to substantiate these clinical benefits.
For example, according to the Canadian Agency for Drugs and Technologies in Health (CADTH), conclusions regarding the benefits of the da Vinci must be drawn carefully due to the lack of clinical research. CADTH’s literature analysis of current research measuring performance of the da Vinci surgical system for laparoscopic prostatectomy, hysterectomy and nephrectomy (common surgeries to treat prostate, cervical and kidney cancers), which is limited, showed statistically significant benefits. This included less blood loss during the procedure and shorter hospital stays after the procedure when compared to a typical laparoscopic and open prostatectomy, hysterectomy and nephrectomy. But, according to CADTH’s report, research in this area is limited making it difficult to come to any substantial conclusions . With that being said, the research that does exist suggests that some laparoscopic procedures that use the da Vinci may be less invasive and provide several short term benefits.
But what about long term benefits? According to CADTH, there are currently no long term clinical benefits to using the da Vinci. This seems to be one of da Vinci’s largest criticisms because robotic assisted surgery is costly compared to open and laparoscopic surgeries. The da Vinci costs roughly C$2.7 million with annual maintenance costs of about C$186,000. In addition, the average instrument cost per procedure is approximately C$2,600 (many of these instruments are not reusable) . The use of the da Vinci may also require additional operating room time and there is a learning curve associated with effective use the of the da Vinci surgical system – surgeons must perform 150 to 200 procedures to really become adept with the technology . Therefore, when push comes to shove, one has to wonder if it is cost effective to use the da Vinci over traditional surgical procedures. Do the benefits outweigh the costs?
Take prostate cancer as an example. A popular treatment for prostate cancer is a laparoscopic prostatectomy. A da Vinci laparoscopic prostatectomy costs (net cost) roughly six per cent more, or $1,600, not including the robot itself, than alternative procedures . Even though it is more expensive, the da Vinci laparoscopic prostatectomy may offer a less invasive surgical option. This may benefit prostate cancer patients because often times patients choose non-surgical interventions such as “watchful waiting” to avoid the consequences of surgery. But the potential for a surgical procedure that offers a faster recovery time as well as fewer complications during the procedure may encourage patients to opt for a surgical intervention using the da Vinci. The extra cost may be offset by reductions in post-operative hospital costs as patients recover more rapidly from this procedure. But this is all speculation. Time will tell if this is truly the case.
So is laparoscopic surgery using the da Vinci superior to traditional laparoscopic surgery? Preliminary research suggests it may be. But the question remains: is it worth the economic price we pay for the technology?
i Canadian Agency for Drugs and Technologies in Health. (September 28, 2010). Draft report - Robot-assisted surgery versus open surgery and laparoscopic surgery: Clinical and cost- effectiveness analyses. Accessed at http://www.cadth.ca/index.php/en/publication/2682
ii Ibid
iii Ibid
iv Vancouver Sun. (October 2, 2010). Meet Jack the surgical robot: He’s on the cutting edge of cancer treatment. Accessed at http://bit.ly/9f9gE0
v Ibid
vi “Watchful waiting” is a non-surgical intervention for prostate cancer. It involves a regular examination of the prostate and its PSA level. Immediate treatment (surgery or other) is only recommended if signs of cancer appear or change. Prostate cancer is not known to be an aggressive cancer. Some prostate cancers are very slow growing and can be present for years without affecting one’s health.
In general, robot-assisted surgery has been associated with reduced blood loss, reduced transfusion exposure, fewer complications, reduced post-operative pain, shorter hospital stays, and reduced recovery times as compared to typical laparoscopic and open surgical techniques . But, given the relatively recent introduction of robotic assisted surgery, there is a lack of substantial medical proof to substantiate these clinical benefits.
For example, according to the Canadian Agency for Drugs and Technologies in Health (CADTH), conclusions regarding the benefits of the da Vinci must be drawn carefully due to the lack of clinical research. CADTH’s literature analysis of current research measuring performance of the da Vinci surgical system for laparoscopic prostatectomy, hysterectomy and nephrectomy (common surgeries to treat prostate, cervical and kidney cancers), which is limited, showed statistically significant benefits. This included less blood loss during the procedure and shorter hospital stays after the procedure when compared to a typical laparoscopic and open prostatectomy, hysterectomy and nephrectomy. But, according to CADTH’s report, research in this area is limited making it difficult to come to any substantial conclusions . With that being said, the research that does exist suggests that some laparoscopic procedures that use the da Vinci may be less invasive and provide several short term benefits.
But what about long term benefits? According to CADTH, there are currently no long term clinical benefits to using the da Vinci. This seems to be one of da Vinci’s largest criticisms because robotic assisted surgery is costly compared to open and laparoscopic surgeries. The da Vinci costs roughly C$2.7 million with annual maintenance costs of about C$186,000. In addition, the average instrument cost per procedure is approximately C$2,600 (many of these instruments are not reusable) . The use of the da Vinci may also require additional operating room time and there is a learning curve associated with effective use the of the da Vinci surgical system – surgeons must perform 150 to 200 procedures to really become adept with the technology . Therefore, when push comes to shove, one has to wonder if it is cost effective to use the da Vinci over traditional surgical procedures. Do the benefits outweigh the costs?
Take prostate cancer as an example. A popular treatment for prostate cancer is a laparoscopic prostatectomy. A da Vinci laparoscopic prostatectomy costs (net cost) roughly six per cent more, or $1,600, not including the robot itself, than alternative procedures . Even though it is more expensive, the da Vinci laparoscopic prostatectomy may offer a less invasive surgical option. This may benefit prostate cancer patients because often times patients choose non-surgical interventions such as “watchful waiting” to avoid the consequences of surgery. But the potential for a surgical procedure that offers a faster recovery time as well as fewer complications during the procedure may encourage patients to opt for a surgical intervention using the da Vinci. The extra cost may be offset by reductions in post-operative hospital costs as patients recover more rapidly from this procedure. But this is all speculation. Time will tell if this is truly the case.
So is laparoscopic surgery using the da Vinci superior to traditional laparoscopic surgery? Preliminary research suggests it may be. But the question remains: is it worth the economic price we pay for the technology?
i Canadian Agency for Drugs and Technologies in Health. (September 28, 2010). Draft report - Robot-assisted surgery versus open surgery and laparoscopic surgery: Clinical and cost- effectiveness analyses. Accessed at http://www.cadth.ca/index.php/en/publication/2682
ii Ibid
iii Ibid
iv Vancouver Sun. (October 2, 2010). Meet Jack the surgical robot: He’s on the cutting edge of cancer treatment. Accessed at http://bit.ly/9f9gE0
v Ibid
vi “Watchful waiting” is a non-surgical intervention for prostate cancer. It involves a regular examination of the prostate and its PSA level. Immediate treatment (surgery or other) is only recommended if signs of cancer appear or change. Prostate cancer is not known to be an aggressive cancer. Some prostate cancers are very slow growing and can be present for years without affecting one’s health.
Thursday, March 10, 2011
Cancer Surgery and Robotics
Cancer is a disease that has plagued the human race for centuries. The world’s oldest documented case of cancer hails from ancient Egypt (1500 B.C.), while the first attempt to treat it surgically dates back to approximately 1600 B.C. Today’s surgical treatments have very little resemblance to the techniques used several centuries ago as our knowledge of the human body, of chronic disease and our technology are much more advanced.
One of the most amazing advancements is cancer surgery has come in the form of a robotic assisted surgery. Robotic assisted surgery was developed to overcome the limitations from minimally invasive surgery. Minimally invasive surgery, known as laparoscopic or keyhole surgery, is a modern surgical technique that is performed by making several small incisions (less than ½ inch) in the abdominal and pelvic regions. By inserting a small camera and tiny surgical instruments into these incisions, the surgeon performs the surgery while watching detailed images on a monitor . Laparoscopic surgery is an effective surgical technique and is mainly used for operations within the abdominal and pelvic regions as well as on the thoracic and chest cavities. This procedure is typically used to treat cancers of the abdominal and pelvic regions including prostate, colon, kidney and ovarian cancers as well as other cancers including throat and esophageal cancers.
Although traditional laparoscopic surgery is a very safe and successful surgical procedure, robotic assisted surgery was developed to improve this technique further. The most known robotic surgical system, and the only one available in Canada, is called the da Vinci Surgical system. The da Vinci Surgical system, owned and designed by Intuitive Surgical, consists of a surgeon’s console (remote control) and a patient side cart (the robot). The surgeon’s console consists of two hand controllers, two foot pedals, and a two-eye viewing screen. The side cart consists of 4 robotic arms, 3 for surgical tools, and 1 for a two lens endoscopic camera.
The surgical procedure using the da Vinci Surgical system is similar to a typical laparoscopic surgery except for one major difference. Unlike a typical laparoscopic surgery where the surgeon operates while standing over the patient, the da Vinci surgical system allows the surgeon to operate by controlling the robotic arms remotely from the console. While seated at the console, normally located in the same room as the patient, the surgeon uses the console’s controllers to manipulate the patients-side carts three or four robotic arms, while looking through the two-eye viewing screen.
The ergonomic design of the da Vinci allows the surgeon to perform the surgery in a much more comfortable manner compared to a typical laparoscopic surgery. The surgeon sits at the console and operates the robotic arms remotely, which come into contact with the patient, while directly viewing the procedure with his/her head rested on the two-eye viewing screen. Instead of standing over the patient using surgical tools while viewing the procedure on a monitor, the da Vinci’s design is seen to reduce fatigue and physical strain on the surgeon.
The design of the da Vinci also has a number of other advantages. This includes the jointed wrist design of the robotic arms, the da Vinci’s ability to translate, filter and scale the surgeon’s movements from the console, and the high definition stereoscopic image provided by the two-eye viewing screen and the two lens endoscopic camera. The jointed wrist design of the robotic arms provides increased dexterity not possible with the human hand. The da Vinci’s ability to filter and scale the surgeon’s hand movements from the controllers enhances the precision to perform complex, delicate procedures and allows the surgeon to operate in a much more graceful manner. The two-eye viewing screen and the two lens endoscopic camera provides the surgeon with a stereoscopic high definition view of the procedure and it provides a much better view of the surgery when compared to the image of the monitor used for a typical laparoscopic surgery.
Although these advantages come from the ergonomic design and the technology of the da Vinci surgical system, the question remains: do they translate into more successful and efficient cancer surgical procedures?
One of the most amazing advancements is cancer surgery has come in the form of a robotic assisted surgery. Robotic assisted surgery was developed to overcome the limitations from minimally invasive surgery. Minimally invasive surgery, known as laparoscopic or keyhole surgery, is a modern surgical technique that is performed by making several small incisions (less than ½ inch) in the abdominal and pelvic regions. By inserting a small camera and tiny surgical instruments into these incisions, the surgeon performs the surgery while watching detailed images on a monitor . Laparoscopic surgery is an effective surgical technique and is mainly used for operations within the abdominal and pelvic regions as well as on the thoracic and chest cavities. This procedure is typically used to treat cancers of the abdominal and pelvic regions including prostate, colon, kidney and ovarian cancers as well as other cancers including throat and esophageal cancers.
Although traditional laparoscopic surgery is a very safe and successful surgical procedure, robotic assisted surgery was developed to improve this technique further. The most known robotic surgical system, and the only one available in Canada, is called the da Vinci Surgical system. The da Vinci Surgical system, owned and designed by Intuitive Surgical, consists of a surgeon’s console (remote control) and a patient side cart (the robot). The surgeon’s console consists of two hand controllers, two foot pedals, and a two-eye viewing screen. The side cart consists of 4 robotic arms, 3 for surgical tools, and 1 for a two lens endoscopic camera.
The surgical procedure using the da Vinci Surgical system is similar to a typical laparoscopic surgery except for one major difference. Unlike a typical laparoscopic surgery where the surgeon operates while standing over the patient, the da Vinci surgical system allows the surgeon to operate by controlling the robotic arms remotely from the console. While seated at the console, normally located in the same room as the patient, the surgeon uses the console’s controllers to manipulate the patients-side carts three or four robotic arms, while looking through the two-eye viewing screen.
The ergonomic design of the da Vinci allows the surgeon to perform the surgery in a much more comfortable manner compared to a typical laparoscopic surgery. The surgeon sits at the console and operates the robotic arms remotely, which come into contact with the patient, while directly viewing the procedure with his/her head rested on the two-eye viewing screen. Instead of standing over the patient using surgical tools while viewing the procedure on a monitor, the da Vinci’s design is seen to reduce fatigue and physical strain on the surgeon.
The design of the da Vinci also has a number of other advantages. This includes the jointed wrist design of the robotic arms, the da Vinci’s ability to translate, filter and scale the surgeon’s movements from the console, and the high definition stereoscopic image provided by the two-eye viewing screen and the two lens endoscopic camera. The jointed wrist design of the robotic arms provides increased dexterity not possible with the human hand. The da Vinci’s ability to filter and scale the surgeon’s hand movements from the controllers enhances the precision to perform complex, delicate procedures and allows the surgeon to operate in a much more graceful manner. The two-eye viewing screen and the two lens endoscopic camera provides the surgeon with a stereoscopic high definition view of the procedure and it provides a much better view of the surgery when compared to the image of the monitor used for a typical laparoscopic surgery.
Although these advantages come from the ergonomic design and the technology of the da Vinci surgical system, the question remains: do they translate into more successful and efficient cancer surgical procedures?
Tuesday, March 8, 2011
The Use of Robotics is Cancer Treatment
There is no doubt that global cancer incidence rates are on the rise. It is estimated that 45% of males and 40% of females in Canada are likely to develop cancer in their lifetime. Here in Ontario, cancer rates have steadily increased since 1996 including here in the Champlain LHIN region . Whether this is primarily a case of an aging population or due to environmental factors related to the food we eat, the water we drink and the air we breath (probably a combination of both), cancer is a growing phenomenon. There is even growing concern, some of it warranted, that cancer incident rates are increasing in younger Canadians – outside of melanoma (skin cancer).
The causes of cancer continue to be hotly debated as the science remains unclear surrounding many of its potential causes and, as a consequence, is creating policy concerns, public confusion and fear. Although this paints a rather bleak but, accurate picture, there is a bright light in the war against cancer – treatment. Cancer treatment has vastly improved over the last number of decades. The odds of surviving many cancers has never been better as cancer treatments such as chemotherapy, radiation therapy and surgery have improved. There have also been several additions to cancer treatment in the areas of complimentary and alternative therapies. But one of the most intriguing advancements in cancer treatment has come in surgery. Over the last number of years, the use of robotic assisted surgery has become more commonplace for the treatment of several types of cancer. The following 4 blog entries will take a critical look at robotic assisted surgery - how it works; how it has contributed to the treatment of cancer; if it makes a difference as compared to more conventional surgical techniques; if the hype surrounding this type of surgery is worth the economic price we pay for the technology; and where in Canada provides access to robotic assisted surgery.
The causes of cancer continue to be hotly debated as the science remains unclear surrounding many of its potential causes and, as a consequence, is creating policy concerns, public confusion and fear. Although this paints a rather bleak but, accurate picture, there is a bright light in the war against cancer – treatment. Cancer treatment has vastly improved over the last number of decades. The odds of surviving many cancers has never been better as cancer treatments such as chemotherapy, radiation therapy and surgery have improved. There have also been several additions to cancer treatment in the areas of complimentary and alternative therapies. But one of the most intriguing advancements in cancer treatment has come in surgery. Over the last number of years, the use of robotic assisted surgery has become more commonplace for the treatment of several types of cancer. The following 4 blog entries will take a critical look at robotic assisted surgery - how it works; how it has contributed to the treatment of cancer; if it makes a difference as compared to more conventional surgical techniques; if the hype surrounding this type of surgery is worth the economic price we pay for the technology; and where in Canada provides access to robotic assisted surgery.
Monday, July 19, 2010
Sunscreen, Cancer and You: Retinyl Palmitate (vitamin A) and Vitamin D Deficiency
Retinyl Palmitate (vitamin A)
A more recent ingredient being added to select sunscreens is retinyl palmitate. Retinyl palmitate is a form of vitamin A commonly used in cosmetic products to reduce wrinkles and fine lines by acting as an antioxidant that slows skin aging.
The problem with retinyl palmitate, according to the Environmental Working Group (EWG), is that there is scientific evidence that illustrates that this form of vitamin A, when applied to the skin in the presence of sunlight, may speed the development of skin tumors and, thus, skin cancer.
The evidence EWG refers to is a study conducted by the Federal Drug Administration (FDA) in 2009. This study is, however, under review and will not be completed until next year.
So should we avoid retinyl palmitate?
As the FDA is still reviewing the research concerning its safety, it might be vigilant to avoid retinyl palmitate in sunscreen until we know more about its possible consequences. This should not be hard to do. According to EWG’s analysis of sunscreens, only 44% of sunscreens sold on American shelves, and by extension Canadian shelves, contain this ingredient.
Vitamin D Deficiency and Sunscreen
Although, according to the latest survey by Statistics Canada, 90% of Canadians have more than adequate amount of vitamin D to provide optimal bone health, two-thirds of Canadians (67%) are below the recommended levels of vitamin D that is associated with a greater risk of breast cancer, colorectal cancer and adenomas.
One of the best sources of vitamin D is sun exposure. Given our lengthy Canadian winters and our culture of working/playing indoors, Canadians simply do not get enough sun exposure to benefit from its vitamin D source.
Sunscreen, as good as it may be at blocking harmful UV rays, also acts as a vitamin D barrier. So on one hand sunscreen may protect us from skin cancer, but on the other hand it may contribute to other cancer risks.
So what should we do?
Vitamin D deficiency is a comprehensive topic that requires some time to discuss. If you are concerned about vitamin D deficiency, please consult your general practitioner.
It terms of sun safety, even if sunscreen may impact our levels of vitamin D, sunscreen remains a strongly recommended secondary measure of sun protection. But remember, primary prevention remains staying in the shade, avoiding the sun during peak hours or remaining covered while outdoors.
Now lets go out and have some fun in the sun!
Environmental Working Group Sunscreen Guide
If you would like more information regarding sunscreen safety, please refer to the Environmental Working Groups Sunscreen Guide. The guide provides some useful quick tips as well as a comprehensive rating system of many available sunscreens. It also provides a search feature, which allows you to search for your sunscreen rating.
The Guide can be found here:
Sources of Information
Canadian Cancer Society. (March, 2010). Sunscreen and cancer. Accessed on June 18th,
2010 at http://bit.ly/dqgNog
Environmental Working Group. (2010). EWG’s 2010 sunscreen guide. Accessed on June
15th, 2010 at http://www.ewg.org/2010sunscreen/
Gavura, Scott. (June, 2010). The great sunscreen cover up. Science-Based Medicine.
Accessed on June 18th, 2010 at http://www.sciencebasedmedicine.org/?p=5541
Statistics Canada. (2009). Vitamin D status of Canadians as measured in the 2007 to
2009 Canadian Health Measures Survey. Accessed on June 30th, 2010 at http://bit.ly/aAkj2e
Tuesday, June 29, 2010
Mineral Based Sunscreens (Titanium Dioxide and Zinc Oxide)
The “burning” question regarding the ingredients: Mineral Based Sunscreens (Titanium Dioxide and Zinc Oxide)
With the lack of scientific evidence regarding the safety of the long-term use of chemical (non-mineral) based sunscreens that contain oxybenzone, mineral based sunscreens provide a great alternative.
Unlike chemical based sunscreens that absorb the harmful radiation from the sun, mineral based sunscreens contain active ingredients that block both UVA and UVB radiation. These ingredients include zinc oxide and titanium dioxide.
Sunscreens that contain these ingredients are seen to be much more efficient as their chemical counterparts. Sunscreens that use zinc oxide and titanium dioxide begin blocking the harmful UV radiation (UVA and UVB) the moment it is applied to the skin. They last longer than your conventional chemical based sunscreen and they are known to be less of a skin irritant especially to those who have sensitive skin, such as myself.
So are mineral based sunscreens better and safer than chemical based sunscreens?
Well, traditionally, mineral based sunscreens leave a lot to be desired in terms of their aesthetic qualities as compared to chemical based sunscreens. They tend to be greasier, whiter (opaque) in colour and do not blend into the skin leaving a white creamy residue.
It has been found that sunscreen aesthetics have a significant impact of whether they are used and applied properly. If the sunscreen is too greasy, too thick and does not blend into the skin, it is normally not used properly no matter how effective the ingredients of the sunscreen may be.
So, yes, mineral based sunscreens may be better and “safer” than chemical based sunscreens but they tend not to be used “properly” which poses a significant issue regarding sun protection and skin cancer prevention.
However, new formulations of mineral based sunscreens have been developed which provide more aesthetically pleasing characteristics. Technology has now allowed sunscreen makers to shrink the size of zinc oxide and titanium dioxide particles to the point where they have become virtually translucent. These “nanoparticles” have allowed mineral based sunscreens to become thinner, less greasy and have given them the ability to blend into the skin more much more effectively.
But, according to the Environmental Working Group (EWG) and a report released last year from Friends of the Earth, an international grassroots environmental network, the size of these particles may be a cause for concern.
It is believed that the smaller the particle, the more easily zinc oxide and titanium dioxide can be absorbed in the body and into the blood steam. It has been shown that when these chemicals are absorbed into the blood stream, they can pose significant harm.
Although this may be a cause for concern, according to EWG analysis, this has yet to be proven whether these nanoparticles are actually absorbed into our skin though sunscreen use.
So which type of sunscreen, those containing oxybenzone or those containing zinc oxide or titanium dioxide, are truly safer?
EWG states:
Although we expected to reach a different conclusion at the outset of our sunscreen investigation, when we balanced all factors important in sunscreen safety, our analysis shows that many zinc and titanium-based sunscreens are among the safest and most effective sunscreens on the market.
Simply, there seems to be more breadth in the research that suggests oxybenzone “may” be more harmful than zinc oxide and titanium dioxide nanopartciles. In time research may, or may not, suggest otherwise, but for now it seems mineral based sunscreens are more recommended.
However, we have to remember that sunscreen is a secondary measure of sun protection. We all know that the primary way to stay safe from the harmful effects of the sun is by staying in the shade, avoiding the sun during peak hours or remaining covered while outdoors.
Next up on Be “Sun” Savvy
• Issues regarding retinyl palmitate (vitamin a) in sunscreen, vitamin D defficieny and issues regarding sunscreen sprays
• Proper sunscreen etiquette and conclusions
Sources of Information
Canadian Cancer Society. (March, 2010). Sunscreen and cancer. Accessed on June 18th,
2010 at http://bit.ly/dqgNog
Environmental Working Group. (2010). EWG’s 2010 sunscreen guide. Accessed on June
15th, 2010 at http://www.ewg.org/2010sunscreen/
Friends of the Earth. (2009). Manufactured nanomaterials and sunscreens:
Top reasons for precaution. Accessed on May19th, 2010 at http://bit.ly/bWcUfK
Gavura, Scott. (June, 2010). The great sunscreen cover up. Science-Based Medicine.
Accessed on June 18th, 2010 at http://www.sciencebasedmedicine.org/?p=5541
With the lack of scientific evidence regarding the safety of the long-term use of chemical (non-mineral) based sunscreens that contain oxybenzone, mineral based sunscreens provide a great alternative.
Unlike chemical based sunscreens that absorb the harmful radiation from the sun, mineral based sunscreens contain active ingredients that block both UVA and UVB radiation. These ingredients include zinc oxide and titanium dioxide.
Sunscreens that contain these ingredients are seen to be much more efficient as their chemical counterparts. Sunscreens that use zinc oxide and titanium dioxide begin blocking the harmful UV radiation (UVA and UVB) the moment it is applied to the skin. They last longer than your conventional chemical based sunscreen and they are known to be less of a skin irritant especially to those who have sensitive skin, such as myself.
So are mineral based sunscreens better and safer than chemical based sunscreens?
Well, traditionally, mineral based sunscreens leave a lot to be desired in terms of their aesthetic qualities as compared to chemical based sunscreens. They tend to be greasier, whiter (opaque) in colour and do not blend into the skin leaving a white creamy residue.
It has been found that sunscreen aesthetics have a significant impact of whether they are used and applied properly. If the sunscreen is too greasy, too thick and does not blend into the skin, it is normally not used properly no matter how effective the ingredients of the sunscreen may be.
So, yes, mineral based sunscreens may be better and “safer” than chemical based sunscreens but they tend not to be used “properly” which poses a significant issue regarding sun protection and skin cancer prevention.
However, new formulations of mineral based sunscreens have been developed which provide more aesthetically pleasing characteristics. Technology has now allowed sunscreen makers to shrink the size of zinc oxide and titanium dioxide particles to the point where they have become virtually translucent. These “nanoparticles” have allowed mineral based sunscreens to become thinner, less greasy and have given them the ability to blend into the skin more much more effectively.
But, according to the Environmental Working Group (EWG) and a report released last year from Friends of the Earth, an international grassroots environmental network, the size of these particles may be a cause for concern.
It is believed that the smaller the particle, the more easily zinc oxide and titanium dioxide can be absorbed in the body and into the blood steam. It has been shown that when these chemicals are absorbed into the blood stream, they can pose significant harm.
Although this may be a cause for concern, according to EWG analysis, this has yet to be proven whether these nanoparticles are actually absorbed into our skin though sunscreen use.
So which type of sunscreen, those containing oxybenzone or those containing zinc oxide or titanium dioxide, are truly safer?
EWG states:
Although we expected to reach a different conclusion at the outset of our sunscreen investigation, when we balanced all factors important in sunscreen safety, our analysis shows that many zinc and titanium-based sunscreens are among the safest and most effective sunscreens on the market.
Simply, there seems to be more breadth in the research that suggests oxybenzone “may” be more harmful than zinc oxide and titanium dioxide nanopartciles. In time research may, or may not, suggest otherwise, but for now it seems mineral based sunscreens are more recommended.
However, we have to remember that sunscreen is a secondary measure of sun protection. We all know that the primary way to stay safe from the harmful effects of the sun is by staying in the shade, avoiding the sun during peak hours or remaining covered while outdoors.
Next up on Be “Sun” Savvy
• Issues regarding retinyl palmitate (vitamin a) in sunscreen, vitamin D defficieny and issues regarding sunscreen sprays
• Proper sunscreen etiquette and conclusions
Sources of Information
Canadian Cancer Society. (March, 2010). Sunscreen and cancer. Accessed on June 18th,
2010 at http://bit.ly/dqgNog
Environmental Working Group. (2010). EWG’s 2010 sunscreen guide. Accessed on June
15th, 2010 at http://www.ewg.org/2010sunscreen/
Friends of the Earth. (2009). Manufactured nanomaterials and sunscreens:
Top reasons for precaution. Accessed on May19th, 2010 at http://bit.ly/bWcUfK
Gavura, Scott. (June, 2010). The great sunscreen cover up. Science-Based Medicine.
Accessed on June 18th, 2010 at http://www.sciencebasedmedicine.org/?p=5541
Monday, June 28, 2010
The “burning” question regarding the ingredients: Oxybenzone
The “burning” question regarding the ingredients: Oxybenzone
Based on their ingredients, there are two different types of sunscreens available in Canada: mineral and non-mineral sunscreens.
Although not normally labeled as such, it is very easy to tell the differences between mineral and non-mineral sunscreens by simply by looking at the ingredients listed on sunscreen products.
Sunscreens that use a varying combination of chemicals to ‘absorb’ the UV radiation, such as oxybenzone and avobenzone are non-mineral sunscreens while sunscreen that contain minerals, such as titanium dioxide or zinc oxide, to “block” UV radiation are, you guessed it, mineral based sunscreens.
As you can see, these two types of ingredients provide UV protection in two different ways – one by absorption (chemical) and one by reflection (mineral).
Most of the criticisms regarding sunscreen composition are directed towards its chemical ingredients; the most problematic being Oxybenzone.
Properly known as 2-hydroxy-4-methoxybenzophenone or benzophenone-3, oxybenzone is one of the main ingredients in non-mineral sunscreens as it is relied upon to provide UVB protection, by absorbing UVB radiation, and UVA protection by acting as a chemical stabilizer for avobenzone, an effective but less chemically stable UVA agent.
Not only has oxybenzone been shown to be easily absorbed through the skin and into the blood stream from sunscreen application, it is also a known hormonal disruptor – a classification of chemicals that can mimic or disrupt the bodies natural production of hormones which may lead to several health consequences including some cancers (e.g. bisphenol-A and breast cancer). However, long-term low environmental exposure to oxybenzone has yet to be conclusively linked to any negative health effects.
We simply do not know if there are any long term health effects from exposure to oxybenzone from sunscreens especially in specific segments of the population including children and pregnant women who may be more vulnerable to hormonal disrupting chemicals.
Should we be concerned?
According to the precautionary principle, it may be prudent to avoid oxybenzone based on the lack of scientific evidence that it poses any long-term harm especially to those who may be more vulnerable to hormonal disrupting agents.
With that being said, we should not be paranoid either. Lack of evidence does not necessarily mean that oxybenzone poses any significant harm. For that reason, the Canadian Cancer Society states:
Like other Canadian and international organizations that make sure laws are enforced to protect health and the environment (regulatory agencies), the Society is not concerned at this time about oxybenzone in sunscreen. The research on oxybenzone is limited, and so far no animal or human studies suggest this chemical might cause cancer
(http://bit.ly/dqgNog)
Based on this information, it is up to you whether you want to use sunscreen that contains oxybenzone. There are alternatives available including mineral based sunscreens (zinc oxide and titanium dioxide) that you may want to use instead but, as we will see in the next blog entry, these types of sunscreens have their own issues.
We all know that the primary way to stay safe from the harmful effects of the sun is by staying in the shade, avoiding the sun during peak hours or remaining covered while outdoors.
Even though the long term of being exposed to the ingredients in sunscreen is still not known, it remains a great secondary measure of sun protection. If we are ever in a situation where the only available protection is from a chemical based sunscreen that contains oxybenzone, rationale says “use it”.
The science is clear what happens when you are exposed to the sun without protection.
Next up on Be “Sun” Savvy
• Issues regarding mineral based sunscreen
• Issues regarding retinyl palmitate (vitamin a) in sunscreen and issues regarding sunscreen sprays
• Proper sunscreen etiquette
• Conclusion
Sources of Information
Canadian Cancer Society. (March, 2010). Sunscreen and cancer. Accessed on June 18th,
2010 at http://bit.ly/dqgNog
Environmental Working Group. (2010). EWG’s 2010 sunscreen guide. Accessed on June
15th, 2010 at http://www.ewg.org/2010sunscreen/
Gavura, Scott. (June, 2010). The great sunscreen cover up. Science-Based Medicine.
Accessed on June 18th, 2010 at http://www.sciencebasedmedicine.org/?p=5541
Based on their ingredients, there are two different types of sunscreens available in Canada: mineral and non-mineral sunscreens.
Although not normally labeled as such, it is very easy to tell the differences between mineral and non-mineral sunscreens by simply by looking at the ingredients listed on sunscreen products.
Sunscreens that use a varying combination of chemicals to ‘absorb’ the UV radiation, such as oxybenzone and avobenzone are non-mineral sunscreens while sunscreen that contain minerals, such as titanium dioxide or zinc oxide, to “block” UV radiation are, you guessed it, mineral based sunscreens.
As you can see, these two types of ingredients provide UV protection in two different ways – one by absorption (chemical) and one by reflection (mineral).
Most of the criticisms regarding sunscreen composition are directed towards its chemical ingredients; the most problematic being Oxybenzone.
Properly known as 2-hydroxy-4-methoxybenzophenone or benzophenone-3, oxybenzone is one of the main ingredients in non-mineral sunscreens as it is relied upon to provide UVB protection, by absorbing UVB radiation, and UVA protection by acting as a chemical stabilizer for avobenzone, an effective but less chemically stable UVA agent.
Not only has oxybenzone been shown to be easily absorbed through the skin and into the blood stream from sunscreen application, it is also a known hormonal disruptor – a classification of chemicals that can mimic or disrupt the bodies natural production of hormones which may lead to several health consequences including some cancers (e.g. bisphenol-A and breast cancer). However, long-term low environmental exposure to oxybenzone has yet to be conclusively linked to any negative health effects.
We simply do not know if there are any long term health effects from exposure to oxybenzone from sunscreens especially in specific segments of the population including children and pregnant women who may be more vulnerable to hormonal disrupting chemicals.
Should we be concerned?
According to the precautionary principle, it may be prudent to avoid oxybenzone based on the lack of scientific evidence that it poses any long-term harm especially to those who may be more vulnerable to hormonal disrupting agents.
With that being said, we should not be paranoid either. Lack of evidence does not necessarily mean that oxybenzone poses any significant harm. For that reason, the Canadian Cancer Society states:
Like other Canadian and international organizations that make sure laws are enforced to protect health and the environment (regulatory agencies), the Society is not concerned at this time about oxybenzone in sunscreen. The research on oxybenzone is limited, and so far no animal or human studies suggest this chemical might cause cancer
(http://bit.ly/dqgNog)
Based on this information, it is up to you whether you want to use sunscreen that contains oxybenzone. There are alternatives available including mineral based sunscreens (zinc oxide and titanium dioxide) that you may want to use instead but, as we will see in the next blog entry, these types of sunscreens have their own issues.
We all know that the primary way to stay safe from the harmful effects of the sun is by staying in the shade, avoiding the sun during peak hours or remaining covered while outdoors.
Even though the long term of being exposed to the ingredients in sunscreen is still not known, it remains a great secondary measure of sun protection. If we are ever in a situation where the only available protection is from a chemical based sunscreen that contains oxybenzone, rationale says “use it”.
The science is clear what happens when you are exposed to the sun without protection.
Next up on Be “Sun” Savvy
• Issues regarding mineral based sunscreen
• Issues regarding retinyl palmitate (vitamin a) in sunscreen and issues regarding sunscreen sprays
• Proper sunscreen etiquette
• Conclusion
Sources of Information
Canadian Cancer Society. (March, 2010). Sunscreen and cancer. Accessed on June 18th,
2010 at http://bit.ly/dqgNog
Environmental Working Group. (2010). EWG’s 2010 sunscreen guide. Accessed on June
15th, 2010 at http://www.ewg.org/2010sunscreen/
Gavura, Scott. (June, 2010). The great sunscreen cover up. Science-Based Medicine.
Accessed on June 18th, 2010 at http://www.sciencebasedmedicine.org/?p=5541
Sun Screen, Cancer and You: Buyer be Ware
Sun Screen, Cancer and You: Buyer be Ware
Should sunscreen be used for primary protection from the sun’s harmful ultraviolet rays? Seems like a simple question doesn’t it?
Not necessarily.
Recently, The Environmental Working Group (www.ewg.org), a non-profit organization with the mission of using the power of public information to protect public health and the environment, came out with a very detailed report concerning sunscreen safety.
According to the report, many of the ingredients in sunscreen may be potentially hazardous as well as carcinogenic especially to those who do not apply sunscreen properly or are part of vulnerable segments of the population including children and pregnant women.
Now, before we become paranoid over the types of sunscreen we use, I would like to stress that research concerning sunscreen is far from conclusive. In fact, it is similar to the debate concerning cell phones and cancer. We simply don’t know the impact of many of the common ingredients in sunscreens.
But that does not mean we should not be precautionary and be aware of what these ingredients are and how they may be harmful. With that in mind, I have been asked to, next week (mid-week), provide you with a series of blog entries concerning sun screen safety so that you can become “sunscreen” smart and protect yourself and your family from not only skin cancer but from the other potential health risks associated with sunscreen.
So, before you go and throw out all the sunscreens you have that may, for instance, contain oxybenzone (one of the most common ingredients in sunscreen that may be harmful), or may be higher than SPF 50 (research suggests that SPF50+ may pose more harm than good)
Should sunscreen be used for primary protection from the sun’s harmful ultraviolet rays? Seems like a simple question doesn’t it?
Not necessarily.
Recently, The Environmental Working Group (www.ewg.org), a non-profit organization with the mission of using the power of public information to protect public health and the environment, came out with a very detailed report concerning sunscreen safety.
According to the report, many of the ingredients in sunscreen may be potentially hazardous as well as carcinogenic especially to those who do not apply sunscreen properly or are part of vulnerable segments of the population including children and pregnant women.
Now, before we become paranoid over the types of sunscreen we use, I would like to stress that research concerning sunscreen is far from conclusive. In fact, it is similar to the debate concerning cell phones and cancer. We simply don’t know the impact of many of the common ingredients in sunscreens.
But that does not mean we should not be precautionary and be aware of what these ingredients are and how they may be harmful. With that in mind, I have been asked to, next week (mid-week), provide you with a series of blog entries concerning sun screen safety so that you can become “sunscreen” smart and protect yourself and your family from not only skin cancer but from the other potential health risks associated with sunscreen.
So, before you go and throw out all the sunscreens you have that may, for instance, contain oxybenzone (one of the most common ingredients in sunscreen that may be harmful), or may be higher than SPF 50 (research suggests that SPF50+ may pose more harm than good)
Friday, June 18, 2010
Sun Screen, Cancer and You: Buyer be Ware
Sun Screen, Cancer and You: Buyer be Ware
Should sunscreen be used for primary protection from the sun’s harmful ultraviolet rays? Seems like a simple question doesn’t it?
Not necessarily.
Recently, The Environmental Working Group (www.ewg.org), a non-profit organization with the mission of using the power of public information to protect public health and the environment, came out with a very detailed report concerning sunscreen safety.
According to the report, many of the ingredients in sunscreen may be potentially hazardous as well as carcinogenic especially to those who do not apply sunscreen properly or are part of vulnerable segments of the population including children and pregnant women.
Now, before we become paranoid over the types of sunscreen we use, I would like to stress that research concerning sunscreen is far from conclusive. In fact, it is similar to the debate concerning cell phones and cancer. We simply don’t know the impact of many of the common ingredients in sunscreens.
But that does not mean we should not be precautionary and be aware of what these ingredients are and how they may be harmful. With that in mind, I have been asked to, next week (mid-week), provide you with a series of blog entries concerning sun screen safety so that you can become “sunscreen” smart and protect yourself and your family from not only skin cancer but from the other potential health risks associated with sunscreen.
So, before you go and throw out all the sunscreens you have that may, for instance, contain oxybenzone (one of the most common ingredients in sunscreen that may be harmful), or may be higher than SPF 50 (research suggests that SPF50+ may pose more harm than good), be sure you come back to the ORCF blog next week.
Should sunscreen be used for primary protection from the sun’s harmful ultraviolet rays? Seems like a simple question doesn’t it?
Not necessarily.
Recently, The Environmental Working Group (www.ewg.org), a non-profit organization with the mission of using the power of public information to protect public health and the environment, came out with a very detailed report concerning sunscreen safety.
According to the report, many of the ingredients in sunscreen may be potentially hazardous as well as carcinogenic especially to those who do not apply sunscreen properly or are part of vulnerable segments of the population including children and pregnant women.
Now, before we become paranoid over the types of sunscreen we use, I would like to stress that research concerning sunscreen is far from conclusive. In fact, it is similar to the debate concerning cell phones and cancer. We simply don’t know the impact of many of the common ingredients in sunscreens.
But that does not mean we should not be precautionary and be aware of what these ingredients are and how they may be harmful. With that in mind, I have been asked to, next week (mid-week), provide you with a series of blog entries concerning sun screen safety so that you can become “sunscreen” smart and protect yourself and your family from not only skin cancer but from the other potential health risks associated with sunscreen.
So, before you go and throw out all the sunscreens you have that may, for instance, contain oxybenzone (one of the most common ingredients in sunscreen that may be harmful), or may be higher than SPF 50 (research suggests that SPF50+ may pose more harm than good), be sure you come back to the ORCF blog next week.
Monday, May 17, 2010
Perfume Contains Secret Chemicals – Study Finds
On May 12th, 2010, the Ottawa Citizen published Perfume Contains Secret Chemicals – Study Finds. The article highlights a study, conducted by Toronto-based Environmental Defence and California’s Campaign for Safe Cosmetics, that illustrates that many brand name perfumes and colognes contain undisclosed chemicals not listed on the labels that are associated with hormone disruption and allergic reactions which may have some long term negative health affects including the onset of asthma, cancer and birth defects.
According to the article (http://bit.ly/aRYmgk), the study illustrates that out of the 17 fragrances tested, 91 ingredients were identified by laboratory tests or product labels. However, out of these ingredients 38 were found not be listed on the labels of these products with an average of 14 so-called “secret” chemicals per product.
However, other than illustrating that under Canadian cosmetic regulations (in effect since 2004) companies may lump intentional fragrance ingredients under the generic term "parfum” leaving many ingredients undisclosed, this article does not provide any useful information concerning how these chemicals may be harmful or which of the 17 products tested are available in Canada. This information would be useful for those who may be using these products.
According to the study, Not so Sexy: The Health Risk of Secret Chemicals in Fragrance (http://bit.ly/aRGpBn), only 4 of the 17 fragrances tested are available in Canada. They are:
• American Eagle Seventy Seven;
• Acqua Di Gio by Giorgio Armani;
• Light Blue by Dolce and Gabbana;
• and Quick Silver (for men)
Interestingly, these four products had some of the highest scores in terms of number of total chemicals, unlabeled “secret” chemicals, multiple sensitizing chemicals (chemicals known to trigger allergic reactions, such as asthma, wheezing, headaches and contact dermatitis) and multiple hormone disruptors (chemicals known for mimicking hormones which may impair basic body functions like tissue growth and repair which may increase the risk of some cancers).
The study states on page 2 of the report:
Acqua Di Gio contained the highest number of total chemicals and the highest number of sensitizing chemicals, and American Eagle Seventy Seven contained the highest number of secret chemicals. Quick Silver (for men) was tied with two others for the highest number hormone disrupting chemicals.
This study is quite concerning and provides a glance at how little is known about the many fragrant ingredients used in every day products including shampoos, lotions, bath products, cleaning sprays, air fresheners and laundry and dishwasher detergents. Some research (cited in the study) has shown that many of these ingredients commonly found in these products may cause allergic reactions, asthma cancer and birth defects. But, this research leaves a lot to be desired in proving the extent to which these ingredients may be harmful. Very little funding or research is dedicated towards studying how we react to multiple combinations of these ingredients.
There is also a lack of proper regulation to ensure that we know which ingredients may be questionable and which products contain these ingredients. This information should be provided without question so we can make rational choices in terms of which products we feel safe to use.
If I knew which ingredients were questionable and which products contained these ingredients, I would think twice before purchasing and using them. For example, I have been known to wear Light Blue by Dolce and Gabana. However, after reading this study, I am going to think twice before wearing this cologne.
According to the article (http://bit.ly/aRYmgk), the study illustrates that out of the 17 fragrances tested, 91 ingredients were identified by laboratory tests or product labels. However, out of these ingredients 38 were found not be listed on the labels of these products with an average of 14 so-called “secret” chemicals per product.
However, other than illustrating that under Canadian cosmetic regulations (in effect since 2004) companies may lump intentional fragrance ingredients under the generic term "parfum” leaving many ingredients undisclosed, this article does not provide any useful information concerning how these chemicals may be harmful or which of the 17 products tested are available in Canada. This information would be useful for those who may be using these products.
According to the study, Not so Sexy: The Health Risk of Secret Chemicals in Fragrance (http://bit.ly/aRGpBn), only 4 of the 17 fragrances tested are available in Canada. They are:
• American Eagle Seventy Seven;
• Acqua Di Gio by Giorgio Armani;
• Light Blue by Dolce and Gabbana;
• and Quick Silver (for men)
Interestingly, these four products had some of the highest scores in terms of number of total chemicals, unlabeled “secret” chemicals, multiple sensitizing chemicals (chemicals known to trigger allergic reactions, such as asthma, wheezing, headaches and contact dermatitis) and multiple hormone disruptors (chemicals known for mimicking hormones which may impair basic body functions like tissue growth and repair which may increase the risk of some cancers).
The study states on page 2 of the report:
Acqua Di Gio contained the highest number of total chemicals and the highest number of sensitizing chemicals, and American Eagle Seventy Seven contained the highest number of secret chemicals. Quick Silver (for men) was tied with two others for the highest number hormone disrupting chemicals.
This study is quite concerning and provides a glance at how little is known about the many fragrant ingredients used in every day products including shampoos, lotions, bath products, cleaning sprays, air fresheners and laundry and dishwasher detergents. Some research (cited in the study) has shown that many of these ingredients commonly found in these products may cause allergic reactions, asthma cancer and birth defects. But, this research leaves a lot to be desired in proving the extent to which these ingredients may be harmful. Very little funding or research is dedicated towards studying how we react to multiple combinations of these ingredients.
There is also a lack of proper regulation to ensure that we know which ingredients may be questionable and which products contain these ingredients. This information should be provided without question so we can make rational choices in terms of which products we feel safe to use.
If I knew which ingredients were questionable and which products contained these ingredients, I would think twice before purchasing and using them. For example, I have been known to wear Light Blue by Dolce and Gabana. However, after reading this study, I am going to think twice before wearing this cologne.
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