Can you tell from the labels on cosmetics whether the products contain ingredients that may be harmful?
In most cases, no, although a coalition of environmentalists known as the Campaign for Safe Cosmetics (safecosmetics.org) is trying to change this, with some success.
In 2005, one of the members of the campaign, the Washington-based Environmental Working Group, issued a report comparing ingredients in 7,500 personal care products against lists of known or suspected chemical health hazards.
It found that one in every 120 cosmetic items - including shampoos, lotions, makeup foundations and lip balms - contained known or probable carcinogens.
In January, the safe cosmetics campaign announced that more than 500 cosmetics and body care products companies have signed a pledge to replace potentially harmful ingredients with safer alternatives.
The companies include The Body Shop and Burt's Bees, "but the mainstream companies have not [signed the pledge], so we are disappointed by that," said Stacy Malkan, a campaign spokeswoman.
The Cosmetic, Toiletry and Fragrance Association, the industry's trade group, said that "thousands of scientific studies have been done on cosmetics and their ingredients" and that the industry determines the products "are safe before they are sold to consumers."
California recently enacted a law requiring manufacturers selling cosmetics in that state to disclose to the state Department of Health Services a list of any products containing chemicals identified as potentially causing health problems, according to the environmental working group. Other states are considering similar actions. Government oversight of the cosmetics industry is minimal.
The U.S. Food and Drug Administration is not authorized to approve cosmetics before they go on the market, although some products that consumers think of as cosmetics - such as sunscreen and anti-dandruff shampoo - are actually classified as over-the-counter drugs and hence must get FDA approval. In 2005, the agency said it was setting cosmetic safety as a top priority, but it has taken limited action since then.
How important is it to shop around when looking for a breast cancer surgeon?
Nobody knows - yet - whether a woman's chances of survival will be better if she takes the time to pick a breast surgeon carefully.
But a new study of nearly 2,000 patients, published in January in the Journal of Clinical Oncology, shows that women who choose a surgeon carefully - as opposed to merely accepting a referral from their health plans - were more likely to be treated by a surgeon who does a high volume of breast surgeries.
They're also more likely to be cared for in a hospital with a comprehensive cancer program approved by the American College of Surgeons or a National Cancer Institute-designated cancer center.
Many women, especially if they are poorer or less educated, simply see whichever surgeon their plan suggests, regardless of whether that surgeon specializes in breast surgery or does a bit of everything, said Dr. Steven Katz, the study's lead author and a professor of medicine and health management and policy at the University of Michigan.
"We found that women who were involved in the selection of a surgeon were more likely to see an experienced surgeon in a more comprehensive center," Katz said.
In general, the more a surgeon specializes, the better the outcome. Dr. Michele Gadd, a breast cancer surgeon at Massachusetts General Hospital, used to perform different kinds of surgery but concluded she "could only do one well" and now exclusively does breast surgery.
She suggested that women looking for a breast cancer surgeon ask whether the doctor specializes in breast surgery and how many mastectomies (removal of the whole breast) the surgeon does in a month. Ideally, the answer is five or more, and 15 or so lumpectomies (removal of the tumor itself) per month.
In addition, she suggested that women ask the surgeon about recurrence rates and "skin-sparing" mastectomies (in which the breast is removed, but the skin is saved for a better cosmetic result). They should also inquire about nipple-sparing procedures, "sentinel node" biopsies (in which just one or a few lymph nodes are removed, not all the nodes in the armpit) and "neo-adjuvant therapy," in which a woman gets chemotherapy before surgery.
As for whether choosing a surgeon carefully improves outcomes, Katz said his team is about to study that.
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