Personal care products can help us look, smell, and feel good, but what’s in them—and how they affect our health—is not so obvious. While regulated, many of these products contain carcinogens and other ingredients harmful to human health. Knowing what to avoid can help you reduce your risk for cancer and other health problems.

Emanuela Taioli, MD, PhD

“I read beauty product labels the same way I read food labels,” says Emanuela Taioli, MD, PhD, Associate Director for Population Science and a Co-Leader of the Cancer Prevention and Control Program at The Tisch Cancer Institute at Mount Sinai. “Just like I want to make sure I’m not eating too much sugar when buying a food product, I want to make sure I’m not exposing myself to something potentially dangerous when using products in my skin and hair.”

In this Q&A, Dr. Taioli, who is also the Director of the Institute for Translational Epidemiology and the Center for the Study of Thoracic Diseases Outcomes at Mount Sinai, explains why it’s important to read product labels and what to look for.

Do some personal care products pose a cancer risk?
Many personal care products contain chemicals that pose a cancer risk. Check labels on hair products, cosmetics, deodorants, skin creams, and sunscreens, etc., for potential carcinogens—especially shampoos and conditioners, hair extensions, and hair relaxants. These products can contain formaldehyde, a known carcinogen, and other potentially harmful ingredients, which can become even more dangerous when hair is heated.

What should I look for and avoid in product labels?
Products labels don’t tell you whether a product contains carcinogens. For example, just because a product label says “fragrance-free,” “natural,” or “organic,” does not necessarily mean a product does not contain chemicals that can increase your risk for cancer and other health issues.

For example, hormonal ingredients are natural but can interfere with your natural hormone system and pose health risks, including cancer. Hormones are added to some  personal care products, from shampoos to anti-aging creams and cosmetics. Some products contain placental ingredients, which are loaded with hormones. Skin bleaching products contain estrogen-like compounds.

If you want to know if a product is potentially harmful, you need to look at the ingredients.

What common ingredients should I avoid due to potential cancer risk?
These products can contain definite and probable carcinogens. Some of the most common ones include, but are not limited to:

Definite carcinogens:

• Formaldehyde
• Coal tar
• Benzene
• Asbestos
• 1,4-Dioxane
• Arsenic
• Crystalline silica
• Ethylene oxide
• Cadmium compounds
• Polycyclic aromatic hydrocarbons (PAHs)

Probable carcinogens:

• Phthalates (e.g., DEP, DBP)
• Nitrosamines
• Talc
• Titanium dioxide (inhalable form)
• BHA (butylated hydroxyanisole)

If hormonal ingredients are natural, why are they considered unsafe?
Certain cancers, like prostate and breast cancer, are very sensitive to hormones. Treating your skin or hair with hormones may feed a cancer that is in an initial stage and promote the growth of that cancer. If these products are used on children, they can trigger early puberty.

Any ingredient that starts with “estra,” like estradiol, for example, is a hormone derivate. Ingredients known as “endocrine disrupters” are not hormones but mimic them. Examples include parabens, phthalates (e.g., DEP, DBP), triclosan, resorcinol, and BHA/BHT.

Why does heating my hair increase my cancer risk?
Let’s say you put a product containing formaldehyde or other carcinogen in your hair and then straighten it with a flat iron—you are treating the chemicals at a very high temperature, and that creates a chemical reaction, which you can breathe in. If you do this only once, it’s unlikely to be harmful. But if you do it on a regular basis, you are increasing your risk. Hair dryers emit less heat, and don’t have direct contact with hair, so are less risky than flat irons and curling irons.

Are there any reliable resources that will tell me what ingredients or products are unsafe?
The California Safe Cosmetics Database (on the California Department of Public Health website) and the EWG Skin Deep® Cosmetics Database both contain lists of ingredients you should avoid or treat with caution, and are great resources to bookmark and reference when you are shopping for these products.

You may have seen headlines recently about a link between CT (computed tomography) scans and cancer due to radiation exposure. CT scans project X-rays into the body to produce detailed images and are often necessary in situations where a medical diagnosis needs to be made quickly. While they are generally considered safe, multiple CT scans over time pose a small increase in cancer risk.

To keep you safe, radiologists take steps to reduce your exposure as much as possible.

Bradley Delman, MD, MS

In this Q&A, Bradley Delman, MD, MS, a neuroradiologist and Vice Chair of Quality at Mount Sinai, explains the benefits of CT scans and how radiologists work to reduce the risks.

What is a CT scan, and why is it important for diagnosing health conditions?
CT is a powerful tool that uses carefully focused beams of radiation to generate images inside the body. These scans enable doctors to see structures in three dimensions to diagnose a wide variety of conditions including strokes, bleeding, infections, tumors, and traumatic injuries. Sometimes dye is injected into the veins to improve visualization of blood vessels, tumors, and inflammation. These scans have become invaluable for emergency situations and presurgical planning.

Can CT scans increase my risk of developing cancer from radiation exposure?
CT machines do expose patients to ionizing radiation, which over time can damage DNA. Fortunately, DNA is believed to repair itself in most instances. DNA that does not get repaired can slightly increase your long-term risk for cancer. Cumulative exposure from multiple CT scans over time may cause DNA damage to accumulate, and that is also believed to increase cancer risk.

It’s important to note that we only scan when necessary and that we use the lowest radiation doses necessary for diagnosis. Scanners are getting even more efficient at this. Ultimately, we must compare the risks and the benefits, and it is more essential to diagnose and treat what is wrong with the patient now than to be concerned with the very low potential for cancer years into the future. Our scanners use low radiation doses overall, so the risk is thought to be justified by the value scans provide in patients’ care.

What are the safest alternatives to CT scans for medical imaging?
Low- or no-radiation alternatives to CT scans include X-rays, ultrasounds, and magnetic resonance imaging (MRIs). These do have their role and are used when they can provide comparable or superior information, but CT is fast and reliable, and has become an essential part of diagnosis, especially in the Emergency Department.

How does the number of CT scans I get affect my long-term cancer risk?
If you have many CT scans over a short period, the long-term risk for cancer is thought to be higher than with fewer scans, or with scans spaced apart. But again, we should be concerned about diagnosis and treatment of the ill patient. Scans are offered only when they offer clinical value.

How do radiologists minimize radiation dose from CT scans while ensuring accurate results?
Our responsibility is to keep doses as low as we can. To do that, we follow the “As Low As Reasonably Achievable,” or ALARA, principle:

• Using low-dose CT scan protocols
• Scanning only your necessary body parts
• Limiting the scan coverage to what is necessary
• Basing scan settings on your age, weight, and scan type
• Optimizing protocols from the companies that build our advanced CT scanners, which require less radiation than older models

How is my radiation exposure from multiple CT scans tracked to reduce long-term health risks?
Many hospital systems, including Mount Sinai, use digital imaging records and dose tracking systems to monitor patient exposures. We continually use radiation exposure data to refine and optimize our scanning protocols. This tracking does not mitigate radiation risks for individual patients, but it does create transparency for patients to understand their doses over time.

The U.S. Surgeon General recently released a report advising the public on the link between alcohol and cancer. According to the report, alcohol consumption increases your risk for at least seven types of cancer, including liver, colon, and breast cancer, and drinking is a leading preventable cause of cancer in the United States, contributing to almost 100,000 cancer cases a year.

Frances Lee, MD

“The advisory confirms what doctors have known for many years—alcohol causes cancer,” says Frances Lee, MD, Assistant Professor of Medicine (Liver Diseases), Icahn School of Medicine at Mount Sinai. “This advisory is not meant to cause shame or fear, but to empower the public. We all have the right to know the risks of our daily choices, and this advisory is a way for people to know the risks of alcohol use from a reliable source.”

In this Q&A, Dr. Lee discusses what you need to know about the relationship between alcohol and cancer, how to reduce your risk, and how to get help if you need it.

How does alcohol cause cancer?
Alcohol and its metabolites causes inflammation and damage to DNA, which is the pathway for cancer development. Additionally, when you drink alcohol, you increase the absorption of other carcinogens in your environment—for example, chemicals from cigarette smoke. Alcohol can also increase various hormones levels, such as estrogen, increasing breast cancer risk.

What types of cancer does alcohol increase my risk for?
In addition to breast cancer, alcohol increases your risk for various digestive cancers, including in the mouth, throat, esophagus, liver, and colon. Alcohol also causes chronic liver disease, and alcohol-related liver disease is also now the leading indication for liver transplant.

Is there any safe amount of alcohol that I can drink?
There is technically no safe amount of alcohol to drink; as the surgeon general advisory notes, increases in alcohol intake leads to stepwise increases in risk for developing cancer. However, we live in a society where social events are often centered on alcohol intake. For those without risks for developing chronic diseases or certain cancers, it may be reasonable to consume no more than one standard beverage a day for women and no more than two standard beverages a day for men. In the end, you have to weigh the risks and benefits of alcohol in the context of each person’s unique risk factors.

How can I reduce my risk for alcohol-related cancers?
The only way to completely reduce your risk is to not drink alcohol. That can be difficult, even for people who are not heavy drinkers, since alcohol is part of our culture. But reducing your intake by any amount will decrease your risk for developing alcohol-related cancers.

When should I see a doctor?
Alcohol can cause various chronic disease that go unnoticed. As a liver doctor, I’m most concerned about alcohol-related liver disease that goes undiagnosed until it’s too late. Whether you are a heavy or moderate drinker, I recommend getting a regular checkup with standard blood work. If there is a problem with your liver enzymes, it is important to see a liver doctor and work together to reduce alcohol intake to allow the liver to heal and regenerate.

Are there any medications that can help me stop drinking?
There are medications that are very safe, even for people with liver disease. These medications are evidence-based and well tolerated. These medications reduce cravings by targeting the central nervous system, which has altered reward signals after years of alcohol intake. To be sure, the treatment of alcohol use disorder includes therapy/behavioral interventions, along with medications.

You may have been hearing a lot lately about “forever chemicals,” or PFAS (per- and polyfluoroalkyl substances), so called for their ability to stay in the body and environment for years and resist breakdown.

In this Q&A, Shelley H. Liu, PhD, Associate Professor of Population Health Science and Policy at Mount Sinai, explains what these chemicals are, why they are linked to cancer, and how to reduce your exposure. An expert on PFAS, Dr. Liu researches the wide-ranging health impacts of these chemicals, including identifying disparities in exposure burden across populations.

Shelley H. Liu, PhD

What are forever chemicals?

PFAS are a big class of man-made chemicals that have been around for decades. They are very useful to industry due to their stain- and water-resistant properties. They are used in all kinds of products from consumer products (like nonstick pans, carpeting, and textiles), to food packaging and firefighting foam. Because these chemicals are so widely used, they can be detected in the blood of more than 98 percent of Americans, including people who have not been exposed through their jobs. Because we may be continually exposed at low amounts to PFAS through everyday living, our accumulated exposure over time (such as over decades) to PFAS and other synthetic chemicals is a growing concern for our health and wellbeing.

What is the link between forever chemicals and cancer?

There is a lot of great ongoing research around PFAS and cancer. While emerging findings show concern, there is still a lot we don’t know. For example, there has been some early work showing potential links between PFAS and different types of cancer in what scientists call a “dose-response relationship,” meaning that higher concentrations of PFAS chemicals in the blood are associated with a higher risk of liver cancer or kidney cancer. This means that even if you can’t absolutely remove your exposure to PFAS, doing your best to reduce exposure over time could still be quite helpful. There is also very new research that suggests PFAS might be linked to hormonally-driven cancers, such as breast cancer, depending on whether you’re female or male and also your race and ethnicity. These are early studies right now, and we don’t quite know yet what those links are.

What products are forever chemicals commonly found in?

We don’t know every product that PFAS are in, but we do know some of the major ones. These include products with nonstick and water-resistant properties, such as nonstick pans and nonstick coatings in food packaging, as they are used as grease-proofing agents in fast food wrappers and take-out paperboard containers, as well as stain-resistant fabrics on your couches and carpets. Diet can also be another exposure source. For example, fish, such as freshwater fish, can sometimes be contaminated with PFAS, and there are many communities in the United States, including in New York, that have contaminated public drinking water. This spring, the U.S. Environmental Protection Agency proposed the first-ever enforceable federal-level regulation of PFAS in public drinking water, although this has not finalized yet. Private wells can also be contaminated with PFAS, and are not part of federal-level regulations. Unfortunately, PFAS are a pervasive problem because they are very stable molecules and resist degradation. Some PFAS can be eliminated fairly quickly from the human body, but others can remain for years (for example, three to five years), and they can accumulate in your organs, such as the liver. In the environment, PFAS can also be transported great distances by weather patterns and groundwater, and eventually make their way into public drinking water and food sources.

Who is most at risk?

Scientists are still researching which groups are at higher risk of exposure to PFAS and/or more vulnerable in terms of health impacts. We know that some people are highly exposed to PFAS through their occupation—for example, firefighters have high exposure to PFAS chemicals because PFAS are a major component of firefighting foam. When we think about non-occupational types of exposures, our research has shown that Asian Americans have a higher exposure burden to PFAS than other race/ethnicities, and we are researching why. It may be a combination of diet, consumer product use and immigration history, as PFAS are used and regulated and disposed of differently in other countries. The other way to think about who is at higher risk is to look at groups who already have poorer health or chronic conditions, and understand whether higher PFAS exposure may worsen their disease progression compared to people with a similar disease stage but with lower PFAS exposure. Perhaps their threshold of tolerance to cumulative PFAS exposure could be diminished. These are all ongoing and important research questions.

What are a few specific ways to reduce my exposure to PFAS?

A few ways to reduce your exposure include lowering your PFAS exposure through diet, using stainless steel cookware instead of nonstick when possible, replacing old nonstick cookware that contain coatings that may have worn off over time, and reducing use of paper and paperboard takeout containers. For babies and young children, carpeting may also be an exposure source. Some newer carpets are not treated with PFAS, so consider replacing old carpets with new ones. If your drinking water comes from private wells, it could be helpful to get your water tested for PFAS, and if you discover high PFAS contamination, consider using water filters, installing a reverse osmosis filtration system, which purifies water, or drinking bottled purified water (which is made with reverse osmosis filtration). In general, using water filters is helpful for PFAS and other contaminants, even if you have a public water supply. While it’s hard to eliminate PFAS exposure completely, it can be quite helpful in the long term if you can reduce your exposure. It would be helpful for our governments to regulate PFAS, and while there is some progress on this front, much more work needs to be done.

Is there a way to rid my body of PFAS?

Unfortunately, there are not many ways for your body to expel PFAS. They are extremely stable molecules, which is why they can remain in your body for years. As such, PFAS levels are often higher in older adults because they accumulate over one’s lifetime. However, menstruation, breastfeeding, and childbirth have been shown to be ways that PFAS are expelled from the body, though research shows that mothers can pass them to their babies. That said, there is no way to totally avoid exposure. You can even find PFAS in the Arctic because they get transported everywhere and persist in the environment. Further, PFAS are not the only concern. Over the last few decades, society has exponentially increased the production of all kinds of synthetic chemicals, some of which can eventually make their way into the human body, and we don’t yet know what that means for human health going forward.