epidemiologist Carmen Rodriguez, MD.Rodriguez is the lead author of an ACS

Cancer Prevention II study of over 600,000women published in Lancet (1998;352:1354-1355) that found a similar reduction of theovarian cancer mortality rate in women whotook daily doses of acetaminophen, and foundno association between the ovarian cancermortality rate and aspirin use.

Other studies support just the oppositeconclusion, however. Their findings suggestthat aspirin, but not acetaminophen, canprotect women against ovarian cancer.

“As a group, these studies, including mine,that do show a decreased risk with the use ofacetaminophen did not have a consistent doseresponse, and that is always a requirement,” saysRodriguez. “You need a proven, reproducibletemporal relationship and a biologicalmechanism.”

So for now, there is lack of agreement as towhether acetaminophen lowers ovarian cancerrisk.And no agreement has been reached as tohow much is needed, and how it might workif it is indeed effective as an ovarian cancerchemopreventive agent.

Further Studies Needed

The Roswell Park researchers agree thatstudy results have been inconsistent. Regardinga possible mechanism, some investigators havesuggested that acetaminophen may haveantigonadotropic activity. This hypothesis issupported by at least one study reportingreduced gonadotropin and estrogen levels inwomen who were regular acetaminophenusers.Whether this is the mechanism by whichacetaminophen may reduce ovarian cancer riskis still uncertain.

“Clearly, future research is needed to furtherexplore this association,” the researchers write.“Laboratory investigations should beconducted to further define the biologicalmechanism by which acetaminophen mightinfluence cancer risk.”

“The main message is that we really don’t

know enough to recommend this for ovariancancer chemoprevention,” says Rodriguez.“It’san interesting finding that has already beenseen in two other studies, but there’s still nounderstanding of how it works. Becauseacetaminophen is a nonprescription drug,many patients assume that it is completely safe.However, regular acetaminophen use, oroveruse, can cause hepatotoxicity, especially inindividuals with pre-existing liver disordersand those exposed to other hepatotoxins.”

TOBACCO ADS STILL AIMED AT KIDS; EXPERTS

ADVISE STRONGER PROTECTIONS

Kids are still being targeted by cigarettecompany ads in spite of a 1998 court-approvedagreement the companies signed to end thepractice, says a report in the New EnglandJournal of Medicine (2001;345:504-511).

The concession, made by tobacco companiesas part of a Master Settlement Agreement of 46states’ lawsuits against them, called for thecompanies not to “take any action, directly orindirectly, to target youth…” in their advertisingor marketing, the researchers point out.

“But ‘targeting’ isn’t defined in theagreement, and the companies still are findingways to reach kids with the message to smoke,”says lead study researcher Michael Siegel, MD,MPH, associate professor at BostonUniversity’s School of Public Health.

Cigarette Ad Spending Goes Up One Year

After Agreement

The study found that cigarette ad dollarsspent in youth magazines actually increased inthe year following the settlement—from $219million in 1998 to $291 million in 1999. In2000 cigarette ad spending dropped to $216million—a drop of less than two percent from1998 levels.

“And we found that cigarette brands that arepopular among youth smokers are more likelyto advertise in magazines that have higherlevels of youth readership,” Siegel adds.

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“If they weren’t trying to reach kids, youwouldn’t expect to find that the specific brandsthat are popular among youth are preciselythose brands that are advertising most heavilyin those magazines read by large numbers ofkids; it just doesn’t make sense,” notes Siegel.

Philip Morris Agreement’s Impact Is Less

Than Expected

One company, Philip Morris, promised inthe 1998 agreement that starting in September2000, it would advertise only in magazineswith less than 15 percent of readers betweenages 12 and 17 and fewer than 2 millionreaders.

But even if other tobacco companiesfollowed the example of Philip Morris, itwouldn’t stop cigarette ads from reaching kids,researchers found, because over half thenation’s youth are still getting the message that“smoking is cool” from other ad placements.

“Even if Marlboro [a Philip Morris product]hadn’t put any ads at all in youth-orientedmagazines in the year 2000, they still wouldhave reached 57 percent of the nation’s youththat year just through ads in adult magazines,”notes Siegel.

The data shows that on average, 82 percentof the kids in the US were exposed tomagazine ads for youth cigarette brands (brandsthat are popular among young smokers) in theyear 2000.

“There was kind of a perception out thereamong the public that the Philip Morris policywas going to substantially reduce youthexposure to cigarette ads in magazines, and ourstudy suggests that this simply is not the case,”emphasizes Siegel.

Unfortunately, states Siegel, research has alsoshown that ads enticing kids to smoke are veryeffective, regardless of where they appear.

Experts Call for Stronger Protections

In an accompanying editorial that appearedin the journal, two prominent tobacco-controladvocates pointed out that as the tobacco

companies reduced magazine ad spending, theamount they spent on store displays, discountpromotions on brands popular with kids, andfree gifts appealing to young people“skyrocketed,” resulting in kids still beingbombarded with tobacco company ads.

The editorialists—Yale University School ofMedicine’s dean and former US Food andDrug Administration (FDA) head David A.Kessler, MD, and the National Center forTobacco-Free Kids’ president Matthew L.Myers, JD, agree with Siegel that with tobaccoads still enticing kids to smoke after the 1998Agreement, stronger action—including placingtobacco products under control of the FDA—makes sense. The American Cancer Society(ACS) agrees.

“The tobacco companies continue to try tohook new generations of customers on theiraddictive and lethal products because they needto do that for the very survival of theirindustry,” says Dileep G. Bal, MD, MS, MPH,President of the ACS.

“By ostensibly targeting adults (especiallyvulnerable 18 to 24 year olds), tobaccocompanies know that kids will get the messagethat it is cool and sophisticated to smoke andso they do,” Bal says.“It is a known advertisingfact that kids “aspire up” and this is usedingeniously by the Tobacco Industry in theirMadison Avenue blitz. More than 80 percent ofadult smokers began smoking at 18 or younger,according to the Centers for Disease Controland Prevention (CDC).”

“As a vital part of its mission to reducesuffering and death from cancer, the ACSstrongly advocates a wide range of actions toreduce tobacco’s impact on public health,” Balemphasizes.

Those actions entail not only effectiverestrictions on tobacco-marketing practicesdirected toward kids, notes Bal, but also includesupport for:

• Strong regulation of tobacco by the FDA;• Effective clean indoor air laws and

restrictions on smoking in public places; and

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• Congressional passage of the newly-introduced Medicare, Medicaid, Maternal andChild Health (MCH) Smoking Cessation Actto expand Medicare and Medicaid coverage forsmoking-cessation materials and services.

OBESITY AND INACTIVITY INCREASE RISK OF

PANCREATIC CANCER

Obesity may increase the risk of pancreaticcancer, according to a report in JAMA(2001;286:921-929). But for those who areoverweight, moderate physical activity of atleast 90 minutes each week could reduce thatrisk considerably, the study authors report.

Pancreatic cancer is the fifth leading cause ofcancer-related deaths in the US.Although it iswell known that cigarette smoking increasesthe risk of pancreatic cancer, less is knownabout other modifiable risk factors.

Dominique Michaud, ScD, of the NationalCancer Institute, and colleagues analyzed datafrom two large ongoing cohort studies to seeto what degree a person’s body mass index andphysical activity level might influence the riskof pancreatic cancer.

One of the studies, the Health ProfessionalsFollow-up Study (started in 1986), includedmore than 46,000 male health professionalsages 40 to 75 years old.The second study, theNurses’ Health Study (started in 1976),included about 117,000 female nurses ages 30to 55.

Weight Loss, Physical Activity May Help Decrease

Pancreatic Cancer Risk

After following the two cohorts for a 10-to-20 year period, investigators found 350 newcases of pancreatic cancer. Michaud and hercolleagues determined that obese individualswere 72 percent more likely to be diagnosedwith pancreatic cancer than those who wereneither obese nor overweight. However,overweight and obese people who exercised

moderately by regularly engaging in sustainedactivity, such as hiking or walking, were muchless likely to develop pancreatic cancercompared with inactive people.

Obese and overweight individuals withinthe highest third of physical activity had a 41percent lower risk of developing pancreaticcancer than individuals in the bottom third. Incontrast, physical activity had no significantimpact on pancreatic cancer risk for leanindividuals, other than the potential valueexercise has in maintaining a healthy bodyweight.

“Losing weight should be a priority forpeople who are obese—to reduce their risk ofpancreatic cancer, as well as other importantdiseases,” Michaud says. “In addition, engagingin moderate exercise may also help to lowerthe risk of pancreatic cancer amongoverweight and obese individuals.”

High Insulin Levels May Be the Cause

Why obesity, physical inactivity, andpancreatic cancer are linked is still unclear,according to Michaud, but she speculates thatabnormal glucose metabolism and high insulinlevels may play a role in the development ofpancreatic cancer.

In an editorial in the same journal Susan M.Gapstur, PhD, and Peter Gann, MD, ofNorthwestern University Medical School, notethat cigarette smoking causes about 25 percentof all cases of pancreatic cancer.They estimatethat obesity and inactivity could account for anadditional 15 percent of cases.

According to Michael Thun, MD, VicePresident of Epidemiology and Surveillance forthe American Cancer Society, “Eliminating 40percent of the estimated 28,900 deaths causedby pancreatic cancer would save 11,560 liveseach year. And, eliminating these risk factorswould have an even greater impact on severalother cancers as well as on cardiovasculardisease.”

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