Watch: Prevent cancer with lifestyle changes

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What do tobacco, alcohol and obesity have in common? They can all increase your risk of developing cancer. Smoked tobacco is strongly linked to cancer in almost every part of the body.

"Smoked tobacco produces about 7,000 chemicals, and when you inhale those chemicals in your body, they cause alterations in cells. And it's those alterations in cells that can lead to cancer," says Dr. Ebbert.

He says smoking also weakens your immune system, making it harder to fight cancer cells. One of the best ways to lower your cancer risk is to not use any kind of tobacco.

"We always say it's never too late to stop smoking. And the risk for cancer after quitting cigarette smoking, for example, goes down. But it takes some time," says Dr. Ebbert.

Consuming alcohol increases your risk of breast, head and neck, esophageal, and colorectal cancers.

"At every level of alcohol consumption, there is cancer risk, but heavier drinkers have higher cancer risk than lighter drinkers," says Dr. Ebbert.

Finally, packing on extra pounds can increase your risk of cancer in several ways.

"Excess body weight increases estrogen and insulin, which can increase the rate of cellular division, which can increase the risk for cancer. But also, excess body weight is associated with inflammation, and inflammation is a known risk factor for the development of cancer," says Dr. Ebbert.

Bariatric surgery has been shown to decrease risk of hormone-related cancers such as breast, endometrial and prostate, as well as pancreatic and colorectal cancers. However, there are less drastic steps people can take.

"Small sustainable steps toward weight loss are the most effective when we think about diet and exercise. Those are the classic approaches, but also there are new medications on the market that can help people lose weight," says Dr. Ebbert.

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From the traditional cigarette to the modern electronic cigarette, from the communal hookah to the discreet pinch of smokeless tobacco, each has proven to be detrimental to a person's health. In this Mayo Clinic Minute, Dr. Jon Ebbert, medical director of the Mayo Clinic Nicotine Dependence Center, discusses why there is no "lesser evil" when it comes to tobacco use.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:10) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Smoked tobacco has the strongest association with cancer, and it goes beyond cigarettes.

"Hookah, which is a smoked and inhaled tobacco, has a similar cancer risk because it's the process of smoking and inhaling those 7,000 chemicals that increases the risk for cancer," says Dr. Ebbert.

There's no safe, or safer, way to consume tobacco. A common misconception is that cigars are less harmful than cigarettes.

"All the same risks that you get with cigars that you inhale are exactly the same risks you have with conventional cigarettes," says Dr. Ebbert.

He says even cigar users, who tend not to inhale, are still at risk.

"If you smoke a cigar and just hold it in your mouth and exhale, all the tissues in your mouth that are exposed to the cigar smoke have an increased risk for cancer," says Dr. Ebbert.

Head and neck cancers are more common in people who smoke cigars as well as those who use smokeless tobacco, which is also associated with pancreatic and kidney cancer.

"With electronic cigarettes specifically, we don't have enough longitudinal data to know whether those products are associated strongly with cancer," says Dr. Ebbert. "But we do know that those products result in the release of carbonyls and heavy metals. And those are known, theoretically, to lead to cancer."

No Tobacco Day is recognized this year on May 31 to inform the public of the dangers of using tobacco. All forms of tobacco consumption carry significant health risks and can lead to cancer.

"We always say it's never too late to stop smoking, and the risk for cancer after quitting cigarette smoking, for example, goes down. But it takes some time. So, if you think about reductions in cancer risk for lung cancer, in about 15 years, you have half the risk of cancer that you would if you had continued to smoke. So it takes some time, but it's never too late to stop smoking," says Dr. Ebbert.

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Thomas Bennett had tried to quit chewing tobacco 75 to 100 times before he came to Mayo Clinic. Even a precancerous lesion in his mouth hadn’t stopped him. Before every doctor’s appointment, “I’d throw my can of chew out, she would say I don’t have cancer, and then I would go get a can of chew again,” Thomas recalls. “That’s how strong my addiction was.”

It was in April 2021 that Thomas joined Mayo Clinic’s Intensive Tobacco Treatment Program, a five-day inpatient option in Rochester, Minnesota. Two-thirds of participants successfully quit — even though only 7.5% of American smokers manage to do so each year.

“This is the most intensive therapy you can get,” says Dr. Jon Ebbert medical director of the Mayo Clinic Nicotine Dependence Center. “Most of the time participants say, ‘This is my last hope,’” having tried every other treatment option. But Dr. Ebbert insists, “It’s not your last hope. Even if you relapse, you’ll be able to quit again because you’ll have all the skills — and all the pills — to be successful.” The methods are effective for cigarettes, smokeless tobacco or vaping (if adopted to replace other tobacco products).

Even when he arrived at Mayo Clinic, Thomas had his can of chew. Before check-in, “I was secretly chewing tobacco in a tobacco-free environment,” he laughs. Yet Thomas also was determined to invest in his health. “I just wanted to be locked away,” he says. “But Mayo’s approach is so different from anywhere else.”

The Intensive Tobacco Treatment Program was inspired in 1992 by a Mayo Clinic pilot study. For two weeks, researchers provided 24 smokers with inpatient care — group counseling, stress management, nicotine-replacement therapy. A year later, many remained tobacco-free. This inspired the Mayo Clinic team to launch a similar program, and it has proven remarkably effective. One study showed a success rate nearly double that of an outpatient option, even though the residential patients were heavier smokers.

For five days, participants immerse themselves in recovery. Each person receives a custom treatment plan, with medications and nicotine-replacement therapies targeted to their needs. “I don’t think there was one of us on the exact same program,” says Brian Fulford, a 2021 participant who successfully quit smoking after 30 years. “It was very tailored.”

For five days, participants immerse themselves in recovery. Each person receives a custom treatment plan, with medications and nicotine-replacement therapies targeted to their needs. “I don’t think there was one of us on the exact same program,” says Brian Fulford, a 2021 participant who successfully quit smoking after 30 years. “It was very tailored.”

A physician visits each participant daily, adjusting dosages to manage withdrawal or cravings.  The program also provides one-on-one counseling, group support and medical lectures. Topics include relapse prevention, mindfulness and the physiology of addiction. “You’ve got to get away from your life, manage depression and anxiety, learn about mindfulness, understand the pills. We bring all of that together,” says Dr. Ebbert.

Teresa, a Mayo Clinic nurse who smoked for nearly four decades, still relies on many of the strategies she learned during her five days. “Cigarettes were my best friend,” she says. “My new best friend is now crocheting.” Teresa picked up the hobby while in treatment, partly to occupy her hands. She also keeps nicotine gum and lozenges close by — strategically stashing them in her purse, car and around her house. It’s been a year since she’s had a cigarette.

Four individual follow-up sessions and ongoing medication management are included in the cost of the program. “It’s an intense five days where you’re extracting yourself from your daily routine, but it’s a long-term program,” says Dr. Ebbert. 

Virtual group follow-ups are also available, though many participants choose to stay connected on their own. For Brian, this camaraderie proved critical to his success. “I picture the faces of everyone — my co-patients and my counselors — and that provides me with an incredible amount of strength (not to smoke),” he says. His group still meets on Zoom every month. 

At the end of the program, participants are invited to write a goodbye letter to tobacco. “It was emotional,” recalls Thomas. “Tobacco had been such a part of my life.” But, nearly two years later, he hasn’t gone back to it. “This program 100% transformed the trajectory of my life.”

Sessions are scheduled regularly. Click here to enroll.

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Cigarette smoking remains the leading cause of preventable disease, disability and death in the U.S., accounting for more than 480,000 deaths every year, according to the Centers for Disease Control and Prevention.

Lung cancer claims more lives each year than colon, breast and prostate cancers combined. Although the disease can occur in people who have never smoked, people who smoke or have smoked have the greatest risk of lung cancer, as well as other cancers. 

The American Cancer Society will host the Great American Smokeout on Thursday, Nov. 17, when thousands of people across the country take charge of their health that day by quitting smoking.

Dr. J. Taylor Hays, director of the Mayo Clinic Nicotine Dependence Center, shares what treatments and tools work for people to quit smoking and the health risks if people continue to smoke. He also addressed vaping and provided some tips if you're looking to help someone quit.

Journalists who have already registered on the News Network can log into their accounts to download a recording of the Zoom briefing found at the end of this post.

Journalists who would like to access the media briefing video can register with the News Network here.

Related information:

• Mayo Clinic Minute: Why are menthol-flavored cigarettes a concern?

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For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorde

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ROCHESTER, Minn. — Social distancing guidelines have reduced the spread of COVID-19, but lockdowns and isolation also have created or aggravated other well-being concerns, reports new research. Mayo Clinic investigators found a significant increase in loneliness and a decrease in feelings of friendship during the pandemic. The study, published Feb. 20 in the journal Social Science & Medicine, also showed disproportionate negative effects among women and those with poorer health.

The researchers say that while physical distance is important during the pandemic, distance within and among relationships can cause undue harm to a person's mental health and well-being. The decision to close businesses and schools, and cancel social gatherings and events ― while effective at slowing the spread of disease ― can have unintended social, mental, financial and substance abuse issues.

"A conscious effort should be made to make meaningful social connection with others," says Jon Ebbert, M.D., a Mayo Clinic internal medicine physician and senior author of the study. "During times of social strain and stress, it is important to not only be helpful to one another, but also be present."

To measure changes during the pandemic, the researchers compared survey results from 1,996 patients who completed a questionnaire in February 2018 and again during the stay-at-home orders throughout much of the U.S. in May 2020. The questions were split into six areas of support: emotional, logistical (helping with daily tasks), friendship, loneliness, perceived rejection and perceived hostility.

Women reported higher levels of loneliness during the pandemic, compared to men. The researchers hypothesize that one contributing factor could be that women's employment was significantly more likely to have been affected by the COVID-19 pandemic, according to U.S. unemployment data.

"The workplace is often a place of social networking and support. Furthermore, as jobs transitioned from the workplace to the home setting, this could have further strained social connections for women," says lead author Lindsey Philpot, Ph.D., a health services researcher and epidemiologist in the Department of Medicine at Mayo Clinic.

The largest change was a decrease in friendships, followed by an increase in loneliness.

"Personal connection comes in many forms. We may be observing that during an infectious pandemic, women may suffer a greater burden of loneliness," Dr. Ebbert says. "All of us should remember to focus on friendships to remain resilient during significant changes in social structures."

It's not all bad news, though, as there was an increase in emotional and logistical support, and a decrease in perceived hostility, the team found. However, those who had poorer health to begin with said their emotional support decreased. The researchers did not observe any changes in perceived rejection.

"Individuals with more health problems may experience the greatest negative impact on emotional support during significant social change when these may be times they need it the most," Dr. Ebbert says.

The researchers say their findings are supported by the stress buffering hypothesis, which concludes that social relationships can be a buffer during stressful times.

"Prior to physical distancing directives, we benefited from passive social interaction ― interacting with fellow parents at basketball practice or PTA meetings, chatting with colleagues between meetings," Dr. Philpot says. "Physical distancing requires us to be more intentional about reaching out, connecting, and spending (virtual) time with others. So consider scheduling a virtual coffee date with a friend, joining or hosting an online trivia night, or picking up the phone and calling a family member or friend."

People in a lifetime relationship made up 77% of survey respondents. Of the respondents, 63% were women, 78% said they were in good or very good health, and the average age was 60.

Study co-authors ― all from Mayo Clinic ― are Priya Ramar; Daniel Roellinger; Barbara Barry, Ph.D.; and Pravesh Sharma, M.D.

The research was supported by Mayo Clinic Alix School of Medicine, and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Adam Harringa, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

Learn more about tracking COVID-19 and COVID-19 trends.

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EAU CLAIRE, Wis. — Before the COVID-19 pandemic, information about the dangers of vaping was emerging. To investigate the potentially serious health and respiratory implications of vaping, Mayo Clinic researchers wanted to better understand the factors influencing vaping in the community. They were ready to launch a survey of young adults in rural and urban areas when COVID-19 shifted the focus of this survey.

In a recent article in SAGE Open Medicine, the team of investigators report on vaping among adults ages 18–25 during the pandemic and their use of other common substances, such as alcohol, marijuana and tobacco. Inserting a timely additional survey question allowed the team to better understand the effects of compounding daily stresses with a public health crisis.

"As COVID-19 came on the scene, it was primarily thought to have severe respiratory implications," says Pravesh Sharma, M.D., a psychiatrist at Mayo Clinic Health System in Eau Claire, and the study's lead author. "Since we were about to launch a study examining the factors associated with vaping use, which can lead to lung injury, it made sense to revise our questionnaire slightly to address the broader question of the use of vaping and other common substances during a respiratory disease pandemic."

"We found shifts in substance use across the board," says Dr. Sharma. "Most concerning was a significant increase in alcohol use."

About the research

Dr. Sharma and his team developed a survey for patients who were seen for any reason in any outpatient setting at any Mayo Clinic location across the Midwest. The survey was emailed in April to 6,119 adults, ages 18–25 as of Jan. 24, who had been seen in the 4.2 months prior to the survey being sent. The survey came on the heels of state and local governments announcing stay-at-home orders and social distancing guidelines in March due to COVID-19.

The team's planned survey collected information on vaping attitudes and behaviors, as well as the types of vaping products used, including nicotine, marijuana extracts and oils, and other substances. The survey also asked respondents if any of their use had increased or decreased since the COVID-19 pandemic began.

"Substance use is highest in the young adult age group, so we wanted to target this population," says Dr. Sharma. "We would like to understand why they vape and what their attitudes were regarding the potentially harmful nature of vaping."

Of 1,018 respondents, more than half, or 542, reported vaping, or using marijuana, tobacco or alcohol, during the COVID-19 pandemic. Of the respondents, 269 self-reported having an anxiety disorder and 253 reported having depression. Of note, the authors write that study limitations are a reliance on self-reporting of these behaviors and disorders, as well as a 16.6% response rate.

Given that COVID-19 emerged as a primarily respiratory illness and vaping had been increasingly connected to lung damage, the team expected to see a reduction in vaping and smoking. The paper reports that 34.3%, or 186 people, reported a change in their use patterns due to COVID-19:

• Nearly 70% increased alcohol consumption.
• Vaping decreased in 44% of people, while 27.9% of people increased use.
• Tobacco product use decreased in 47.3% of people, while 24.1% of people increased use.
• Of the 140 people who described a change in marijuana use, 39.2% increased use and 36% decreased use.

Using a previously validated scale, the researchers also measured loneliness among the participants, and collected self-reported depression and anxiety information.

"We did see some reduction in inhaled substances, which could mean that young adults were reacting to the news coverage of COVID-19's respiratory effects," says Dr. Sharma.

"However, we saw that the more lonely, depressed or anxious these young people felt, the more likely they were to change their usage," he says. "They may be trying to cope with social and emotional strain by adding or replacing one substance with another, especially if their access to other support is limited."

"In this time of COVID-19, when we are focused on symptoms of infectious diseases, we need to remain vigilant about changes individuals experience with substance use," says Jon Ebbert, M.D., an internal medicine physician at Mayo Clinic in Rochester, Minn., and a study co-author.

"During the time of this pandemic, screening for substance use, loneliness, anxiety and depression is crucial," states Dr. Sharma. "Just asking, 'How are you holding up during this difficult time' goes a long way."

Drs. Sharma and Ebbert agree it is important for people to be aware of the effect of the pandemic on their well-being.

"As loneliness, anxiety and depression can potentially fuel increases in alcohol consumption during these times of social distancing, introspection with ourselves and observation of our social supports are critical for identifying and addressing substance use issues early," says Dr. Ebbert.

Dr. Sharma suggests checking in regularly with friends and family, inquiring about their well-being, and maintaining a connection. "Social distancing should not mean social isolation," he says.

He and fellow authors also highlight nontraditional socialization opportunities as essential during the continuing COVID-19 pandemic, especially for people with poor emotional health and loneliness.

The senior author of this study is Lindsey Philpot, Ph.D., director of Advanced Analytics and Practice Innovation, Mayo Clinic Department of Medicine. Jordan Rosedahl, a statistical program analyst at Mayo Clinic, also is a co-author.

The research was funded by the Office of Mayo Clinic Health System Research. Conducting research in the diverse communities served by Mayo Clinic in the Midwest allows Mayo to advance knowledge of rural health, a National Institutes of Health designated health disparity. The project also was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and Mayo Clinic's Survey Research Center.

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About Mayo Clinic Health System
Mayo Clinic Health System consists of clinics, hospitals and other facilities that serve the health care needs of people in more than 60 communities in Iowa, Minnesota and Wisconsin. The community-based providers, paired with the resources and expertise of Mayo Clinic, enable patients in the region to receive the highest-quality physical and virtual health care close to home.

Media contact:

• Elizabeth Zimmermann, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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Dr. Jon Ebbert and fellow researcher Alexandra Ward found a unique way to learn about the chemical makeup of vape solutions and determine if any are a safe alternative to smoking.

Jon Ebbert, M.D., is sympathetic to the plight of the patients he sees who are struggling with addiction. "I saw a lot of addiction growing up," he tells Rochester Magazine's Steve Lange. "I know the damage it can do."

Dr. Ebbert, a Community Internal Medicine physician and researcher in Mayo Clinic's Nicotine Dependence Center, also understands why it can be so hard for his patients to stop using tobacco despite the negative effects the drug has on their bodies. "I understand that life is complicated. I understand that what drives drug addiction is the innate desire that we all have to escape pain and discomfort. I understand that we all need coping mechanisms," he tells Rochester Magazine.

It's that compassionate, firsthand understanding that's driven Dr. Ebbert and fellow Mayo Clinic researcher Alexandra Ward to learn all they can about the chemical makeup of today's ever-increasing and ever-changing vape solutions. The two also work to discover what patients are inhaling when they use cannabidiol (CBD) and tetrahydrocannabinol (THC) for the treatment of medical conditions — in hopes of figuring out, once and for all, if any are safe to inhale. "Half a million people die in this country every year from cigarettes," he tells the magazine. "I'd love to find something safe to reduce that harm."

Read the rest of the article.
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This story originally appeared on the In the Loop blog.

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Watch: The Mayo Clinic News Network

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"There are lots of different chemical classes in the aerosol that we need to understand because, depending on exposure over time, they could lead to adverse health consequences," says Dr. Ebbert.

Right now, no one knows what's produced when e-cigarette juice is heated and aerosolized.

"You actually produce new chemical species in the aerosol that don't exist in the e-liquid because of the heating process. And what we need to understand is there's a lot of different products on the market, they're all operating at different temperatures, and those temperatures and the e-liquids in those substances result in potentially toxic exposures," says Dr. Ebbert.

These toxic ingredients may contribute to vaping-related illness.

"What we're trying to do in our lab is really focus on the aerosol because the aerosol is the risk," says Dr. Ebbert.

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Listen: Mayo Clinic Radio 8/3/19

On the Mayo Clinic Radio podcast, Dr. Jon Ebbert, associate director of the Mayo Clinic Nicotine Dependence Center, talks about smoking cessation, nicotine addiction and electronic cigarettes. Also on the podcast, John Konfala, a Mayo Clinic patient, shares his story. Konfala had an aortic valve replacement done by surgeon Dr. Juan Crestanello, at Ohio State University Hospital. When Konfala needed a second surgery, he followed Dr. Crestanello to his new location — Mayo Clinic. And Skip Sturtz, another Mayo Clinic patient, shares why he chose to become an altruistic kidney donor.

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Cigarette smoking has fallen to its lowest point in recorded history, according to the Centers for Disease Control and Prevention. But there’s a new problem at hand: electronic cigarettes. These battery-powered devices were introduced to the market to help smokers switch from traditional cigarettes. They work by heating a liquid into an aerosol that a user inhales. They are not an aid to quit smoking that has been approved by the Food and Drug Administration. Using e-cigarettes, also called vaping, has become increasingly popular among teens and young adults. 

Because e-cigarettes don't burn tobacco, most experts agree that they're likely to cause fewer harmful effects than traditional cigarettes. But some e-cigarettes may contain harmful substances, such as carcinogens; toxic chemicals; and THC, the psychoactive ingredient in marijuana. E-cigarettes containing nicotine aren't considered safe for children, young adults or pregnant women. Nicotine can harm brain development in children and adults into their early 20s, and it is toxic to developing fetuses. In youth and adult nonsmokers, e-cigarette use also poses the risk of a nicotine addiction, which could lead to long-term use of e-cigarettes — the effects of which aren't known — or the use of traditional cigarettes. 

On this Mayo Clinic Radio podcast, Dr. Jon Ebbert, associate director of the Mayo Clinic Nicotine Dependence Center, will talk about smoking cessation, nicotine addiction and e-cigarettes. Also on the program, John Konfala, a Mayo Clinic patient, will share his story. Konfala had an aortic valve replacement done by surgeon Dr. Juan Crestanello, at Ohio State University Hospital. When Konfala needed a second surgery, he followed Dr. Crestanello to his new location — Mayo Clinic. Skip Sturtz, another Mayo Clinic patient, will share why he chose to become an altruistic kidney donor.

Here's your Mayo Clinic Radio podcast.

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