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Questions for Dr. Kennedy
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Hair coloring and lymphoma
Posted by: Bob
Date: November 14, 2003 1:29 PM

I am concerned about the links between hair coloring and lymphoma. My father colored his hair (including his moustache) for about 20 years before he died at 79 from lymphoma. I am convinced that the coloring, especially of the moustache, was a factor in his death. Meanwhile, my wife has been coloring her hair (dark brown) for about 10 years. I am concerned for her, and I am concerned for myself. When we go to bed, we like to snuggle up together in each otherís arms. Inevitably, it means that my face is buried in her neck, against her hair. Also, my head is then on her pillow, which has been in contact with her hair. In addition, when we dance, or just hug together, my face inevitably comes into contact with her hair. Should I/we be concerned about this? Is there a danger to her, to me, or to both in this situation? I have discussed this with her, and I fear that she is too concerned with vanity and the need to conform with other women her age to stop the coloring. I do not look forward to an end to our intimacy if there is a danger and she doesnít want to give up the coloring. I am 66 years old and she is 64. Neither of us has a moustache.

RE: Hair coloring and lymphoma
Posted by: Ron Kennedy, M.D.
Date: November 14, 2003 2:56 PM

Of course, this question came to public awareness wit the death of Jacqueline Onassis Kennedy in 1994 from non-Hodgkins lymphoma. Jackie has been a long time user of dark brown hair dye.

Rather than give an opinion, which would be relatively worthless, let me reproduce a review of the matter from Mindspring.com and then try to put it all in perspective.

A report published in the February 2, 1994 issue of the Journal of the National Cancer Institute, showed that women who use permanent hair dyes do not have an overall increased risk of dying from cancer. However, women who used black hair dye for more than 20 years had a slightly increased risk of dying from non-Hodgkin's lymphoma and multiple myeloma. Less than 1 percent of women in this study reported that they had used permanent black hair dye for more than 20 years. This study, carried out by Michael J. Thun, M.D., and colleagues at the American Cancer Society (ACS) and the U.S. Food and Drug Administration, included information from 573,369 women enrolled in a cancer prevention study. At the beginning of the study in 1982, the women answered a questionnaire that included questions on use of permanent hair dye. The women were contacted periodically over the next seven years, and those who had died were identified and their causes of death recorded. The use of temporary, semi-permanent, or progressive hair dyes was not studied, and any women who began to use hair dyes after the initial questionnaire were not classified as hair dye users. This study of women may not apply to men because men tend to use hair dye products that differ chemically from women's hair dyes. The ACS study also looked at cancer deaths and not at cancer incidence (new diagnoses), which was the measurement used in previous studies of personal use of hair dye.

Another report, published as an abstract in the Oct. 15, 1993 issue of the American Journal of Epidemiology, showed men and women who used permanent or semi-permanent hair dyes for 16 or more years had an increased risk for leukemia. Dale Sandler, Ph.D., and colleagues at the National Institute of Environmental Health Sciences (NIEHS) compared hair dye use among 615 leukemia patients and 630 people without the disease. The researchers found that those who had used any type of hair dye had a 50 percent increased risk of leukemia compared with people who never dyed their hair. Most of the risk shown in this NIEHS study was associated with permanent and semipermanent dyes, which increased risk by 60 percent and 40 percent respectively. Temporary rinses increased risk by 20 percent. Long-term users, who used hair dye for 16 or more years, were two and a half times more likely to have leukemia than those who never used hair dye.

A study by Anastasia Tzonou, D.M.Sc., and colleagues at the Harvard School of Public Health and the University of Athens Medical School, published a report in the Sept. 30, 1993 issue of the International Journal of Cancer, that suggested regular use of hair dye might increase the risk of ovarian cancer. The researchers asked 189 cancer patients and 200 hospital visitors how often they dyed their hair each year. Compared to women who had never dyed their hair, women who dyed their hair one to four times a year had a 70 percent increased risk for ovarian cancer. Women who used hair dye five times or more per year had twice the risk of developing ovarian cancer compared to women who never used hair dye.

Previous National Cancer Institute Studies

Linda Morris Brown, M.P.H., and her colleagues at the National Cancer Institute (NCI) and the University of Iowa published a report in the December 1992 issue of the American Journal of Public Health, that showed a 90 percent increased risk for multiple myeloma in a study of 173 men with the disease and 650 men without it. More than 8 percent of the men diagnosed with multiple myeloma reported using hair dyes, compared to less than 5 percent of the men without the disease. In addition to the overall increased risk of multiple myeloma, risk increased among men who had used hair dyes at least monthly for a year compared with men who used dyes less frequently or for a shorter time.

In an NCI study conducted by Shelia Hoar Zahm, Sc.D., published in the July 1992 issue of American Journal of Public Health, women who used hair dyes had a 50 percent higher risk for developing non-Hodgkin's lymphoma and an 80 percent higher risk of multiple myeloma than women who never dyed their hair. Among the 876 women in the study, the risk associated with permanent hair coloring products was higher than that for semi-permanent or non-permanent hair coloring products. Risk was increased 70 percent in women who used permanent hair dyes and 40 percent in women who used semi-permanent or non-permanent dyes. Risk did not increase with frequency of hair dye use, although risk increased with the number of years of use. Women who used black, brown/brunette, and red hair coloring products had a twofold to fourfold increased risk of being diagnosed with these cancers compared with no increased risk of cancer in women who dyed their hair with lighter colors. Other cancer risk factors, such as family history of cancer, cigarette smoking, and herbicide or pesticide exposure, did not
change the risks calculated for hair dye use.

An earlier NCI study published in the May 1988 issue of the American Journal of Public Health, showed that men who had used hair dyes had a two-fold risk for non-Hodgkin's lymphoma and almost double the risk of leukemia. Kenneth P. Cantor, Ph.D., and his colleagues at NCI, the University of Iowa, and the University of Minnesota found this increased risk by interviewing men with non-Hodgkin's lymphoma, men with leukemia, and men without cancer.

Statistics

In the United States, about 12,700 new cases of multiple myeloma (6,500 men and 6,200 women) will be diagnosed in 1994, and about 9,800 people (5,000 men and 4,800 women) will die of the disease. About 45,000 new cases of non-Hodgkin's lymphoma will be diagnosed in 1994 (25,000 men and 20,000 women), and about 21,200 people will die of the disease (11,200 men and 10,000 women). Leukemia's of all kinds will account for about 28,600 new cases of cancer (16,200 men and 12,400 women) and about 19,100 cancer deaths (10,500 men and 8,600 women) in 1994. About 24,000 women will be diagnosed with ovarian cancer in 1994, and about 13,600 women will die from the disease.

To put this in perspective, if 50,000 people die of cancers which are possibly related to hair dye in a population of 300,000,000 and if 50% of those cases could be related to hair dye, then 2 people out of every 12,000 people die each year of one of these cancers and one of those deaths would have been unnecessary. Remember, this is on a yearly basis and if we multiply it times some factor, perhaps 20 (representing the number of years an average hair dye using person uses hair dyes), then over those 20 years 2 out of 40 people will have died of one of these cancers and one of those deaths would have been unnecessary. So, maybe one out of 20 people who uses hair dyes for 20 years is going to die of one of the cancers under consideration. And, perhaps one other person out of those 20 will have the illness, but survive it to die of another cause.

As to coming into contact with your wifeís hair, I know of no studies about that. It seems unlikely that it would be a problem since absorption is through the skin and surely 99.999 percent of that is from application of the dye in the soluble state.

References for Studies Mentioned Above:

1. "Hair Dye Use and Risk of Fatal Cancers in U.S. Women." The authors are M. J. Thun, S. F. Altekruse, M. M. Namboodiri, E. E. Calle, D. G. Myers, and C. W. Heath, Jr.
2. "Hair Dye Use and Leukemia. " The authors are D.P. Sandler, D.L. Shore, C.D. Bloomfield, and Cancer and Leukemia Group B Investigators.
3. "Hair Dyes, Analgesics, Tranquilizers and Perineal Talc Application as Risk Factors for Ovarian Cancer." The authors are A. Tzonou, A. Polychronopoulou, C. Hsieh, A. Rebelakos, A. Karakatsani, and D. Trichopoulos.
4. "Hair Dye Use in White Men and Risk of Multiple Myeloma. The authors are L. M. Brown, G. D. Everett, L. F. Burmaister, and A. Blair.
5. "Use of hair coloring products and the risk of lymphoma, multiple myeloma, and chronic lymphocytic leukemia." The authors are S. H. Zahm, D. D. Weisenburger, P. A. Babbitt, R. C. Saal; J. B. Vaught, and A. Blair.
6. "Hair dye use and risk of leukemia and lymphoma." The authors are K. P. Cantor, A. Blair, G. Everett, S. VanLier, L. Burmaister, F. R. Dick, R. W. Gibson, and L. Schuman.



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