Sunday, May 15, 2011

Tylenol- Reduces pain, but causes cancer?

Acetaminophen, or as it is known in it's most common over-the-counter medicinal form, Tylenol, is one of the most commonly used analgesics and antipyretics in the world. Its low cost, effectiveness in reducing symptoms and versatility make it a staple in the medicinal cabinets of many homes. The exact biochemical mechanisms which acetaminophen utilizes to reduce pain, fever, and inflammation are still being researched and discussed today, but it has been well-established that it oxidizes the COX-2 enzyme, which ordinarily produces chemicals that promote inflammation. Via oxidation, the enzyme is inactivated, leading to reduced inflammation and fever in the body.

<-- Acetaminophen chemical structure, from

However, there are certainly some health risks associated with the use of acetaminophen, especially when used in excess. The Journal of Arthritis Research and Therapy published an article concluding that high dose-usage (2000 mg+/day) has been associated with stomach and other gastrointestinal bleeding. Additionally, acetaminophen users are at risk for overdose, which can cause acute liver failure and death, according to The Journal of Hepatology. However, the risks associated with prolonged acetaminophen use may be far greater than previously known, according to recent research.

A recent article in the Journal of Clinical Oncology has also shown that long-term usage of acetaminophen could also be associated with increased risk of hematologic malignancies. The study, which surveyed men and women ranging from age 50 to 76 years, concluded that prolonged "high use of acetaminophen was associated with an almost two-fold increased risk of incident hematologic malignancies other than chronic lymphocytic leukemia and small lymphocytic lymphoma." The article defined "high use" as four or more days a week for four or more years.

Another study found that "use of acetaminophen was associated with an increased risk of renal cancer, with a direct relation between risk and number of prescriptions." In essence, these new studies are suggesting that high duration and volume in usage of acetaminophen products is putting users at higher risk for developing certain types of cancer.

Usually, when a product is labeled carcinogenic, people make an effort to decrease or stop use of it altogether. This raises a problem with products like Tylenol though, as it is so commonly used. Is a mother potentially putting her son at risk for blood cancer when she tries to reduce his fever? Are you condemning yourself by your morning routine to get rid of headaches? Somewhat ironically, acetaminophen is "used to help relieve pain in cancer patients", according to The American Cancer Society. Should the use of acetaminophen be further regulated to protect against these risks?

In my opinion, the answer is not simply yes or no. In people that may already be predisposed to hematologic malignancies, like those possessing a variant allele of the GFI1 gene, should consider taking lower, more infrequent doses to treat fever or pain symptoms. Using non-steroidal anti-inflammatory drugs like ibuprofen or aspirin, which have "no association with increase risk of incident hematologic malignancies" according to the aforementioned Clinical Oncology study, may be beneficial.

There is no cut-and-dry rule to the use of these over the counter medicines; it is different in each individual's case. Those concerned with the use and risks associated with these drugs should consult their own personal doctor, and make an informed decision for their own well being. As is the case for nearly anything that we put in our bodies, moderation is key. Putting too much of anything into our systems can kill us- even water! Using the minimal dosage of acetaminophen to treat symptoms is always recommended, to keep our livers- and now too, our blood- healthier.