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Your Good Health: VOC cancer risk depends on level of exposure

The risk of developing cancer from air fresheners and fabric softener is very, very low.
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Dr. Keith Roach

Dear Dr. Roach: I heard that air fresheners and fabric softener sheets may cause lung cancer. Is this true?

P.G.

What is true is that these products release volatile organic compounds, according to a 2011 study. VOCs encompass a large group of chemicals, some of which will increase the risk of cancer if ingested at high-enough dosages for a long-enough period of time.

Some of these include alcohol and acetaldehyde, both of which are known definite or probable carcinogens. Nonetheless, people ingest alcohol at high levels, and acetaldehyde is found in ripe fruits, among other places.

The study found products listed as “organic,” “green,” “natural” or “nontoxic” that had similar amounts of potentially toxic or hazardous chemicals. The type of study precluded any assessment of the magnitude of risk from exposure to these chemicals. However, the Environmental Protection Agency has estimated less than a 1 in 100,000 chance of developing cancer from continuous exposure to acetaldehyde. The effect of multiple volatile organic compounds acting together hasn’t been studied.

Saying that “air fresheners cause lung cancer” is sensational, and doesn’t really address the factors a person should concern themselves with, such as the level of exposure to something that’s necessary to develop risk, and the amount of risk of getting lung cancer from using fabric softeners with the laundry.

It is clear that these products can lead to allergic reactions. I see respiratory symptoms and rashes fairly frequently. However, my best guess from the studies I have read is that the risk of developing cancer from these products is very, very low.

Dear Dr. Roach: I am writing on behalf of my 91-year-old father, who has been diagnosed with carpal tunnel syndrome. He has seen a specialist, who is ready to proceed with surgery. My father’s symptoms include numbness (lack of feeling) in the fingers to the point that he can’t button shirts and tie laces easily. Is there any treatment that you could recommend that would deal directly with the numbness? My father feels little pain and has no problem gripping. He wonders if nerve compression could be coming from his neck and shoulder, and if chiropractic care, massage or range of motion physical therapy may be the answer. He is very hesitant to go ahead with surgery.

T.S.

Carpal tunnel syndrome is caused by nerve compression in the wrist. The carpal tunnel is a literal tunnel of space bordered by the carpal (wrist) bones and their ligaments, and by a connective tissue structure called the flexor retinaculum.

The compression is alleviated by surgical release of the retinaculum, which gives the nerve adequate room. Surgery is the definitive therapy for carpal tunnel syndrome, but surgery is not always necessary. Lifestyle changes, such as wearing a wrist brace, and medications can sometimes keep a person from needing surgery.

You haven’t expressed any good reason why your father needs surgery now. Surgery in any 91-year-old should not be taken lightly, even carpal tunnel release, which is a very effective surgery with a low complication rate. But low complication rate doesn’t mean zero, and I saw a patient recently whose nerve was damaged by the surgery.

Before surgery, the surgeon should be completely certain the nerve compression is happening in the wrist, not the shoulder or neck. Your father will need an EMG study. If surgery is necessary because other treatments have not worked or because there is evidence of severe nerve damage, such as weakness or muscle atrophy, I highly recommend contacting a hand surgeon, who has special expertise in this surgery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu