How do you navigate a world where everything is apparently carcinogenic?

While you might panic over consuming—either topically or orally—an ingredient that’s in the news for its cancer-causing properties, it is also crucial to be aware of half-baked information

The first time a consumer’s bubble of perception busted was when brands, dermatologists and ‘woke’ beauty enthusiasts on the Internet began to look at the  term ‘chemical’ in a positive light by explaining that ‘chemical’ doesn’t essentially equal ‘toxic’. Similarly, in the past few years, for consumers both nationally and internationally, everything has suddenly become a potential source of cancer—from what they eat to what they apply. Multiple theories and specimens testify to this. 

For instance, recently, aspartame, an artificial sweetener used in aerated beverages like Diet Coke, became a topic of controversy, for some claimed it was potentially carcinogenic. A report by Reuters on the subject revealed that “since 1981, JECFA (Joint FAO/WHO Expert Committee on Food Additives) has said that aspartame is safe to consume within accepted daily limits. For example, an adult weighing 60 kgs (or 132 pounds) would have to drink between 12 and 36 cans of diet soda—depending on the amount of aspartame in the beverage—every day to be at risk.” However, it doesn’t take one too many guesses to conclude that a sizeable number of people would now reconsider consuming a single can of Diet Coke. Upon asking Kripa Jalan, a nutrition expert and founder of Burgers to Beast, whether aspartame actually deserves a bad reputation, she says, “When it comes to aspartame, you’ve probably heard one of two things. One, it’s clearly linked to cancer. Two, everything possibly causes cancer and aspartame has been proven to be safe.” However, in her opinion, “the first statement is alarmist and is, in a large part, derived from good rodent studies. The second is making a false equivalency that most substances frequently labelled as potential carcinogens aren’t consumed as frequently as diet soda is.” She further states, “Importantly, the World Health Organisation (WHO) classified the substance as Group 2 B, which means it’s a possible carcinogen. ‘Possible’ is way different from ‘probable’ or ‘definite’.”

Previously Nestle-owned Maggi, a staple in most Indian households, was also subjected to endless rounds of trials, when, in 2015, multiple state governments in the country banned Maggi due to an unacceptable amount of lead and other carcinogenic components. These foods, including anything ‘diet’ like Diet Coke, certainly don’t make for the healthiest choice, but the fact that they’ve been put through media and public trials is indicative of the lack of awareness among the public, highlighting the need to fully understand what ‘cancer-causing’ compounds really are. 

The food industry isn’t the only victim—the beauty industry has been equally scrutinised. From Johnson & Johnson’s Baby Powder lawsuit to a complaint against L’Oréal’s chemical hair-straightening product filed by a US-based woman in 2022 and the recall of dry shampoos from Dove and other brands under the Hindustan Unilever umbrella due to the presence of benzene, several instances have linked a cosmetic ingredient with cancer. So is there anything to eat, drink, apply or use that is not posing a threat to cancer? We attempt to find out.

What does ‘carcinogenic’ really refer to?

“A substance that has the potential to trigger cancer in humans (or experimental animals) is called ‘carcinogenic’,” says Dr Madhuri Agarwal, a Mumbai-based celebrity dermatologist. “The carcinogen does so by interfering with normal cell functioning,” adds Rakhee Jain, a Mumbai-based nutritionist. Broadly speaking, there are three categories of carcinogens—chemicals that can cause cancer (direct-acting carcinogens), chemicals that do not cause cancer unless they are changed when metabolised (procarcinogens), and chemicals that do not cause cancer by themselves but can act with another chemical to cause cancer (co-carcinogens), states a report.

Enumerating the common carcinogenic ingredients used in devising skincare formulations, New Delhi-based Dr Kiran Sethi says, “Formaldehyde, ingredients that turn into formaldehyde and phthalates are all shown to cause cancer. Parabens may also cause cancer but it’s not yet proven. Heavy metals can cause cancer as well, and that’s a pretty well-proven correlation.” Agarwal makes additions to the list of carcinogens, stating, “Ethanolamine compounds become a concern when they have the impurity of nitrosamines as nitrosamines have carcinogenic potential. The cosmetic expert panels recommend ethanolamines can be used in rinse-off products or those left on for a brief period.  Fluorine and poly-fluoroalkyl are known to be harmful to the skin—they are present in products to provide long-lasting and water-resistant properties. However they are shown to have hormone disruptors, increase the risk of diabetes and obesity and are linked to certain cancers only.”

Meanwhile, carbon black used in skincare undergoes a process called incomplete combustion. “The materials used in the process are coal tar, ethylene and crackling tar. It is known to be a carcinogen as it contains polycyclic aromatic hydrocarbons. Though it is used in small amounts, the cumulative effect can make a person vulnerable to skin cancer,” says Agarwal. 

Is ‘carcinogenic’ always a cause for alarm?

Firstly, not every ambiguous substance might actually be carcinogenic. Even in the case of carcinogenic substances, not each one of them is sure to cause cancer. Umesh Wadhavani, a nutrition and fitness expert and educator says, “Aspartame is a carcinogen but will drinking one Diet Coke give you cancer? It won’t! A high quantity of carcinogen substances consumed, combined with poorly managed risk factors, will potentially increase your chances of getting cancer.”

While Wadhavani believes that identifying a carcinogenic ingredient is as simple as a Google search, both he and Jain opine that the information overload online may not give a consumer the most relevant data. “Yes, most of them are based on scientific data which is correct, but the information is not being communicated correctly to the layperson,” says Jain. Sethi feels that the problem with conversations about carcinogenicity is that we get theories of correlation versus causation. “Some research revealed that paraben was found in a cancerous breast tissue. However, what else was found in breast tissue? Did we even examine if anything else was found? And, were parabens there in non-cancerous breast tissue? We actually don't know this. That’s the difference between correlation and causation,” she explains. 

How much should you believe?

“Studies about carcinogenicity tend to raise alarm and leave you in a state of panic. However, very often, they’re in vitro (literally translates into ‘in glass, ’referring to studies conducted using components of an organism that have been isolated from their usual biological surroundings, such as microorganisms, cells or biological molecules). The studies are conducted on cells, not on humans, or they’re on animals which may not really translate forward to humans, or are conducted on such a small human  population, and in ways where they use 100 million times the quantity you’re actually using/consuming,” explains Sethi, indicating that not every study issued publicly can be blindly believed. Of course, there are exceptions based on health history and other similar factors, but on a larger scale, more elaborate and honest research is key to substantiating a generalised statement.

The quantity one is exposed to plays a significant role in determining the quantum of damage and risk that one is vulnerable to. “Always remember, in most cases, the dose makes the poison. Anything in excess is harmful so be mindful of what you consume and how much of it you consume,” says Jain. “Genetics and lifestyle both play a role in how your body reacts to these substances,” adds the nutritionist, who believes that one can’t make a blanket statement but as a preventive measure, these substances are best avoided.

Dr Sewanti Limaye, director of Medical Oncology at Mumbai’s Sir HN Reliance Foundation Hospital mentions that the classification of compounds as ‘carcinogenic’ is a complex process that involves rigorous scientific evaluation and assessment. “While it’s true that occasional substances are identified as carcinogens, these classifications are typically based on comprehensive studies involving various research methodologies, including epidemiological studies, animal testing and mechanistic investigations. Regulatory agencies like the International Agency for Research on Cancer (IARC) provide classifications based on the strength of evidence available. It’s important to recognise that not all compounds that undergo evaluation are ultimately classified as carcinogenic.”

The best way forward

One should realise that fretting over any of this won’t be fruitful; in fact, the fear-mongering could be hazardous. Whenever there is an apprehension about a carcinogenic substance, it is necessary to do the homework, emphasises Agarwal. “Read the label of ingredients to check for toxic ingredients. It is important to know which chemicals are labelled as risky or harmful. For that, you can look at various registered databases that provide information on carcinogenic substances in skincare. In the US and Europe, there are government bodies like EWG (Environmental Working Group) and Think Dirty that have a roster of potential carcinogenic ingredients. In India, there is the BIS (Bureau of Indian Standards) and the D&C Act (Drugs & Cosmetics).” However, the D&C Act does not have the complete data, apprises the dermatologist.

While the quantities of carcinogens consumed are strong criteria that command their impact, other lifestyle factors can be contributors too, says Wadhavani. “They include unhealthy diet, bad sleep, stress, working in a polluted area, a sedentary lifestyle and genetic factors. The combination of risk factors and carcinogens might potentially give one cancer. You need to understand that whether or not something is cancer-causing depends on a combination of, firstly, if it is a carcinogen, plus the dosage, duration of exposure and frequency of exposure.”

Limaye concurs, adding, “No, a carcinogenic substance doesn’t always guarantee the development of cancer. While it increases the risk, the relationship between exposure and cancer can be complex. Some individuals might be more resilient, while others could be more vulnerable to the effects of carcinogens.”

A good diet could be of assistance in minimising the risks. “Fresh fruit and vegetables high on antioxidants, good quality protein, fibrous wholegrains instead of processed flour, and good fats like nuts and seeds are great additions. A balanced diet usually has enough vitamins and minerals to sustain our body. Still, get tested for vitamin D3 levels and supplement regularly,” suggests Jain. However, there’s a slight note of caution here too. “Broccoli contains sulforaphane, a plant compound found in cruciferous vegetables that may have potent anticancer properties.But just like the risk factors, these food items can’t work in isolation. Eating broccoli every day can’t prevent cancer if you are a regular smoker and your overall lifestyle is unhealthy,” informs Wadhavani.

“Maximise what is potentially helpful for your health and minimise what is potentially harmful. You know what’s what. The more you follow it, the safer you will be,” concludes Wadhavani.

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