Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.”

“My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video.

No further details have been released about the Princess of Wales’ treatment.

But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment.

It’s not the same as preventing cancer

To prevent cancer developing, lifestyle changes such as diet, exercise and sun protection are recommended.

Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at high risk of breast cancer.

Aspirin can also be used for those at high risk of bowel and other cancers.

How can chemotherapy be used as preventive therapy?

In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning.

If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer.

If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate around the body .

The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer coming back. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later.

With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.

If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer.

How effective is preventive therapy?

The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy.

Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The first chemotherapy tested improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%.

Preventive chemotherapy is usually given for three to six months.

How does chemotherapy work?

Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations.

Chemotherapy is not selective for cancer cells. It kills any dividing cells.

But cancers consist of a higher proportion of dividing cells than the normal body cells. A greater proportion of the cancer is killed with each course of chemotherapy.

Normal cells can recover between courses, which are usually given three to four weeks apart.

What are the side effects?

The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells.

The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection.

Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance.

Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet.

There are also generalised symptoms such as fatigue.

Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.

Ian Olver, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Anecdotal reports from some professionals have prompted concerns about young people using prescription benzodiazepines such as Xanax for recreational use.

Border force detections of these drugs have almost doubled in the past five years, further fuelling the worry.

So why do young people use them, and how do the harms differ to those used as prescribed by a doctor?

What are benzodiazepines?

You might know this large group of drugs by their trade names. Valium (diazepam), Xanax (alprazolam), Normison (temazepam) and Rohypnol (flunitrazepam) are just a few examples. Sometimes they’re referred to as minor tranquillisers or, colloquially, as “benzos”.

They increase the neurotransmitter gamma aminobutyric acid (GABA). GABA reduces activity in the brain, producing feelings of relaxation and sedation.

Unwanted side effects include drowsiness, dizziness and problems with coordination.

Benzodiazepines used to be widely prescribed for long-term management of anxiety and insomnia. They are still prescribed for these conditions, but less commonly, and are also sometimes used as part of the treatment for cancer, epilepsy and alcohol withdrawal.

Long-term use can lead to tolerance: when the effect wears off over time. So you need to use more over time to get the same effect. This can lead to dependence: when your body becomes reliant on the drug. There is a very high risk of dependence with these drugs.

When you stop taking benzodiazepines, you may experience withdrawal symptoms. For those who are dependent, the withdrawal can be long and difficult, lasting for several months or more.

So now they are only recommended for a few weeks at most for specific short-term conditions.

How do people get them? And how does it make them feel?

Benzodiazepines for non-medical use are typically either diverted from legitimate prescriptions or purchased from illicit drug markets including online.

Some illegally obtained benzodiazepines look like prescription medicines but are counterfeit pills that may contain fentanyl, nitazenes (both synthetic opioids) or other potent substances which can significantly increase the risk of accidental overdose and death.

When used recreationally, benzodiazepines are usually taken at higher doses than those typically prescribed, so there are even greater risks.

The effect young people are looking for in using these drugs is a feeling of profound relaxation, reduced inhibition, euphoria and a feeling of detachment from one’s surroundings. Others use them to enhance social experiences or manage the “comedown” from stimulant drugs like MDMA.

There are risks associated with using at these levels, including memory loss, impaired judgement, and risky behaviour, like unsafe sex or driving.

Some people report doing things they would not normally do when affected by high doses of benzodiazepines. There are cases of people committing crimes they can’t remember.

When taken at higher doses or combined with other depressant drugs such as alcohol or opioids, they can also cause respiratory depression, which prevents your lungs from getting enough oxygen. In extreme cases, it can lead to unconsciousness and even death.

Using a high dose also increases risk of tolerance and dependence.

Is recreational use growing?

The data we have about non-prescribed benzodiazepine use among young people is patchy and difficult to interpret.

The National Drug Strategy Household Survey 2022–23 estimates around 0.5% of 14 to 17 year olds and and 3% of 18 to 24 year olds have used a benzodiazepine for non medical purposes at least once in the past year.

The Australian Secondary Schools Survey 2022–23 reports that 11% of secondary school students they surveyed had used benzodiazepines in the past year. However they note this figure may include a sizeable proportion of students who have been prescribed benzodiazepines but have inadvertently reported using them recreationally.

In both surveys, use has remained fairly stable for the past two decades. So only a small percentage of young people have used benzodiazepines without a prescription and it doesn’t seem to be increasing significantly.

Reports of more young people using benzodiazepines recreationally might just reflect greater comfort among young people in talking about drugs and drug problems, which is a positive thing.

Prescribing of benzodiazepines to adolescents or young adults has also declined since 2012.

What can you do to reduce the risks?

To reduce the risk of problems, including dependence, benzodiazepines should be used for the shortest duration possible at the lowest effective dose.

Benzodiazepines should not be taken with other medicines without speaking to a doctor or pharmacist.

You should not drink alcohol or take illicit drugs at the same time as using benzodiazepines.

Counterfeit benzodiazepines are increasingly being detected in the community. They are more dangerous than pharmaceutical benzodiazepines because there is no quality control and they may contain unexpected and dangerous substances.

Drug checking services can help people identify what is in substances they intend to take. It also gives them an opportunity to speak to a health professional before they use. People often discard their drugs after they find out what they contain and speak to someone about drug harms.

If people are using benzodiazepines without a prescription to self manage stress, anxiety or insomnia, this may indicate a more serious underlying condition. Psychological therapies such as cognitive behaviour therapy, including mindfulness-based approaches, are very effective in addressing these symptoms and are more effective long term solutions.

Lifestyle modifications – such as improving exercise, diet and sleep – can also be helpful.

There are also other medications with a much lower risk of dependence that can be used to treat anxiety and insomnia.

If you or someone you know needs help with benzodiazepine use, Reconnexions can help. It’s a counselling and support service for people who use benzodiazepines.

Alternatively, CounsellingOnline is a good place to get information and referral for treatment of benzodiazepine dependence. Or speak to your GP. The Sleep Health Foundation has some great resources if you are having trouble with sleep.

Nicole Lee, Adjunct Professor at the National Drug Research Institute (Melbourne based), Curtin University and Suzanne Nielsen, Professor and Deputy Director, Monash Addiction Research Centre, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.