The Dark Side of Sunlight: Let the “Bather” Beware

July 1, 2008

Fewer people are smoking than in past decades; as a result, the number of lung cancers should decrease. Because of widespread use of screening mammography, more cases of breast cancer are detected and treated at an early stage, and survival has improved. What about a similar success story for the most common cancer?

Are adolescents and young adults heeding advice to limit ultraviolet exposure?

The cause-and-effect relationships leading to specific cancers, as well as the need for early screening in at-risk cohorts, have been well publicized-and the messages are reaping important health benefits. Fewer people are smoking than in past decades; as a result, the number of lung cancers should decrease. Because of widespread use of screening mammography, more cases of breast cancer are detected and treated at an early stage, and survival has improved.

RISING INCIDENCE OF SKIN CANCER

What about a similar success story for the most common cancer? Skin cancer is the most common cancer not only in the United States but also in several other countries. For example, the incidence of non-melanoma skin cancer in Australia is more than 5 times that of all other cancers combined.1 Skin cancer will develop in 20% of persons in the United States during their lifetime; more than 1 million cases will occur this year alone.2 The incidence of malignant melanoma is increasing faster than that of any other cancer in the United States; it has risen to 1 in 63 persons.2

Ultraviolet exposure from the sun and tanning booths is the major risk factor for all types of skin cancer, including melanoma. But do we counsel as many people about sun exposure as we do about smoking-and if so, are they listening?

POPULARITY OF TANNING

Dermatologists at Northwestern University found that more than 80% of sun-worshippers, aged 18 to 30 years, at a beach in Chicago said that people look better with tans.3 Eighty-seven percent of those surveyed said this after admitting that they knew about the link between the sun, tanning, and skin cancers! In addition to sun exposure at the beach, 27% of the respondents had used tanning beds in the preceding year.

Previous studies have also demonstrated this “relaxed” attitude toward ultraviolet exposure and skin cancer. Only 41% of women and 29% of men reported that they used sunscreen, protective clothing, and shade to protect themselves from sun exposure.4 More than 2 million adolescents visit tanning salons each year, and the use increases 5-fold from the 9th to the 12th grade.5

WHAT CAN BE DONE

We need to revisit our public health approach to ultraviolet exposure and skin cancer. The Australian government aggressively educated children and adolescents about the link between sun exposure and malignancy in the 1960s, and skin cancer incidence leveled off as that cohort aged.1 The present popularity of tanning beds and of unprotected exposure to the sun-and the alarming incidence of melanoma-suggests that we have a daunting task before us.

Related article: Rutecki GW. May the Sun Shine Half Day Long: Balancing the Risks and Benefits of Sun Exposure.Consultant. 2009;49:e25.

References:

REFERENCES:1. Staples MP, Elwood M, Burton RC, et al. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust. 2006;184:6-10.
2. Rigel DS. Cutaneous ultraviolet exposure and its relationship to the development of skin cancer. J Am Acad Dermatol. 2008;58:S129-S132.
3. Robinson JK, Kim J, Rosenbaum S, Ortiz S. Indoor tanning knowledge, attitudes, and behavior among young adults from 1988-2007. Arch Dermatol. 2008;144:484-488.
4. Eide MJ, Weinstock MA. Public health challenges in sun protection. Dermatol Clin. 2006;24:119-124.
5. Olson AL, Starr P. The challenge of intentional tanning in teens and young adults. Dermatol Clin. 2006;24:131-136.