Your Epidermis Is Showing

Skin cancer rates are rising. How can you protect the skin you’re in?

Sunscreen and Sunglasses

Five Figures to Consider

200% increase in the rate of melanoma occurrence from 1982 to 2011
20% of Americans will develop skin cancer before age 70
74% increased melanoma risk from use of indoor tanning beds before age 35
5 blistering sunburns needed to increase melanoma risk by 80%
50-73% decrease in melanoma risk with daily use of sunscreen

Labor Day may have passed, but that doesn’t mean it’s safe to stash your sunblock with your beach towels. Skin cancer rates are rocketing, and sun protection is more important than ever. More than 3 million Americans develop skin cancer every year and incidences of melanoma, its deadliest form, have increased 200% since the 1980s. In fact, 20% of Americans will develop skin cancer before age 70. Over the past 30 years more people have had skin cancer than all other cancers combined. That’s not surprising when you consider that unprotected skin can be damaged by the sun’s UV rays in as little as 15 minutes. Even when it’s cool and cloudy.

Check out Instagram #tanning #tanned #beachbum, each with millions of posts, to see that Americans’ devotion to a healthy glow is undiminished despite what we know about skin cancer — that it’s preventable and 85-90% of cases are caused by sun or tanning bed exposure. Consider that while the average age of diagnosis is 63, skin cancer is striking more young women and men than ever before. (An 800% increase in melanoma in women and 400% increase in men ages 18-39 from 1970 to 2009.) As for people with dark complexions, they are diagnosed with skin cancer less often than those with fair skin, but their survival rates are lower. Same for men; they are diagnosed less often than women before age 50 but have higher mortality rates. One possible reason for the lower survival rates among men and people of color is that they use sunblock less often and visit the dermatologist less often. By the time they do visit a doctor for that “funny-looking scab that won’t go away,” they already have advanced stage cancer. Meanwhile, just because you aren’t at the beach is no reason not to cover up. Melanoma rates are higher among people who live in northern American cities and mountain states than among coastal dwellers. Go figure. Utah has the highest incidence of skin cancer in the U.S.  

The good news? The earlier skin cancer is detected, the easier it is to cure. Non-melanoma skin cancer, which includes basal cell carcinoma and squamous cell carcinoma, has a survival rate of over 99%. This type of cancer develops slowly on the upper layers of skin often exposed to the sun like the head, neck, ears, lips and backs of hands. Melanoma skin cancer is rarer but more deadly. If detected early, the survival rate is also about 99%. However, the survival rate falls to 63% when the disease reaches the lymph nodes and 20% when the disease metastasizes to distant organs. It frequently develops in a mole or suddenly appears as a new dark spot on the skin. It can spread to other parts of the body including lymph nodes, the brain or lungs within weeks. Melanomas are more common with intermittent intense exposure to the sun – think vacation sunburn. In some people, particularly those of color, moles often appear on the palms, soles of the feet, in mucous membranes and under the fingernails.

Increased awareness and detection, an ageing population, ozone depletion and global warming have all contributed to the rise in skin cancer, but some factors put you at higher risk: (1) fair skin (2) freckles (3) blue or green eyes (4) blond or red hair (5) family or personal history of skin cancer (6) a large number of moles (7) lots of time spent in the sun (8) past indoor tanning use — melanoma risk increases 74% from use of indoor tanning beds before age 35 and (9) a history of sunburns — just five blistering sunburns between the ages of 15 and 20 increases melanoma risk by 80% and nonmelanoma skin cancer risk by 68%. Hurray! People can control three of these risk factors — time spent in the sun, indoor tanning and severe sunburns. Yet, while Americans have evolved since “laying out” was weekend recreation, we still aren’t protecting ourselves the way we ought. Dermatologists recommend a “just say no” approach to indoor tanning, sun avoidance especially between the hours of 10 a.m. and 4 p.m., seeking shade whenever possible, wearing protective clothing such as sunglasses, long sleeves, pants, wide-brimmed hats (baseball caps don’t cut it), and applying a daily slathering of broad-spectrum SPF 30 sunscreen.

Maybe it’s because people think that skin cancer is curable that they don’t take simple precautions but, according to the Centers for Disease Control (CDC), about two-thirds of American adults do not regularly wear sunscreen. Don’t be one of them. Regular sunscreen use can reduce melanoma risk by as much as 50-73%.  In recognition, cities from Los Angeles to New York have put free sunscreen stations in outdoor public spaces. The best sunscreens are broad-spectrum, SPF 30 and mineral-based. In the U.S. that usually means they contain zinc oxide or titanium dioxide which actually block the sun’s rays from penetrating the skin, as opposed to relying on a chemical reaction. Generally, these sunscreens contain less harmful toxins like oxybenzone and are more likely to be safe for marine and reef environments and for sensitive skin. Forget about ultra-high SPFs; they’re inherently misleading. An SPF 50 sunscreen blocks 98% of UVB rays, while SPF 100 blocks 99%. In addition, high-SPF products tend to screen out sunburn-causing UVB rays at the expense of screening cancer-causing, age-accelerating UVA rays. Only sunscreens marked “broad spectrum” protect against both ray types. Sunscreens are designed to stay at their original strength for up to three years. If a bottle is still in your medicine cabinet after that time, throw it out. Two to try: Neutrogena Sheer Zinc Dry Touch Sunscreen, SPF 30 and Beauty Counter Mineral Sunscreen, SPF 30.

A recent CDC report suggests comprehensive community-based skin cancer prevention programs could prevent 20% of new skin cancer cases between 2020 and 2030, saving $2.7 billion dollars in treatment costs. In addition to providing shade and encouraging the use of sunscreen and hats (they’re often mandated on school playgrounds in Hong Kong and Australia), communities can reduce skin cancer occurrences by banning tanning beds. While the FDA has proposed a total ban on tanning bed use by minors, 16 states and one territory have already banned their use by anyone under age 18. Another possibility, ensure more have access to early detection. Insurers aren’t required to cover annual full body skin checks. But, maybe they should be. In the meantime, the American Academy of Dermatologists in partnership with Bristol-Myers Squibb offers free Spotme skin cancer screening across the country. For those considered high-risk, mole mapping is an option. A technician takes digital skin surface photos that are saved and used at future check-ups to help identify suspicious changes in moles over time.

FIVE FIGURE THINKING
Simple prevention efforts can halt rising skin cancer rates. It is time for the FDA to follow through on its proposed tanning bed ban for minors and for individuals to incorporate broad-spectrum sunscreen and annual skin check-ups into their healthcare routines.

 

Sources

American Academy of Dermatology, American Cancer Society, Beauty Counter, Centers for Disease Control, Food and Drug Administration, Impact Melanoma, Journal of American Academy of Dermatology, Mayo Clinic, Melanoma Research Foundation, National Conference of State Legislatures, National Institutes of Health, Neutrogena, oceanconservancy.org, Skin Cancer Foundation