HOW TO PREVENT CANCERS

With spring in the air and the long sunny days of summer not too far off, the American Academy of Pediatrics has released a new policy statement on the hazards of UV radiation exposure in children and adolescents.  The statement, published in the journal Pediatrics (link), refreshes and reinforces what many of us know - that unprotected sun exposure and tanning bed use are unhealthy activities for everyone, but particularly so for youth.    UV radiation exposure raises the risk of skin cancer, including deadly melanoma, rates of which keep climbing higher and higher.

As we've chronicled in a number of previous blog posts (UV, tanning beds), a lot of us fall short when it comes to protecting ourselves against UV exposure.  About a third of people in the US report at least one sunburn a year, with about 20 percent reporting four or more.  The high rates of tanning bed use by teenagers, particularly girls, is particularly concerning, given the high concentration of UV radiation delivered by tanning beds and that the exposure occurs in a time of life that seems most important for later melanoma risk.

Taking steps to lower exposure to natural and artificial sources of UV in youth and young adults could have huge health benefits.  Among a number of items, the AAP policy statement recommends that:

Pediatricians -

• Incorporate advice about UV exposure in their practices
• Use visits for sunburns as "teachable moments" about UV protection
• Continue to encourage outdoor physical activity but in a sun-safe manner
• Talk jointly with parents and children about sun-safe practices when kids get older and more independent, around ages 9 - 10
• Advocate for safe-sun practices at school - earlier outdoor time, loosening of restrictions against hats, and shaded play areas

Governments -

• Develop communication campaigns that raise awareness of the dangers of indoor tanning
• Support broad use of successful safe-sun programs, such as the EPA's SunWise
• Work toward laws/policies that ban minors' use of indoor tanning

Wholesale changes in sun exposure policies and behaviors aren't required to see positive results.  Like most public health efforts, small changes can lead to significant health benefits and, even more importantly, can get the ball rolling toward bigger changes in policies and behaviors.

Coming out of a long winter, it's that time of year when the sun is at its most inviting.  It also makes it a great time to lay the foundation for the sun-protection practices that we, and our kids, will carry throughout the summer and, hopefully, the rest of life.

Related CNiC Posts

Mother/Daughter Tanning and the Dual Nature of Family History

With summer a distant memory and fall giving way to the cold, darker days of winter, a lot of us put our sunscreen into storage, along with our shorts, sandals, and t-shirts.  But, even though the warmth of the sun may have gone on hiatus, some of its ultraviolet (UV) punch hasn't; this is especially so in the high, snow-covered mountains.

A recent Archives of Dermatology study of ski resorts in the western United States found that UV exposure could reach significant levels throughout the ski season (paper).  Elevation of these resorts plays a part in this - with every 1000 feet in elevation gain resulting in about a 5 percent rise in UV levels,  as does the snow itself, which can reflect about 50 - 80 percent of the direct UV from the sun.   The result is UV levels high enough to damage skin even while the mercury remains well below freezing. And with UV reflecting so effectively off of the white snow, skin we don't normally protect during the warmer months can be prone to burning during winter.

To protect yourself during those fun days in the mountains, do most of what you'd do during the warmer seasons. 

• Apply an SPF 15+ sunscreen to skin that could be exposed during the day.  Remember, you remove layers as the temperature rises.

• Use a lip balm  with SPF 15+ protection

• Wear long sleeved tops, long pants, and hats that cover ears.

As spring starts to take hold, it's tempting to expose more skin, but the deeper into spring, the stronger the UV rays (and their reflection off the snow), so it's important to keep skin covered and/or protected.

In the June issue of the journal Cancer Epidemiology, Biomarkers & Prevention, University of Minnesota researcher DeAnn Lazovich and colleagues published a study further confirming the dangers of indoor tanning, finding significant increases in the risk of melanoma linked to regular tanning bed use (link).  She summarizes her findings and take-home messages in this nice little video:

A new study in this month's Archives of Dermatology suggests that indoor tanning can be addicting in young adults (study) (1).  While the study was relatively small, with just over 400 participants surveyed, the results seem to bolster the need for moves toward greater regulation of the indoor tanning industry, especially through policies that curtail use by youth (related post).

The release of the study seems particularly well timed with the signing of the new health care reform bill, which institutes a 10 percent tax on all indoor UV tanning services (related post).  Raising the price point of risky items has proved a particularly effective approach in limiting certain high risk behaviors in youth.  The classic example of this is tobacco (study) (2).  As excise taxes on - and therefore the prices of - cigarettes go up, the use of cigarettes by youth go down.  Keeping smoking rates low in youth means fewer will go on to develop lifelong smoking habits.

Though tanning bed use is not as destructive, nor likely as addictive, as tobacco use, it is an activity that can have serious lifelong consequences.  Much of the melanoma (and other skin cancer) risk related to UV exposure comes  from unprotected exposure in youth and young adulthood.  Taking a cue from the tobacco control playbook and raising the cost of tanning should help a good percentage of young people decide that it's just not worth it.  And they'd be right.

Related CNiC posts
Health Care Reform and Prevention of Cancer - April 7, 2008
More Blistering Truths About Tanning Bed Use by Youths - April 5, 2008 


Related media
Washington Post: Tanning beds may get closer scrutiny based on findings about skin cancer risk - April 20, 2010


Literature cited

1. Mosher, C., Addiction to Indoor Tanning: Relation to Anxiety, Depression, and Substance Abuse. Arch Dermatol, 2010. 146(4): p. 412-417.
2. Liang, L., et al., Prices, policies and youth smoking, May 2001. Addiction, 2003. 98 Suppl 1: p. 105-22.

Australian population growth projection leads to increasing burden of cancer for health services and for the community. The continuing growth through births and migration lead to projections that the Australian population will substantially increase in size and in age over the next 50 years. By 2056 5% percent or more of the population will be aged 85 or older compared to only 1.6 percent in 2007. Because the risk of cancer increases with age a larger number of older Australians will result in more cases of cancer diagnosed each year, even if the risk at a given age holds steady. Therefore, efforts to reduce risk and prevent cancer must be an even higher priority to avoid this burden on society and the pain and suffering for individuals.

3222.0 - Population Projections, Australia, 2006 to 2101

A new study this week out of Stanford University found that the more acculturated Asian Americans are, the more likely they are to practice unhealthy patterns of sun exposure (study).

Surveying close to 550 individuals of Asian decent living in northern California, the researchers found that those from families who have been in the US longer, or have lived half or more of their lives in the United States, were much more likely to sunbathe and to prize darker skin than those who lived less time in the US or spent most of their lives in Asia. Strikingly, nearly 60 percent of those raised at least half of their lives in the United States reported that they had practiced sunbathing, whereas only 34 percent of those raised largely in Asia said they did so. Attitudes about safe-sun practices (like using sunscreen) tracked very similarly with levels of acculturation.

With sun exposure the major cause of skin cancer, including deadly melanoma, these results could have obvious health implications for the growing Asian American population in the US, especially since skin cancer diagnoses are often delayed, with more serious results, in Asian groups compared to Caucasians. Clearly, better education of individuals and doctors would be a good first step in addressing this issue.

Beyond this, though, this paper further reinforces what we’ve known in public health for years now: that culture can have a large influence on health behaviors and rates of chronic diseases. Previous studies in Asian populations have found that as immigrants to the US adopt its Western culture, their rates of diseases like heart disease and colon cancer rise to match, or even exceed, those of the US average (figure).

While such findings can certainly be viewed through a gloomy lens, they have a positive side as well: they show the potential power of prevention. If population changes in lifestyle that raise the risk of disease can change so quickly, they also have the potential to move in healthful directions as well.

Of course, it takes a concerted effort from government, communities, and individuals alike to effect such changes, even small ones, populations wide. But it can happen with a combination of large and small steps. So, as you put on your sunscreen, buy your fruits and vegetables, and get outside for a walk, remember you’re not only helping yourself but also helping create a culture of healthfulness that will benefit those around you as well.


Articles referenced:
Gorell E, et al. Adoption of western cultures by Californian Asian Americans: Attitudes and practices promoting sun exposure. Arch Dermatol. 145(5):552-556, 2009.

Flood DM, et al. Colorectal cancer incidence in Asian migrants to the United States and their descendants. Cancer Causes and Control. 11: 403±411, 2000.

Related web resources:
Your Disease Risk -- Melanoma

Cancer Prevention -- Google Knol