HOW TO PREVENT CANCERS

We've dedicated a number of posts over the past year on the policy and health pitfalls of indoor tanning - from the potential benefits of the "tanning tax" (post) to surprisingly high rates of tanning by some youth (post).  Now comes a fascinating, if not perfectly surprising, little analysis on the influence parents can have as indoor tanning enablers.

The small study - reported in the New York Times (story) and printed as a research letter in the Archives of Dermatology (letter - subscription required for full text) - included just over 200 female college students who had at any time in their lives tanned indoors.  Results showed that 40 percent of these students had had their very first tanning experience with their mothers, and that this mother/daughter group of students started tanning at earlier ages and were much more likely to be heavy tanners in college than those who'd first tanned with friends or gone on their own.

For an activity that has well demonstrated health risks, it's surprising that such a high percentage of students were actively introduced to tanning by a parent.  Using an extreme example, it's hard to imagine such a high percentage being introduced to smoking in the same way.

But perhaps the most interesting aspect of the study is how well it demonstrates the dual way that family history may influence future risk of disease.  Genes can certainly play a role but so to can the lifestyle choices that also permeate families - whether it's the food served in the kitchen or the activities done for leisure.  And with over half of all cancer and up to 75 percent of heart disease and diabetes preventable with things we can all do, it's important to realize that the choices made by families could have just as much, if not more, influence on health than the genes they carry.

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