HOW TO PREVENT CANCERS

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.

The potential for prevention of breast cancer through drug therapies is supported by results from randomized trials of SERMs (Fisher, Costantino et al. 1998; Cummings, Duong et al. 2002; Martino, Cauley et al. 2004; Vogel 2010; Vogel, Costantino et al. 2010). Both tamoxifen and raloxifene have been shown to reduce the incidence of invasive breast cancer by approximately 50%, with the benefit largely limited to ER+ tumors, where risk is reduced by as much as 80%. Adverse effects of tamoxifen suggest that the potential use for chemoprevention will be limited to a subset of women at increased risk and younger in age, in large part because of increasing incidence of adverse effects with age (Gail, Costantino et al. 1999). The adverse effects experienced in the 8 year randomized trial of raloxifene (Continuing Outcomes Relevant to Evista (CORE)), on the other hand, are somewhat fewer than those observed for tamoxifen (Chen, Rosner et al. 2007). Of note, there was no statistically significant difference in overall mortality or uterine cancer among women randomized to Raloxifene compared to placebo. While Raloxifene is approved in the United States for use to prevent osteoporosis in postmenopausal women (Physicians' Desk Reference 2005), and a number of cost effectiveness studies support this use in conjunction with screening for osteoporosis (Kanis, Borgstrom et al. 2005; Stevenson, Lloyd Jones et al. 2005; Mobley, Hoerger et al. 2006).

We calculated some numbers to help women decided (Chen, Rosner et al. 2007). Among women in the top 10 percent of breast cancer risk in each 5-year age group we estimated how many women would need to take a SERM for 5 years to prevent one case of breast cancer. Thee numbers are summarized in the table below from Chen, et al., Cancer 2007. Physicians will need to play a key role in advising women in this rapidly evolving field.

Age group	Incidence of breast cancer per 100,000	Number treated for 5 years to prevent 1 case
50-54	504	79
55-59	668	60
60-64	756	53
65-69	921	43

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