Skin Cancer Education - Heather D. Rogers, M.D.

Skin cancer, what causes it and how to prevent it, is now well understood. We know the sun and tanning beds expose us to ultraviolet radiation that causes mutations in our skin cells’ DNA that increasing our risk of developing skin cancer. It is estimated that 90 percent of basal and squamous cell carcinomas and 86 percent of melanomas can be attributed to ultraviolet radiation1. Studies have shown a person’s risk for developing melanoma doubles if he or she has had more than five sunburns as an adult or even one blistering sunburn as a child2,3.

 

Since its inception in 1979, The Skin Cancer Foundation has been educating the public about skin cancer and risk of sun exposure. Its work, and that of many other groups, have significantly raised awareness of the dangers of the sun, tanning beds and skin cancer. Yet, despite a clear understanding that sun and tanning beds cause skin cancer; more skin cancers are being diagnosed each year in the United States. Skin cancer is the most common form of cancer in the United States, with more than 3.5 million cases diagnosed annually4. The majority of skin cancers could be prevented with sun safe habits so why is there a skin cancer epidemic? The answer is not fully understood but we know our aging population, the difficulty of changing behaviors, and increasing patient awareness all play roll.

 

Skin cancer historically is an affliction of the elderly after decades of exposure to ultraviolet radiation. In the US, the 65 and over age group has the greatest incidence, with between 40 and 50% of individuals developing as least one skin cancer5. The number of Americans over the age of 65 is increasing. Life expectancy in the US in 1950 was 68 and in 2010 it was 78 years of age6. In 1950, people 65 and older composed 8.5% of the US population and by 2012 it was 13.7% (Figure 1)7,8. As people are living longer, more active lives their total lifetime exposure to the sun increases and with it the risk of developing skin cancer. Current reports show the number of nonmelanoma skin cancer in the Medicare population increased on average 4.2% every year between 1992 and 20064. Today there are 40 million people in the United States 65 years old and older. This number is projected to 89 million by 2050. As our population ages, the number of skin cancers developing will continue to increase until we have successfully changed sun behaviors at all ages.

 

And it can be so difficult to change behavior! Despite wide spread public knowledge about the dangers of the sun, we as a nation continue to tan and to use tanning beds. Half of adults report at least one sunburn in the past 12 months9. This behavior has lead to number of women under the age of 40 being diagnosed with basal cell carcinoma to more than double over the last 30 years10. There also remains a misconception that the majority of sun damage occurs before the age of 18 and as adults it is “too late” and “the damage is already done.” This is not true! Adults over the age of 40, especially men, have the highest annual exposure to UV and therefore need to protect themselves11.

 

Yet, there is good news. Improved public awareness has lead to important changes in legislation. Some cities and states are implementing better regulation of tanning beds and/or limiting access to minors. Most recently in New York City the board of health unanimously adopted new rules to monitor tanning salons and warn customers of the dangers of skin cancer from ultraviolet radiation. Last year the FDA created regulations for sunscreen to ensure accurate labeling to help the public make informed sun protection decisions. Increased public awareness has also lead to a slowing of the incidence of melanoma and improved survival. The incidence of melanoma showed an annual increase of 6.1% from 1975 to 1981 but from1996 to 2005 it has slowed to 1.6%. Even more exciting from 1975 to 1989 the mortality rate increased 2.2% in men and 0.8% in women annually. Yet, from 1990 to 2005 the only significant change in melanoma mortality rates was a 0.6% decrease in woman12,13. Figure 2 highlights this divergence of the incidence and mortality of melanoma in US young adults14. Melanoma is a disease where timely diagnoses and treatment makes a significant difference in survival. A significant contributor to this improved survival is that people now know to see their dermatologists, get full body skin exam where skin cancers can be diagnosed and treated earlier.

 

As Americans are living longer, healthier lives, people want to look as young as they feel. More than 90% of visible changes attributed to skin aging are caused by the sun (42). Studies now show these changes can be prevented with sun protection. Over a 4.5 year period, people who used SPF 15 or higher sunscreen daily had 24% less skin aging than those who did not. It has also been show that daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by 40% and the risk of developing melanoma by 50% (Green A Lancet and Green A J clin oncol). Protecting oneself from the sun decreases ones risk of getting skin cancer and slows the signs of aging. These facts have increased the public’s demand for cosmetically elegant sunscreens and fashionable sun protective clothing hats and sunglasses. The skin cancer epidermic can be stopped. Please help.  

 

 Figure 1

 

Figure 2

 

 

 

 

 

 

References

 

  1. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer: Current status. Archives of Dermatology. 1996; 132: 436-442
  2. Pfahlberg A, Kolmel KF, Gefeller O.  Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma.Brit J DermatolMarch 2001; 144:3:471.
  3. Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study.J Dermatol Surg Onc 1983; 12:981-6.
  4. Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol2010; 146(3):283-287.
  5. Sun Protection. Cancer Trends Progress Report – 2009/2010 Update. National Cancer Institute.http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2007&chid=71&coid=711&mid.  Accessed November 1, 2010.
  6. National Center for Health Statistics, National Vital Statistics Reports. cdc.gov/nchs
  7. US Census Bureau, decennial census of population, 1900 to 2000; 2010 Census Summary File 1.
  8. Godar DE, Urbach F, Gasparro FP, Van der Leun JC. UV doses of young adults. Photochem Photobiol2003; 77(4):453-457.
  9. Gellar AC, Colditz G, Oliveria S et al. use of sunscreen, sunburning rates, and tanning bed use amoun more than 10,000 US children and adolescents. Pediatrics 2002; 109(6):1009-1014.
  10. Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA2005; 294(6):681-690.
  11. Centers for Disease Control and Prevention. Sunburn and sun protective behaviors among adults aged 18-20 years – United States, 2000-2010. MMWR Morb Mortal Wkly Rep2012; 61:317-22.
  12. Erickson C, Driscoll MS. Melanoma epidermic: facts and controversies. Clin Dermatol 2010; 28(3):281-6.
  13. Glocker-Reis LA, Melber D, Krapcho M et all. Editiors. SEER Cancer Statistic Review, 1975-2005, National Cancer Institute; 2008. Bethesda, MD.
  14. MP Purdue, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma amoung US Caucasian young adults. J Invest Dermatolo 2009; 128(12):2905-8.
  1. Gilchrest BA. Skin and aging process. CRC Press. 1984; 124.
  2. Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 2013 June; 158 (11):781-790.
  1. Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinoma of the skin: a randomized controlled trial. Lancet1999; 354(9180):723-729.
  2. Green A, Williams G, Logan V, Strutton G. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol2011; 29(3):257-263.
  3. Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesa, MD: National Cancer Institute;http://seer.cancer.gov/csr/1975_2009_pops09/; Accessed August 22, 2012.

 

 

  1. Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA2005; 294(6):681-690.

 

Survival with melanoma increased from 49 percent (1950 – 1954) to 92 percent (1996 – 2003).12

  1. Ries LAG, Melbert D, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2004. Bethesda, MD: National Cancer Institute;http://seer.cancer.gov/csr/1975_2004/. Accessed January 24, 2011.

 

 


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