By Jenna Rosenstein, Allure
An entire generation of women has grown up schooled on the critical importance of sunscreen. So why are more of us being diagnosed with skin cancer than ever?
[post_ads]Because I spent the first 18 years of my life in south Florida, I learned early that people either love the sunshine or are, like me, shade-seeking vampires. My mother was in the first group—a member of the baby-oil-and-reflector club—until she was diagnosed with malignant melanoma, the most aggressive form of skin cancer, at age 23 (she found a second melanoma in 2000; both were removed with surgery). I wore her diagnosis like a permanent wide-brimmed hat throughout my childhood, knowing that my risk of developing one as well was significant. I did my eighth-grade science-fair project on skin cancer. I never let myself tan. (My prom makeup artist had to pull my foundation shade, alabaster, out of storage: "I have never used this on anyone in Miami before!" he marveled.) I stood out like a fir among palms.
But it wasn't just my pallor that made me the odd girl out; my ardent commitment to sun protection did, too. I wore dorky cover-ups at the pool and performed sunscreen-application ambushes on my friends. There was a disconnect between what I knew—that all UV exposure, at the beach and during a normal day, contributes to premature aging and skin cancers—and what my perfectly smart peers were doing. Hitting the beach after school was a common social activity, as was indoor tanning. Nothing could stop them from baking.
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So why is it so hard to get young women, my friends included, to quit tanning, both outdoors and in? The main reasons are as simple as they are intractable: Many young women love the way a tan looks—and the way the sun feels. "If you can't tone it, tan it" is a phrase I've actually heard from a handful of friends. "In my research, people say it makes you look healthy, thinner, and outdoorsy," says Joel Hillhouse, an associate dean of research at East Tennessee State University in Johnson City, who specializes in skin cancer and tanning. And when someone regularly tans, they're hooked on that warm, happy, energized feeling. UV exposure releases endorphins, which is possibly why people with seasonal affective disorder or low serotonin levels are more likely to be frequent indoor tanners. A recent study even found a genetic link to tanning addiction.
[post_ads]Because I spent the first 18 years of my life in south Florida, I learned early that people either love the sunshine or are, like me, shade-seeking vampires. My mother was in the first group—a member of the baby-oil-and-reflector club—until she was diagnosed with malignant melanoma, the most aggressive form of skin cancer, at age 23 (she found a second melanoma in 2000; both were removed with surgery). I wore her diagnosis like a permanent wide-brimmed hat throughout my childhood, knowing that my risk of developing one as well was significant. I did my eighth-grade science-fair project on skin cancer. I never let myself tan. (My prom makeup artist had to pull my foundation shade, alabaster, out of storage: "I have never used this on anyone in Miami before!" he marveled.) I stood out like a fir among palms.
But it wasn't just my pallor that made me the odd girl out; my ardent commitment to sun protection did, too. I wore dorky cover-ups at the pool and performed sunscreen-application ambushes on my friends. There was a disconnect between what I knew—that all UV exposure, at the beach and during a normal day, contributes to premature aging and skin cancers—and what my perfectly smart peers were doing. Hitting the beach after school was a common social activity, as was indoor tanning. Nothing could stop them from baking.
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So why is it so hard to get young women, my friends included, to quit tanning, both outdoors and in? The main reasons are as simple as they are intractable: Many young women love the way a tan looks—and the way the sun feels. "If you can't tone it, tan it" is a phrase I've actually heard from a handful of friends. "In my research, people say it makes you look healthy, thinner, and outdoorsy," says Joel Hillhouse, an associate dean of research at East Tennessee State University in Johnson City, who specializes in skin cancer and tanning. And when someone regularly tans, they're hooked on that warm, happy, energized feeling. UV exposure releases endorphins, which is possibly why people with seasonal affective disorder or low serotonin levels are more likely to be frequent indoor tanners. A recent study even found a genetic link to tanning addiction.
"When someone is tanning, you see changes in the brain in the same area associated with other addictive behaviors," says Brenda Cartmel, a senior research scientist at Yale School of Medicine and the author of the study. "After all, one hallmark of addiction is that you continue with the same behavior even though you know it's harmful." Combine that endorphin rush with all the things we regularly associate with summer—white bikinis, rooftop pools, BBQs—and it's hard to see the sun as evil. "Our relationship with the sun is inherently ambivalent," says Ellen Marmur, an associate clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. "The sun gives us energy, and it has amazing healing properties. It's not all bad. But it's hard to know the balance."
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Here's what we do know: Skin-cancer rates have been on the rise for 30 years, despite decades of lectures about sunscreen. Skin cancer is the most common cancer in this country. Nearly 5 million Americans are treated for the disease each year, and the incidence rate is up 300 percent from 1994. Indoor tanning alone is linked to 419,000 cases of skin cancer a year in the U.S. Though melanoma represents only a small percentage of diagnoses, it can spread fast and be lethal, and it's the most common form of cancer among young adults aged 25 to 29. Between 40 and 50 percent of all Americans who reach age 65 will develop a basal-cell or squamous-cell carcinoma. It's a misconception that these are never deadly; they're sometimes fatal and can be disfiguring. "The rise in skin-cancer rates boils down to UV exposure," says Dawn Holman, a behavioral scientist in the division of cancer prevention and control at the CDC and a lead writer of the Surgeon General's Call to Action to Prevent Skin Cancer. "If we can decrease that, we can decrease the number of skin cancers."
By now, we all know better than to lie outside slathered in baby oil. You see tubes of sunscreen scattered on every Florida beach I went to growing up. The sunscreen section at the drugstore is as packed with options as the shampoo aisle, and we use daily moisturizers with SPF. But we're still not doing enough. Most skin cancers are preventable, but while the Skin Cancer Foundation and dermatologists have preached a multipronged approach—including seeking shade during the peak sun hours of 10 a.m. to 4 p.m., covering up with clothing, and using sunscreen daily—the only rule that seems to have stuck so far is the last one. Which isn't a good thing. Sunscreen works, but it shouldn't be mistaken for a foolproof, magical elixir.
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Here's what we do know: Skin-cancer rates have been on the rise for 30 years, despite decades of lectures about sunscreen. Skin cancer is the most common cancer in this country. Nearly 5 million Americans are treated for the disease each year, and the incidence rate is up 300 percent from 1994. Indoor tanning alone is linked to 419,000 cases of skin cancer a year in the U.S. Though melanoma represents only a small percentage of diagnoses, it can spread fast and be lethal, and it's the most common form of cancer among young adults aged 25 to 29. Between 40 and 50 percent of all Americans who reach age 65 will develop a basal-cell or squamous-cell carcinoma. It's a misconception that these are never deadly; they're sometimes fatal and can be disfiguring. "The rise in skin-cancer rates boils down to UV exposure," says Dawn Holman, a behavioral scientist in the division of cancer prevention and control at the CDC and a lead writer of the Surgeon General's Call to Action to Prevent Skin Cancer. "If we can decrease that, we can decrease the number of skin cancers."
By now, we all know better than to lie outside slathered in baby oil. You see tubes of sunscreen scattered on every Florida beach I went to growing up. The sunscreen section at the drugstore is as packed with options as the shampoo aisle, and we use daily moisturizers with SPF. But we're still not doing enough. Most skin cancers are preventable, but while the Skin Cancer Foundation and dermatologists have preached a multipronged approach—including seeking shade during the peak sun hours of 10 a.m. to 4 p.m., covering up with clothing, and using sunscreen daily—the only rule that seems to have stuck so far is the last one. Which isn't a good thing. Sunscreen works, but it shouldn't be mistaken for a foolproof, magical elixir.
"The number-one problem with sunscreens—all formulas—is that the average patient does not apply enough," says David Herschthal, the doctor who treated my mother's second melanoma and a professor of dermatology at the University of Miami Miller School of Medicine. "Number two is that they don't reapply it. They have a false sense of empowerment." That sense of invincibility, coupled with the lingering desire to achieve a moderate tan, leads to risky sunscreen behavior. "In the beginning of the summer, women will slather on lots of sunscreen so they don't get burned," says Hillhouse. "But over time, they slowly back off so they can get a tan. But any tan still indicates damage."
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Another problem is that until recently, sunscreens most effectively blocked UVB radiation, the kind that turns your skin red. The sun's other radiation, UVA, doesn't burn as severely, but it does age your skin and cause the DNA damage that leads to skin cancers. (In fact, says Hillhouse, there's some evidence that use of the older, UVB-only formulas allowed people to stay out longer in the sun without burning, leading to increased UVA-radiation damage.) It wasn't until 2011 that the FDA introduced the broad-spectrum test, which ensures that sunscreens block both UVA and UVB rays effectively. (If a sunscreen isn't labeled broad-spectrum, the SPF refers to only UVB radiation, not UVA.) It's an improvement, but anybody who's ever vacationed in the south of France (lucky) knows just how good European sunscreens are—silkier, more powerful.
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Another problem is that until recently, sunscreens most effectively blocked UVB radiation, the kind that turns your skin red. The sun's other radiation, UVA, doesn't burn as severely, but it does age your skin and cause the DNA damage that leads to skin cancers. (In fact, says Hillhouse, there's some evidence that use of the older, UVB-only formulas allowed people to stay out longer in the sun without burning, leading to increased UVA-radiation damage.) It wasn't until 2011 that the FDA introduced the broad-spectrum test, which ensures that sunscreens block both UVA and UVB rays effectively. (If a sunscreen isn't labeled broad-spectrum, the SPF refers to only UVB radiation, not UVA.) It's an improvement, but anybody who's ever vacationed in the south of France (lucky) knows just how good European sunscreens are—silkier, more powerful.
That's because overseas, sunscreen manufacturers have many more ingredients to choose from. Here on U.S. soil, sunscreens are treated like drugs, which means new ingredients are incredibly slow to be approved. Since 1999, there has been just one new active sunscreen ingredient approved by the FDA (and that was for limited use). For eight additional sunscreen applications, the agency has asked for more data, even for some ingredients that are used in Europe. President Obama passed the Sunscreen Innovation Act last November, and that law aims to get better ingredients approved—though how soon is still in question—because if we're going to be relying so heavily on sunscreen, it had better be good.
Smart sun protection should not be a matter of dodging the sun entirely, because where's the fun in that? Even a relative vampire like myself enjoys a day (or several) at the beach. What we should really aim for is knowledge: knowing when you've been out too long, knowing when you should see a doctor, knowing that sunscreen is only one part of the sun-protection equation. And once that information is as commonplace as a surgeon general's warning, it will be easier to enjoy the sun—a lot more safely.
For more on skin cancer:
Smart sun protection should not be a matter of dodging the sun entirely, because where's the fun in that? Even a relative vampire like myself enjoys a day (or several) at the beach. What we should really aim for is knowledge: knowing when you've been out too long, knowing when you should see a doctor, knowing that sunscreen is only one part of the sun-protection equation. And once that information is as commonplace as a surgeon general's warning, it will be easier to enjoy the sun—a lot more safely.
For more on skin cancer:
