Question of the Week

August 7, 2006


As people head outdoors to enjoy the final weeks of summer, the World Health Organization (WHO) has some words of caution...

"Around 60,000 people worldwide die each year from skin cancer caused by too much sun exposure, according to a new estimate by the World Health Organization (WHO). The agency released a report Thursday detailing 9 diseases and conditions caused by ultraviolet (UV) radiation, and estimating their impact on global health. Melanoma is the deadliest disease caused by the sun, and the primary cause of UV-related disease in the Americas, Europe, Australia, New Zealand, Brunei, Japan and Singapore. ... The report serves as an important reminder to take precautions in the sun, said Martin A. Weinstock, MD, a professor of dermatology at Brown Medical School and chair of the American Cancer Society's Skin Cancer Advisory Group. ... The WHO report lists solar keratoses (a type of skin spot that can lead to cancer), sunburn, cataracts, cold sores, and pterygium (an eye condition) as other diseases directly caused by too much sun."

While it is important to take precautions at every age, many children and teens do not understand the need.

"To disseminate information about the importance of minimizing UV exposure during childhood, CDC published Guidelines for School Programs to Prevent Skin Cancer in CDC's Morbidity and Mortality Research and Recommendations Report. Intended to help state and local education agencies and schools play a role in reducing unsafe sun exposure, this publication includes recommendations on
* Establishing policies that reduce exposure to UV radiation.
* Maintaining an environment that supports sun-safety practices.
* Providing health education to students.
* Involving students' families.
* Training health care professionals.
* Evaluating school skin cancer prevention programs."

Educating children, teens, and their families about sun safety is important, but it is also necessary to educate the teachers, coaches, and school officials.

"Acknowledging that students spend a significant amount of time in the sun during school hours and after school in sports and recreation programs, as well as that unprotected exposure to the sun in childhood and adolescence contributes significantly to the incidence of skin cancer, the state legislature/state board/local school board intends that schools shall take measures to protect student health. All students should possess the knowledge, attitudes, and skills necessary to protect their skin from harmful sun exposure and thereby help to prevent skin cancer. The state legislature/state board/local school board further recognizes that skin cancer prevention is important for all school workers, particularly for those who spend significant portions of their day in the sun. Finally, the state legislature/state board/school board acknowledges the essential role of family and community involvement in the school sun safety program. It is not the intent of this policy that schools eliminate physical education or other outdoor programs during or after school. Students need daily, vigorous exercise, but they also need to protect their skin from overexposure to the sun."

The challenge can often be in finding a balance. Schools need to balance the need for students to have "daily, vigorous exercise" with the need to protect their skin from over-exposure to the sun. It is also important that schools, teachers, parents, and students understand that not all sun exposure is bad.

"The promises and pitfalls of vitamin D deserve more research, according to the American Cancer Society (ACS) and 7 other health groups. ... 'There is no dispute among medical professionals that vitamin D is beneficial for our health, and there is no dispute that sun exposure is the major source of vitamin D for most of us,' said ACS deputy chief medical officer Len Lichtenfeld, MD, who participated in the conference. 'But there is also no dispute that exposure to ultraviolet (UV) rays from the sun and other sources can be harmful. ... If vitamin D is good for you, and exposure to the sun is bad for you, what do you do?' Lichtenfeld explained."

What do you do? The advice can be confusing.

"The use of sunscreens has become controversial lately, said Wolf. Some experts are concerned that people will extend their stays in the sun because they are convinced that the sunscreen will protect them. 'If you were ordinarily going to spend two hours in the sun and you use a sunscreen before going out for your two hours, the sunscreen will help you,' he said. If you ordinarily spend two hours in the sun, but when you use sunscreen, you end up spending six hours in the sun, you could end up with damage you might not have had."

Even as improvements are made, no one sunscreen can offer complete protection and make time in the sun 100% safe. There is always new research; there is always new technology; there are always new products. The new sunscreens may offer more thorough protection, but even they are not perfect.

"The Food and Drug Administration (FDA) approved Anthelios SX, an over-the-counter sunscreen that offers protection from both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. Most sunscreens sold in the United States mainly block UVB rays, which helps prevent sunburn and other types of skin damage. But Anthelios offers better protection from deeper penetrating UVA rays, according to the manufacturer. ... What does this mean to you? Anthelios offers various advantages to traditional sunscreens. ... And there's more to skin protection than sunscreen. In addition to using a broad-spectrum sunscreen with a sun protection factor of at least 15, it's important to limit your time in the sun -- especially between 10 a.m. and 4 p.m., when the sun's harmful rays are strongest. When you're outdoors, wear a broad-rimmed hat and tightly woven clothing that covers your arms and legs. Avoid tanning beds and tan-accelerating products. 'No sunscreen is a substitute for avoiding the most intense sun of the day and wearing appropriate clothing,' Dr. Gibson says."

Some might contend that "appropriate clothing" is a t-shirt and shorts. Others might say that a long sleeve shirt and long pants are necessary for appropriate protection. Still others argue that only clothes made of fabric that is specifically designed to protect the wearer from the sun will do.

"The January 2001 edition of ASTM Standardization News announced the USA standards for sun protective fabrics... now the most stringent UV-protective clothing standards in the world! The new units for UV protection are called UPF (Ultraviolet Protection Factor). UPF is like the sun protective factor SPF used on sunscreen lotion bottles and fabrics today, in that both UPF and SPF measure sunburn protection. One difference between UPF ratings and SPF ratings is that UPF measures both UVB and UVA radiation blocked. SPF is a measurement of UVB radiation only. UPF rated fabric requires that fabrics claiming to be sun protective must be prepared in the following ways before testing:
1. Undergo 40 simulated launderings
2. Be exposed to 100 fading units of simulated sunlight (equivalent to 2 years light exposure)
3. And, if intended for swim wear, exposure to chlorinated water"

Sunscreen has its limits, and not everyone wants to spend their time in the sun completely covered in protective clothing. Even with all the new products on the market, the best way to protect the skin from sun damage is knowing when to head for the shade.

"As the bikini turns 60, it's entering the electronic age with a new model featuring a built-in alarm to warn wearers to get out of the sun -- and ease concerns that the scanty swimsuits damage the health. ... So Canadian company Solestrom has come up with a new bikini that goes on sale next month with a UV meter built into its belt and an alarm that beeps to tell wearers when to head to the shade. 'There's so much concern about sun exposure and skin cancer that we saw the demand and designed something to be safe for the wearer,' Solestrom spokeswoman Emily Garassa said. Garassa said the meter on the $190 bikini displays a level of UV intensity on a scale from 0 to 20. A person's sensitivity to UV depends mainly on skin type, but generally three to five would be considered moderate strength, 8-10 very high and anything above 11 extreme. Garassa said the company was already seeing high demand from Australia and South Africa, which have the world's highest skin cancer rates. The United States has about 1 million new skin cancer cases each year."

Questions of the Week:
How can you get the vitamin D that you need without damaging your skin? How can you protect yourself from the sun without spending a lot of money on special products? What do your friends, peers, and family members need to know about the benefits and hazards associated with exposure to the sun? What would be the best way to educate children with what they need to know in order to make healthier choices about sun exposure? What would you do differently (and what would be the same) if you wanted to reach teens or adults with that same information?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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