My wife and I have just arrived in Hawaii to attend the American Medical Association House of Delegates meeting being held in Honolulu today through next Tuesday.
You may recall that last year at this time we were in Las Vegas, where the cigarette smoke in the casinos was (and remains) a major irritant.
Well, it’s hard to be here in this land of sun without thinking about a topic that is also near and dear to our hearts, and that is sun exposure and the risk of skin cancer.
Skin cancer is, in fact, ubiquitous, especially among older Americans like me.
The actual number of skin cancers diagnosed in the United States every year is difficult to determine, since it is not a figure that is closely tracked the way that breast and lung cancers are, as examples.
The American Cancer Society estimates that in 2007 there will be more than 1 million cases of basal cell or squamous cell skin cancer diagnosed in this country. Most of these cancers will be highly curable. But it is important to remember that, although curable, their treatment can be difficult and at times disfiguring, depending on how advanced the cancer may be and/or where it is located on the body.
On the other hand, the more serious form of skin cancer—called melanoma—will be diagnosed about 60,000 times in 2007. There will be close to 8,000 deaths from melanoma in the United States. In addition, there will be an estimated 48,290 very early, non-invasive cases of melanoma (called “melanoma in situ”) diagnosed this year.
Melanoma can be fatal, and the sad fact is that we haven’t made many significant advances in the treatment of melanoma since I began my oncology career in the early 1970’s. Unlike some of the other more common forms of cancer, we haven’t had significant improvement in our ability to treat the more advanced forms of the disease with new chemotherapy drugs or targeted therapies.
That is not to say we haven’t made progress in understanding how better to approach melanoma, or that there haven’t been some very exciting new research approaches to treating the disease (such as lymphocyte transfer, described here last year).
It’s just that we haven’t yet seen the types of advances that can be incorporated in to widespread clinical practice along the lines of what has occurred in breast or colon cancer.
Our American Cancer Society publication Cancer Facts and Figures 2007 notes that during the 1970’s, melanoma diagnoses increased 6% per year.
Since 1980, cases of melanoma have been increasing at a rate of 3% per year. That may not seem like much, but over time that number can accumulate significantly. In simpler terms, at that rate, melanoma cases will double every 24 years.
Perhaps there is some good news on this front. In our most recent “Annual Report to the Nation,” which was just published on October 15th, my epidemiology colleagues reported that in the time period 2000-2004, the incidence of melanoma in men increased “only” at a rate of 0.5% per year.
For women, the increase in annual incidence was calculated on data from 1981 to 2004. The annual increase in women is reported to be 2.3% per year, which is a significant number.
A similar analysis in that same report regarding deaths from melanoma showed some fairly good news for men. From 1975 through 1990, deaths from melanoma had been increasing 2.2% per year. From 1990 to 2004, there was no increase in death rates, nor was there a decrease. The “annual percentage change” (or APC) was 0%.
The change in death rates for women was not reported, since it is not one of the “top 15” causes of cancer deaths in this group. However, there may actually be some good news here, since another data source called SEER reports that from 2000-2004, death rates from melanoma in women have been declining at a rate close to 1.3% per year.
All of this information becomes interesting and important--beyond the very personal experiences of many people when it comes to the burden and suffering of skin cancers such as melanoma—when one considers that much of this disease can be prevented.
Yes, there have been academic discussions recently about how much skin cancer—especially melanoma—is related directly to sun exposure. But numerous reviews of this topic with my expert dermatology colleagues who know the research in this field leaves me to believe that skin cancer is a disease that can in many cases can be prevented through avoidance of sunburns and sun exposure, and proper use of sunscreens.
For all skin cancers—especially melanoma—the odds can be greatly improved with early diagnosis and treatment.
But we are not winning the war as quickly as we could.
In part, that’s because it’s the sun exposure early in life that not infrequently leads to the difficulties later in life. Making that connection in the real world and in the world of science—given the long time between the cause and the event—can create a significant “disconnect” when it comes to science and practical knowledge about skin cancer.
In a prior research article, my colleagues from the American Cancer Society reported data showing that our kids are not getting the message about sunburns. And, although they use sunscreen, they don’t use it effectively.
The sense of invincibility that many young people experience leads them to risk-taking behaviors. In medical terms, that means they do things such as smoking and getting tanned and burned at the beach, even though they know it isn’t is good for their health. (For example, take a look at the report this week about kids and smoking.)
But all of this doesn’t mean we should give up hope.
A couple of years ago, when I first started to become in involved in skin cancer prevention efforts on a national level, I participated in a breakfast meeting in New York.
The participants were a number of editors from leading fashion magazines, along with experts in the field of skin cancer.
We wanted to have a discussion with these opinion leaders about skin cancer and the importance of sun-safe behaviors. Influencing the influencers (the editors) who influence the audience (young women) would seem to be an appropriate way to approach young women at risk for premature skin aging and skin cancer.
Young women are known to emulate their role models, and many actresses, singers and others have been leading the way for our daughters to embrace tanning and poor attention to sun-safe behaviors, such as Slip! Slop! Slap! (Slip on a shirt, slop on the sunscreen and slap on a hat).
The discussion at my table was particularly interesting. Here I was with a group of about 10 editors, most of whom were quite young (at least when measured by my age), and none of them had a particular knowledge or awareness of the issue.
But as we went around the table, each one of them had a story about someone they loved who had skin cancer, and many of those stories were tragic, including disfiguring and repetitive treatments for skin cancer or deaths from melanoma. The last participant at our table told a story of a former boyfriend who, at a young age, was diagnosed and died from melanoma.
I must say that even I was taken aback by the experience. Here were 10 young women, all considered capable of influencing the direction of fashion and culture among their readers, and almost to a person each one of them had a close personal understanding of this “benign” cancer without being aware of it. A very clear picture came out of this discussion that this supposedly “simple” form of cancer wasn’t so “simple” after all.
The comments from the other discussion groups were not much different. But there was a clear picture that emerged that we weren’t dealing with a minor health problem when it came to tanning, sun exposure and the associated risks of skin cancer and premature aging.
There was no specific follow-up to that meeting that I am aware of.
This past week, while attending a meeting of the National Council on Skin Cancer Prevention, a representative of the Skin Cancer Foundation reported to us that they had recently done a survey and video on the attitudes of fashion editors for women’s magazines regarding tanning and skin cancer.
Their discussions revealed that many of these editors were reporting that sun tanning was no longer “in,” and that “glowing natural skin” was the order of the day.
The Skin Cancer Foundation has produced a video of some of these editors telling their stories, along with a very photogenic former Miss Maryland, who herself is a melanoma survivor. (The link to the video is found on this page, which discusses the Foundation's "Glow With Your Own Glow" campaign.)
I would suggest you take a look at this video. It is really impressive to see how attitudes have changed. It shows how these editors—who both influence and reflect fashionable behaviors—have come to understand the importance of this issue and its impact on the women they reach.
I don’t know that our breakfast meeting that day in New York really changed anyone’s mind, or editorial direction. Maybe it did, and maybe it didn’t.
I will say that there are those among us in the research and cancer control communities who are aware that we can have all the scientific understanding in the world about what we can do to prevent cancer, and that we can talk our heads off as we try to tell people what they should do to improve their health, and still not get people to listen to our message.
Unfortunately, despite our best efforts and intentions, we have great difficulty “moving the needle” when it comes to influencing public behavior.
If fashion editors are able to accomplish a goal that leads to results, then more power to them.
If helping them understand that this is a personal issue that affects all of us and that they really do have an opportunity to improve the health of the public, then maybe we need to do more of that type of activity.
In the meantime, our thanks to the editors and to the Skin Cancer Foundation for highlighting this fight against skin cancer.
This is one battle in the war against cancer that we can certainly win if we only did what we already know.