Here’s a sobering fact: Since the 1980s, incidences of melanoma, the deadliest form of skin cancer, have doubled. “The statistics are staggering — mortality rates for melanoma are increasing faster than those for all other common cancers after esophageal cancer,” says Elizabeth Hale, a dermatologist in New York City and a senior vice president of the Skin Cancer Foundation. “Skin cancer is such a unique cancer because we know exactly what causes it — the sun’s ultraviolet rays — and we can limit sun exposure,” says Hale. Yet over the last 30 years, more people have had skin cancer than all other cancers combined, a fact as confusing as it is scary.
“It’s an epidemic among young women.”
Skin cancer used to be incredibly rare for anyone in their 20s, 30s, or early 40s. “We thought it was a disease for grandparents,” says Hale. That’s not the case anymore: Young women are getting melanoma, and squamous- and basal-cell carcinomas (less-aggressive but still potentially deadly forms of skin cancer) are increasing. Just stop and think about that for a second: An age group that almost never got skin cancer before is increasingly being diagnosed with the disease. Melanoma is now the third-leading cancer diagnosis in women under 49.
The X factor here: These young women are part of the first generation that hopped into tanning beds in their teens. (Tanning beds became widely available around the late 1980s.) “In so many ways, we can attribute increasing skin-cancer rates to the invention of indoor tanning,” says Steven Q. Wang, a dermatologist and the director of dermatologic surgery and dermatology at Memorial Sloan Kettering Cancer Center in Basking Ridge, New Jersey.
Using indoor tanning beds before age 35 can increase your risk for melanoma by over 50 percent.
Using indoor tanning beds before age 35 can increase your risk for melanoma by over 50 percent. “But when you’re young, you think you’re invincible, and indoor tanning was incredibly popular when these women were 15, 16 years old,” says Wang. We know tanning beds cause melanoma — the ultraviolet radiation from these beds is as much as 12 times more powerful than that from the sun — “and the cancerous mutations they cause can take more than a decade to show up, so we’re seeing them now. It’s created a skin-cancer epidemic among young women.”
And threats to the Affordable Care Act could help the pattern continue: Under the ACA, there’s an excise tax on indoor tanning salons that, says Wang, has helped put many of them out of business and could dissuade a new generation of teens from tanning when health concerns aren’t enough to stop them. If the tax goes away, so does that deterrent. Hopefully changes on the state level will continue, though. “We’re seeing more and more states pick up laws restricting minors from using tanning beds, and policy changes that protect community youth can make a difference in cancer rates in the long run — look at cigarettes,” says Dawn Holman, a behavioral scientist at the Centers for Disease Control and Prevention, who specializes in researching ways to reduce cancer incidence in the U.S. (It’s a good comparison; in 2009, the World Health Organization reported that tanning beds are as carcinogenic as cigarettes and arsenic.)
You’d sit on your roof and bake and get sunburned.
“There’s no tan like a Coppertone tan!” “Don’t be a paleface!” These were actual advertisements in the ’50s, ’60s, and ’70s. You’d never see that kind of thing now, but 40 years ago? Completely standard. We’re talking about a time when everyone would grab reflective foils and tanning oil, go sit on a roof, and bake. While the spike in skin-cancer cases in young women is alarming, “we’re still seeing the most steady increase in melanoma in adults over 65, who grew up in a time when social norms related to sun safety were different,” says Holman. “Laying out” on weekends is no longer a national pastime, “but for generations that tanned growing up, that damage manifests as skin cancers for adults in their 40s and beyond,” says Wang.
Sunburns at any age are especially dangerous. “Farmers and sailors who work outside rarely get melanoma, even though they’re in the sun all the time,” says Hale. “It’s people who live in temperate climates and then go on vacation and get bursts of intense sun exposure and burn that get melanoma.” Having five serious sunburns between the ages of 15 and 20 increases your risk for melanoma by 80 percent, according to the American Academy of Dermatology.
And while those reflective foils and tanning oils are (mostly) a thing of the past, sunburns didn’t die with the ’70s. “We’ve studied sunburns for the last 15 years, and honestly, the trend has flatlined. Americans continue to get about the same number of sunburns every year,” says Holman. And now global warming may pose a potential new threat — according to NASA, 2017 was the second-warmest year on record. “It’s an emerging issue, and there are researchers looking at the ways changes in weather patterns over time may influence skin-cancer risk, although we don’t have specific data on this yet,” says Holman.
Tips for Safe Self Tanning
Black patients have lower survival rates.
Skin cancers like melanoma are relatively easy to diagnose — “Your skin is a visible organ,” says Hale — and when it’s caught early, the five-year survival rate for melanoma is 99 percent. “But melanoma is still one of the only cancers with increasing mortality rates. We’re getting better at treating it, and still people continue to die.”
The survival rate is lowest for men over 50, who generally see dermatologists less often than women. And there’s a shocking racial disparity: For black men and women of any age, the estimated five-year melanoma survival rate is only 69 percent, versus 93 percent for white patients, who tend to be diagnosed earlier. “Early detection directly saves lives,” says Hale. “Everyone should be getting annual screenings, regardless of skin color” — and then hopefully we can turn these numbers around.
The problem is, not everyone agrees. While the Skin Cancer Foundation recommends universal annual skin checks, they’re not recommended by the U.S. Preventive Services Task Force yet. Under the Affordable Care Act, insurers aren’t required to cover skin checks. And even if a check is covered — by your insurance or through one of the many free screening options you can find on aad.org — a lot of people, including young patients and black patients, just don’t think they’re at risk.
Early detection is key. We have to get you into the dermatologist’s office.
“We’ve made incredible advances in treating skin cancer,” says Hale. Dermatologists are better at diagnosing it, so they’re catching more of them; “it’s another reason skin-cancer rates are going up, and that’s a good thing,” she says. “But early detection is key. We have to get you into the dermatologist’s office.” That’s assuming you can get to a dermatologist, something that’s not always a given: In some rural areas, the closest dermatologist may be 100 miles away. “People in remote or rural areas are at greater risk of death from skin cancer because of lack of access to screening, diagnosis, and treatment,” says Hale.
It’s hard to get excited about sunscreen.
Go to a beach now, and you’ll see kids in rash guards. A lot of kids in rash guards. “Parents are teaching sun safety at a much younger age, which makes me hopeful for the future,” says Wang. But if you didn’t grow up using sunscreen, you’re less likely to wear it as an adult. So some states, like Arizona, have passed laws requiring sun-safety education in health class.
Because if you want to prevent skin cancer, you wear sunscreen. It’s as simple as that — except when it isn’t. “People in low-income households are least likely to use sunscreen,” says Holman. “If you’re trying to make ends meet day to day, buying sunscreen is probably the last thing on your mind.” Some communities have built shade structures in parks and playgrounds, but the best model might be cities like Boston and Austin — they’ve started putting sunscreen stations in public spaces, like parks and stadiums.
Sunscreen can reduce your risk of melanoma by 50 percent.
If you are lucky enough to comfortably afford sunscreen — which can reduce your risk of melanoma by 50 percent — you’re still up against a psychological barrier to wearing it daily. “Sunscreen is a preventative product. You don’t see the benefits right away, so it’s hard to get excited about it,” says Kit Yarrow, a consumer psychologist, professor at Golden Gate University, and author of Decoding the New Consumer Mind: How and Why We Shop and Buy (Jossey-Bass). Trick yourself into wearing one daily by choosing a formula with a tint (if it makes your skin look better on the spot, you’ll be way more likely to use it).
“Small changes can have huge impacts,” says Wang. Wear a hat. Go running early in the morning, when the sun is weak. Put your sunscreen next to your toothpaste. In a recent study, Wang found that participants whose sunscreen was in a box with their toothpaste used 20 percent more sunscreen. “It set off a chain reaction that actually changed people’s habits.” And then we could be having a very different conversation in another 10 years.
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