Alison Bowden spent her childhood summers playing at the Jersey shore, not giving much thought to the sun and its effects on her skin.
“I used sunscreen, but not rigorously, and I experienced sunburns and peeling,” says the 46-year-old resident of Marin County, California. Twenty years later, Bowden, then 35, was diagnosed with basal cell carcinoma, the most common type of skin cancer, making her one of the approximately 1.3 million people in the United States who received such news in 2004 alone, according to the American Academy of Dermatology.
Skin cancer rates are indeed on the rise: The incidence of basal cell carcinoma is estimated to be increasing by 5 percent to 10 percent per year. The number of diagnosed cases of malignant melanoma, the most serious and potentially life-threatening skin cancer, has more than doubled over the past 30 years. And young women have an extra worry. “Melanoma is the number-one serious cancer among women 25 to 29 years old and second to breast cancer among women 30 to 35 years old,” says Kenneth Linden, MD, PhD, a member of the dermatology faculty at the University of California, Irvine.
Theories abound as to why skin cancer has become so common. “Perhaps one factor is that American culture has encouraged people to wear fewer clothes,” says Linden. Other experts postulate that most people don’t apply and reapply enough sunscreen. Sunscreen users also tend to stay in the sun longer because they have a false sense of security that they are protected. Another suspect is increased ultraviolet B rays from a damaged ozone (see “Blown Ozone,” below).
Some studies have even explored a possible connection between melanoma and hormonal changes that occur during pregnancy, for example, but further research is needed, says James Grichnik, MD, PhD, director of melanocytic diseases at Duke University Medical Center in Durham, North Carolina.
Regardless of the causes, there’s no doubt that all of us—especially women—need to know everything we can about protecting our skin.
How it starts
So just how does skin cancer occur? Ultraviolet (UV) radiation, whether from the sun, tanning beds, or sunlamps, damages skin cells and results in a high number of mutations. A healthy immune system can repair some of this damage, but repeated assaults on skin cells can result in permanent genetic mutations. When mutated skin cells begin to multiply with abandon, the result is skin cancer.
UV rays are solidly implicated in the development of basal cell carcinoma and another type of skin cancer, squamous cell carcinoma. Identifying sunlight as a cause of all melanomas, however, is controversial, according to Linden. “We know sunlight causes some percentage of melanomas, but it is unclear what percentage,” he says. Still, melanoma has been linked with severe childhood sunburns as well as brief but intense exposure to the sun (for example, people from northern climates who lie out on a tropical beach during a winter vacation). Genetic makeup also plays a significant role. “Defective genes for melanoma have been identified,” says Grichnik. “About 10 percent to 15 percent of melanoma is hereditary.” Other known risk factors for all skin cancers include fair skin, blond or red hair, skin that freckles easily, a suppressed immune system, and repeated exposure to Xrays.
Having skin cancer once also increases the likelihood of getting it again. In fact, about half of the people who’ve had one diagnosis of basal cell carcinoma will develop another skin cancer within five years. Bowden was no exception: Within three years after discovering the basal cell carcinoma above her eyebrow, she was diagnosed with three more on her face, a common place for them to appear.
What to look for
If there’s any advantage to skin cancer versus other cancers, it’s that skin cancer is visible to the naked eye—and catching any cancer early is crucial to successfully managing or eliminating its development. According to the American Academy of Dermatology, you should be on the lookout for certain changes in your skin. Be alert to unusual and persistent formations on your skin—a pale, waxlike bump or a red, scaly patch or lump that may bleed—and especially to changes in any growths.
If you find a new mole, or one that has changed shape or color, apply the A-B-C-D-E test. If a mole is asymmetrical (the two halves look different); has an irregular border; has different colors or shades; has a diameter larger than a pencil eraser; or has increased in elevation, make a doctor’s appointment right away. If any new growth hasn’t gone away in two to three weeks (even if it doesn’t hurt, which it probably won’t), get it checked.
Although basal cell carcinoma and squamous cell carcinoma spread comparatively slowly, melanoma, which occurs deeper in the epidermis, is more virulent. Once melanoma has moved beyond its site of origin, it’s difficult to treat. Melanoma can occur anywhere, but women tend to find it on their legs more than men do. And although African Americans are much less likely to develop melanoma than lighter-skinned people, they tend to get it in areas not exposed to the sun, such as the soles of the feet, toenails, and genitals. “If you have a family history of melanoma or numerous, large, or atypical moles, you should perform a self-check once a month,” advises Grichnik. “And if you have a mole that seems different from others, particularly if it is changing, it should be checked be a doctor.” Even if you don’t have special risk factors, you should perform a self-examination every three months and get checked by your doctor annually.
Most of us now know that the best way to prevent skin cancer is to stay out of the sun during the most intense UV hours—the two hours before and after the sun is highest in the sky, or approximately 10 a.m. to 4 p.m. Because this is hard for most active people, the next best defense is good protective clothing. Lightweight long pants and long sleeves are best, along with UV-protective sunglasses and a broad-brimmed hat (not just a baseball cap, which doesn’t cover the ears or the back of the neck). There’s even specific sun-protective clothing, such as Sun Precautions and Coolibar brands, as well as photoprotective laundry additives such as Rit Sun Guard that can last a couple dozen launderings. “The third line of defense is a broad-spectrum [UVA- and UVB-protective] sunscreen,” says Grichnik (see “Sunscreen Tips,” below, for more information).
More exciting developments in prevention involve the use of antioxidants, which “help protect DNA from UV damage,” says Paul Reilly, ND, LAc, a clinician at the Seattle Cancer Treatment and Wellness Center and coauthor of How to Prevent and Treat Cancer with Natural Medicine (Riverhead, 2002). According to Reilly, green tea may make it harder for abnormal cells to grow; fish oils and fractionated pectin (modified citrus pectin from the peel and pulp of citrus fruits) block metastasis, or the spread of cancer cells; and curcumin and ginseng may encourage apoptosis (a process that eliminates DNA-damaged cells).
The body also naturally uses vitamins C and E to protect against sunburn. Researchers have found that topical combinations of those vitamins can provide UV protection (Journal of the American Academy of Dermatology, 2003, vol. 48, no. 1). Silymarin, a plant flavonoid from milk thistle (Silybum marianum); white tea; and pomegranate fruit extract are also being investigated for UV protection. “I recommend using both a moisturizing cream with green tea or vitamins C and E and sunscreen, or a sunscreen that includes those ingredients,” says Reilly.
To promote optimum health and a strong immune system, Reilly recommends a diet rich in fruits and vegetables, a few cups of green tea daily, omega 3–rich seafood two or three times a week, lean protein, and minimal refined carbohydrates. Exercising regularly, maintaining a healthy weight, avoiding sunburn, and taking a high-potency multivitamin, extra vitamin C, and an antioxidant blend also contribute to a healthy, cancer-preventive foundation, he says.
Although improved topical solutions continue to be researched, what you can do immediately is practice prevention efforts and instill good sun habits in your children. As of 2000, only 12 states and the District of Columbia had implemented policies for required sun safety or skin cancer prevention in both elementary and high schools. Some parents are taking the initiative to educate teachers about ways they can help during the school day, such as making sure young students apply sunscreen before going outside. In addition, even though 90 percent of pediatricians surveyed last year indicated that skin cancer is a significant problem during childhood, only 22 percent reported counseling patients about it (Pediatrics, 2004, vol. 114, no. 4).
Skin damage is cumulative, so it’s never too early or too late to start exercising more care in the sun. Alison Bowden may not have been a rigorous applier of sunscreen as a child, but she is now. And she has a collection of hats and sunglasses to help keep her skin healthy for years to come.
San Francisco–based freelance writer Katrina Mather is an avid sunscreen user.