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Prevention for Everyone

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  3. Prevention for Everyone
  • Children under 6 months should never be in the sun.
  •  Stay out of the sun between 10-4. If you must go out, and everyone does, COVER UP with sunblock, hats, sunglasses, and clothing. Get a car window sunscreen. Most Americans have skin cancers on the left side of their face; you receive a lot of unnoticeable radiation driving in the car.
  •  There is no such thing as a safe tan (UV radiation damages DNA – a few bad burns can set it in motion). “A tan is not healthy. A healthy tan is almost an oxymoron, because a tan is a body’s reaction to the damage from the sunlight. It represents damage to the skin, can one outcome is skin cancer.” Dr. Scott Fosko, Chairman of Dermatology at St. Louis University School of Medicine, St. Louis Post-Dispatch, June 23, 2003, Health and Fitness Section.
  •  Just say NO to teenagers in tanning booths. Don’t use as a reward for good grades, prom, or pre-vacation. Ultraviolet radiation from a solarium is more intense than natural sunlight; 20 minutes in a solarium can be equivalent to approximately four hours in the sun. www.sunsmart.com.su/s/facts/solariums.htm
  •  Indoor tanning is big business, with tanning trade publications reporting this as a $2 billion_a_year industry in the United States. According to industry estimates, 28 million Americans are tanning indoors annually at about 25,000 tanning salons around the country. http://www.skincancer.org/artificial/index.php
  •  Promote the use of self-tanners and bronzing creams. The teenage years are an age based on the importance of looks, so if you must, promote the use of DHA staining products that “paint” the skin. These are available OTC as sunless tanning lotions and in some tanning salons as sunless spray booths and are a safe alternative.
  •  Avoid tanning pills that contain either canthaxanthin or large doses of beta carotene. These can have serious side effects.
  •  Tanning pre-vacation to prevent burn is a myth. To give you an idea, a tan is equivalent to a SPF of 2 sunscreen. www.sunsmart.com.au/s/facts.tanning.htm
  •  Skin damage has occurred once you tan. “‘Tanning is a response to injury,’ Dr. Steven Spencer, a Dartmouth medical school dermatologist who worked on the study.” Study published in the Journal of the National Cancer Institute, February 2002.
  •  Start behaviors young – teach children to apply sunblock in the morning after brushing teeth.
  •  Have to change the current mind set of our youth. Tanning is the “smoking of the new millennium.” It is easily preventable as a cancer. The School Health Policies and Programs Study (SHPPS 2000) conducted by the CDC in 2000, found that only 13 of 50 states require primary and secondary schools to teach sun safety/skin cancer prevention programs. Available at www.cdc.gov/nccdphp/dash/shpps/summaries/health_ed/tabl…
  •  But the real problem is that we are not addressing this issue, even the YRBSS (Youth Risk Behavior Surveillance System), a survey for high school students conducted by the CDC, summary results for the state of Missouri, 2001, address use of safety belts; driving while drunk; tobacco, marijuana, cocaine, and alcohol use; body weight; diet; physical exercise; sexual intercourse, and birth control, but nothing about sun safety. Available at www.cdc.gov/nccdphp/dash/yrbs/2001/summary_results/misso… and http://www.cdc.gov/nccdphp/dash/yrbs/2003/questionnaire.htm
  •  Remember that solar damage is cumulative. It will catch up with you. Ignoring its damaging effects now will not keep you from experiencing them later. It has been estimated that 80% of your lifetime sun exposure occurs before the age of 18.
  •  Keep an eye on grandparents. Annually, 36% of the new melanoma cases occur in the population over the age of 65, with males having 22% and females 14%, respectively. Also melanoma tends to be more fatal in this age group due to later diagnosis. American Journal of Preventive Medicine 2001; 20(3S):44-6. Healthcare Research & Quality, Rockville, MD. Available at www.ahrq.gov/clinic/ajpmsuppl/skcarr.htm

A. Know your skin type 
See chart below

TABLE 1: Classification of Sun-reactive Skin Types2*

Skin TypeHistory of Sunburning or Tanning
IAlways burns easily, never tans
IIAlways burns easily, tans minimally
IIIBurns moderately, tans gradually and uniformly(light brown)
IVBurns minimally, always tans well(moderate brown)
VRarely burns, tans profusely(dark brown)
VINever burns, deeply pigmented(black)

* Based on 45 to 60 minutes of sun exposure after winter or no sun exposure.

B. Know your area’s daily UV index
See chart below This index is formulated by the National Weather Service based on altitude, cloud cover, sun position, and other elements.

TABLE 2. Exposure Levels Predicted by the UV Index43*

Index ValueExposure LevelTime in Sun Needed for Burn
0 to 2Minimal1 h
3 to 4Low30-60 min
5 to 6Moderate20-30 min
7 to 9High13-20 min
10 to 15Very High<13 min

* These UV effects are on unprotected skin type II, which usually burns easily and tans minimally

Above charts taken from American Academy of Pediatrics Policy Statement. “Ultraviolet light: a hazard to children (RE9913).” Volume 104, Number 2. August 1999, pp. 328-333. Available at http://www.aap.org/policy/re9913.html.

C. All sunblock is not created equal – need both UVA/UVB coverage

UVA,UVB,UVC radiation definitions:

  • UVA (320-400 nm): long wavelength, reaches biosphere, little affected by ozone. Causes deep tissue damage especially loss of collagen and wrinkling. Now found to be responsible for skin cancer. These are the rays used in tanning booth bulbs.
  • UVB (280-320 nm): shorter wavelength, reaches biosphere, very affected by ozone which can block UVB, causes skin cancer, cataracts, macular degeneration. Considered the “burning” rays.
  • UVC (100-280 nm): very short wavelength, little reaches biosphere due to absorption and scattering by atmospheric oxygen, nitrogen and ozone, can be dangerous but little reaches humans.

From paper titled: Ultraviolet Radiation by E. C. Weatherhead.

D. What is SPF?

Sun protection factor is the amount of radiation it takes to produce a pink color (burn) on sunscreen-protected skin 24 hours later compared to the amount of UVR required to produce the pink color on skin without sunscreen. The higher the SPF, the greater the protection; a person who would normally experience an effect within 10 minutes can be protected up to about 150 minutes (10 x 15) with an SPF of 15. Gilmore GD. Sunscreens: a review of the skin cancer protection value and educational opportunities. Journal School Health. 1989;59: 210-213.

This is based on appropriate amount applied, reapplication, and only refers to UVB rays, not UVA.

  • SPF numbers indicate sunburn protection from only UVB rays
  • The FDA will be requiring new labeling of sun lotions in 2005 to measure the effectiveness of UVA protection.
  • SPF values are interpreted as the time it takes for skin to burn with sunscreen compared to the time it would take unprotected skin to burn
  •  Percentage of protection

    SPF 15 = 92 %
    SPF 30 = 97 %
    SPF 40 = 97.5 %

  • Only opaque substances like zinc oxide should be termed sunblocks, because these are the only substances that totally block ultraviolet rays. Other sun lotions absorb and deflect UV radiation.
  • Protection offered by sunscreen is dependent upon other factors such as time of day, cloud cover, atmospheric pollution, and the presence of reflective surfaces. http://www.sunguardman.org/protect2.html

E. Amount of sunscreen to apply:

  • a full ounce for your body and a full teaspoon for your face. So one 8 oz. bottle of suntan lotion should only last for 8 applications.
  • Sunscreen precautions (apply to skin 30 min before going out–allows protective chemicals to bond with skin cells, reapply every 2 hrs and after swimming, sweating, or toweling dry).
  • Date your suntan lotion. Get a new bottle every six months. These are chemicals and they have a limited shelf-life.

F. Seek shade whenever possible.
Remember that sun reflects off many surfaces

  • Grass reflects from 2.5 to 3 percent of UV rays hitting its surface.
  • Sand reflects 20 to 30 percent of UV rays
  • Snow and ice can reflect 80 to 90 percent of UV rays.
  • Depending on the angle of reflection, water can reflect up to a full 100 percent of UV rays striking the surface

http://www.cdc.gov/excite/skincancer/mod06.htm Accessed on 05-29-03

Cloudy skies doesn’t mean you’re protected.

  • Clear skies allow 100 percent of UV rays to reach the surface.
  • Scattered clouds allow 89 percent of UV rays to reach the surface.
  • Overcast clouds allow 32 percent of UV rays to reach the surface.

http://www.cdc.gov/excite/skincancer/mod06.htm Accessed on 05-29-03

Beware of medications that may affect sun exposure. Many antibiotics, antihistamines, birth control pills, diuretics, and antidepressants can increase the skin’s sensitivity to the sun leading to a quick and intense burn.
Apply a sun protective lip balm with an SPF of 30.
People who are bald, have thin or light colored hair should use a spray sunscreen on their scalp.

  • “Very simple and inexpensive protection measures, such as wearing a shirt, hat, sunglasses and sunscreen and seeking shade during midday hours can significantly reduce the risk of these conditions,” reports Intersun, WHO’s Global UV Project. “Such measures could eliminate up to 70% of skin cancers in several countries.” Press Release WHO/60, 23 July 2002, “Helping people reduce their risks of skin cancer and cataract: A practical guide for using the global solar UV index”

    Available at: www.who.int/inf/en/pr-2002-60.html. Accessed May 18, 2003

    A University of Nebraska textile scientist’s research on ultraviolet protective fabrics is helping clothing manufacturers and consumers make better informed decisions about sun protective clothing and helped lay groundwork for establishing national standards.

    Patricia Crews’ work yielded some surprising results. While studying whether ultraviolet absorbers remain effective after laundering, Crews found that washing actually enhances sun protection in cotton fabrics because most commercial detergents contain optical brightening agents that absorb or deflect UV rays. http://ard.unl.edu/rn/0302/clothing2px.html

    Factors Affecting Fabric UV Protection Levels

    There are a number of factors that affect the level of ultraviolet protection provided by a fabric. In order of importance these are:
    weave (tighter is better)
    color (darker is better)
    weight (also called mass or cover factor – heavier is better)
    stretch (less is better)
    wetness (dry is better)
    The other major factor that affects protection is the addition of chemicals such as UV absorbers or UV diffusers during the manufacturing process. http://store.yahoo.com/coolibar/upf_ratings.html
    Add Rit SunGuard Laundry Treatment – wash in sun protective dye for clothing with a SPF 30, lasts for 20+ washings. http://www.ritdye.com/sun_guard/clothes.asp

    • Average t-shirt has a SPF of 6 – when wet the SPF decreases to 2. Remember this when a sunburned child wants to continue swimming; the shirt will do little to protect them.
    • Wear a wide brim (3-5″) hat, not ballcap (leaves much of face, ears, and neck exposed), protect high risk anatomical regions like nose, lips, and eyes. These regions require extensive plastic surgical repairs. Five inch brim hats available at http://www.sunprecautions.com Accessed 07-07-03.
    • Sunglasses – Wear sunglasses that block 99-100 percent of the sun’s UVA and UVB ultraviolet radiation and screen out 75 to 90 percent of light. Prolonged exposure to ultraviolet light over time can cause cataracts and may contribute to age-related macular degeneration, which are potentially blinding. Wide-brimmed caps and hats can only eliminate about 50 percent of UV radiation from reaching the eyes but that’s not enough.
    • Additional tips for picking out sunglasses: if you can see your eyes through the lenses, the glasses are not dark enough. Look for a gray tint lens, as to not distort color perception. http://www.aoa.org/
    • Read the labels: Labels marked “Z 80.3” mean the glasses meet the criteria of the American National Standards Institute and block 60% of UVA and 95% of UVB rays. Labels marked AOA (American Optometry Association) block 99% of UV rays. Dark lenses don’t mean more protection since they may not filter UV light but will allow pupil dilation and more rays can enter. Color distortion is less with gray, brown, and green lenses. Donohue. St.Louis Post Dispatch, pg 34, July 19, 20. “Heat, sunshine and exercise require some special precautions.”
    • Select swimsuits for children that cover the torso (short-sleeved and short-legged) for both genders. Polyester and polyacrylic protect better than nylon and cotton.
    • Purchase lightweight breathable fabrics that cover arms and legs when outside in summer.
  • Skin exam by medical professional. The American Cancer Society recommends skin examination by a medical professional as part of a cancer-related checkup every 3 years for people aged 20-40, and on a yearly basis for anyone aged >40. American Cancer Society. Melanoma: detection and symptoms. Available at: http://www3.cancer.org/cancerinfo/.
  • Baseline skin exam should be performed at a young age, dependent on person’s risk factors. If skin cancer runs in the family, initial exam should be done around 12-13 years. The American College of Obstetricians and Gynecologists recommends yearly or as appropriate, skin examination of women aged > 13 based on risk factors(increased sunlight exposure, family/personal history of skin cancer, clinical evidence of precursor lesions). American Journal of Preventive Medicine 2001; 20(3S):44-6. Healthcare Research & Quality, Rockville, MD. Available at www.ahrq.gov/clinic/ajpmsuppl/skcarr.htm
  • Perform monthly self-exams using the ABCDEF rules.
  • Who most often found melanoma: The patients themselves had found 53% of the lesions. In 26% of the cases, medical care providers (of whom only 3% were dermatologists) discovered the melanoma. Family members found 17% and others, 4%. Melanoma, Prevention, Detection & Treatment by Catherine M. Poole, pg. 45.

Websites that sell sun-protective clothing

Local Stores that sell sun-protective clothing

  • Most outdoor shops (REI, Alpine Shop, etc.)
  • Swim supply stores (B&B Swim)
  • Department and discount stores will often carry these especially in spring/summer

Miscellaneous

  • www.sunports.com –Sun shade structures for playgrounds, parks, cars, etc.
  • www.maui.net/~southsky/uvcard2.html – UV card ($4.95), measures strength of UV light from sun and tests SPF of sunscreen
  • www.sunguardman.org/guidelines.html
  • Sunguard Your Skin: An Educational Kit for Middle School Students. (1999). Coalition for Skin Cancer Prevention in Maryland. 800_492_1056 ext. 340.
  • SunGuard Man Online
  • Sunny Days Healthy Ways: Sun-Safe School Guide. 1998 AMC Cancer Research Center. Denver, Colorado. 800-321-1557.
  • The Sun Safety Activity Guide. (1998). The Environmental Health Center, a division of the National Safety Council. 1025 Connecticut Avenue, NW, Suite 1200, Washington, D.C. 20036.
  • The SunWise School Program. 2000 Environmental Protection Agency. EMPACT Program. 202-564-6791.

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