The Dark Side of Anti-Sun Campaigns

AHS13 has been and gone. Hideous trans-Pacific jetlag is now over. I am off Twitter and other social media, apart from our Whole9 South Pacific page as part of our Personal Growth September (Jamie calls it the Antisocial Media September). I will write a post on it another day to explain why we decided to surrender to our antisocial introverted selves. The main benefit of not spending wasting time scrolling through a Twitter feed is time to think and time to write. I have come to the conclusion that my 20 minute presentation on melanoma at AHS was grossly inadequate to explain my thoughts and conclusions regarding sunlight and melanoma.

I first became interested in sunlight when I was preparing an Honours project on Vitamin D and Multiple Sclerosis in medical school. I never published but I kept the research, as well as the overall feeling that sunlight is good, is necessary, and is sometimes healing. This is in contrast to what I can only describe is the state of fear when it comes to the UV radiation in Australia. This paranoia is incredibly pervasive*. Those of you who do not live Down Under might not appreciate its true extent. Otherwise sensible adults get a look of panic in their eyes when melanoma is mentioned. Children at school are not allowed outside into the sun at recess or lunch unless they wear a wide-brimmed hat. Those whose irresponsible parents dare to forget one, stay in the shade, unable to play. Every preschool and school excursion involves long sleeved rasher shirts, tubs of sunscreen applied liberally on each child and, again, hats.

*I am not talking about whether this is clinically justified as yet, merely describing the situation.

The public awareness campaigns are omnipresent. The iconic Slip!Slop!Slap! campaign launched in 1981 is widely touted as one of the most successful campaigns in the Australian history. From the SunSmart website:

Cancer Council believes its Slip! Slop! Slap! campaign has played a key role in the dramatic shift in sun protection attitudes and behaviour over the past two decades.

Wow! That’s fantastic. That campaign must have saved thousands of lives and stopped cancer in its tracks! From Melanoma Institute Australia website:

Melanoma rates have doubled in the 20 years from 1986–2006.

Awkward.

It is quite fascinating that most people in Australia like to talk quite expertly on the topic of melanoma. We are so well “educated” by various health campaigns that any self-respecting TV owning Aussie off the street will tell you that sunlight causes melanoma. Total strangers will point out that the visible burn on your nose from the weekend SUP adventures is practically cancer waiting to happen. And heaven forbid you mention you had blister burns in childhood. People just shake their heads and look away, as if you are not long for this world.

I like to compare that unshakeable assurance to the society’s view on saturated fat. Your Auntie Madge just KNOWS that butter on your broccoli will clog up your arteries (while she is completely safe with her low fat banana bread) and cause a heart attack. Just like she KNOWS that going out in the sun without sunscreen will result in your untimely death.

Researchers in dermatology may argue about photocarcinogenesis for another 20 years. As far as the  public goes, the sun has already been condemned.

For those of us who have come to question and ultimately reject the conventional wisdom as it relates to the diet-heart hypothesis, it is almost too easy to reject this other “undisputed truth”.

It doesn’t help the cause of the sunlight fighters that they use emotional blackmail and scare tactics to “warn” the population about the dangers of that bright orb in the sky. Let me give you an example. For those of you living in Australia this will be very familiar as you have no doubt seen these “health announcements” on TV multiple times.

The self-professed aim of these campaigns is to discourage the pro-tanning attitude of the younger generation. I don’t know about you, but I feel quite uncomfortable about the imagery used in this commercial. A healthy cell transforms into a black tentacled monster which burrows its way into a blood vessel and multiplies, seeding the body with its progeny. Children will have nightmares. I realise this is a pictorial representation but this is not what happens. Hard-hitting messages are sometimes necessary but you need to be absolutely sure that your message is 100% backed up by solid evidence.

And this is where we hit a little snag.

This particular commercial seems to imply that tanning increases the risk of melanoma. Let’s examine this assertion in a little more detail.

1. Having a tan is generally associated with chronic sun exposure. Chronic (occupational) sun exposure has been repeatedly shown to be protective against melanoma (Elwood and Jopson, 1997).

2. Tanning and sunburn are two different things. The evidence on sunburn and melanoma is not foolproof but there seems to be a slightly increased risk.

3. The ability to tan is first and foremost influenced by your skin phenotype which is genetically predetermined. When it comes to melanoma, your skin phenotype is one of the recognised risk factors. In other words, those who are able to tan are at less risk than those (unfortunate redheads) whose skin seems to go from “pale blue” to “scorched red” to “ginger peel” with not a hint of a healthy glow. So the very fact that you are turning a nice chocolatey brown the minute you expose an inch of flesh may indicate that you have a favourable phenotype. But, of course, not everyone with skin type I develops melanoma either!

4. All tan is not the same. Although they look identical, skin tans induced by different UV wavelengths have different mechanisms. UVB-induced tan causes dramatic increases in melanin synthesis. In contrast, UVA has no effect on melanin content. The tan produced by UVA is due to the distribution and oxidation of pre-existing melanin precursors. (Miyamura et al (2011) The deceptive nature of UVA-tanning versus the modest protective effects of UVB-tanning on human skin, Pigment Cell Melanoma Res). Melanin = photoprotection. Hence UVA and UVB have totally different protective qualities.

Maybe to be on the safe side we should stay indoors and avoid the sun altogether. But it seems that those who work indoors and bask under the cool office lights are, in fact, at higher risk of melanoma.

Godar et al (2009) Increased UVA exposures and decreased cutaneous Vitamin D3 levels may be responsible for the increasing incidence of melanoma. Medical Hypotheses 72:434-443

“Paradoxically, although outdoor workers get much higher outdoor solar UV doses than indoor workers get, only the indoor workers’ incidence of cutaneous malignant melanoma (CMM) has been increasing at a steady exponential rate since before 1940.”

“In fact, outdoor workers have a lower incidence of CMM compared to indoor workers”

In diagnosed melanoma cases, previous exposure, intermittent or chronic, is associated with lower mortality. Which seems to make no sense at all if you subscribe fully to “sunlight causes melanoma” argument.

Rosso et al (2008) Sun exposure prior to diagnosis is associated with improved survival in melanoma patients: results from a long term follow up study of Italian patients. European Journal of Cancer 1275-1281

“Time spend on the beach during adulthood (on average 3 weeks/years for 19 years) was inversely associated with the risk of death…”

There are plenty of grey areas in the UV-melanoma story but tanning is certainly not one of them. I would love sending a public message to the organisation who sponsored the ad, requesting to show a single study linking suntan with melanoma.

Here is my new anti-Sun campaign suggestion. I think we are not far off that.

 

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10 thoughts on “The Dark Side of Anti-Sun Campaigns

  1. Pingback: The Dark Side of Anti-Sun Campaigns | Paleo Digest

  2. Wow OMG! I don’t use sunscreen anymore, haven’t for quite a few years but I watch the mum’s here in Byron Bay coating their children in it. Hats, long sleeved tops and sunscreen. Poor kids, all that fear of the sun would be enough to make a person ill.
    Oh boy what a sad state of affairs. Not only is the sunscreen most likely itself carcinogenic but the lack of sun on the skin has untold downsides.
    Thanks for the article. I had no idea that there was absolutely no evidence linking sun exposure to Melanoma.

    • You know what? I think vegetable oils have a huge influence on how the skin reacts to the sun. I no longer eat them, haven’t for 4 years, I am 54 and most of my age spots have disappeared and I have not had a new instance of melanoma for 3 years. My husband has really fair skin, burnt himself silly as a surfer when young, is 66, and his incidences of melanoma (were getting pretty common) stopped about 2 years ago. Same as me, no vegetables oils and Paleo diet.
      What do you think?

  3. I wish I could fully embrace this. The scaremongering is huge and here in New Zealand, if you’re out in Spring/Summer without any protection burn times can be as little as 15 minutes for some people. My personal time is a bit higher and I tan relatively easily which seems to afford a bit more protection. But here the sun is scary.
    I want to not use sunscreen but when I go to the beach I don’t want to be covered head to foot in clothes or hide under the shade so a broad brimmed hat and sunscreen it is. When I work for any length outside, broad brimmed hat and a longsleeved shirt. I make sure I do get sun exposure without any protection if I know its not going to hurt later and if I burn a wee bit I don’t panic, I’m normally browner in a few days. But even staying outside for an hour can often lead to burns. When visiting other countries its amazing how long you can stay out and not worry. It’s fantastic.
    What are your thoughts on this? Am I embracing the fear too much or am I being sensible?

    • I think we need to find the right balance. The reality is we are largely a population of pale-skinned people living in a subtropical to tropical environment, in which our skin defences can be potentially overrun. I still believe that burning is not a good thing. When I know that I will be out in the sun for a long time I protect my skin with clothing and zinc-based sunscreen. At the same time I try to go out in the sun daily for a few minutes around lunch. Everybody’s duration will be different: some will have to duck back indoors after a few minutes only. But to slather litres of sunscreen on daily is madness (and has no scientific evidence!). I think you sound pretty sensible. And of course, there are other lifestyle changes which are protective: good sleep, plenty of vegetables and fruit rich in antioxidants, avoiding large quantities of polyunsaturated fats like in seed oils.

  4. Hmmmm, it’s really hard for me to find a way to grab onto this article. I am Australian, 43 yrs old, I had melanoma when I was 36 and have had numerous treatments for BCC, Solar Keratosis, Bowen’s Carcinoma etc including excision and chemotherapy drugs. All I can attribute this to is a childhood lived at the beach and schooling that was hatless. I went to school from 1976 to 1988. The first 20 years of my life, 1970 – 90 is the period I believe where my sun damage occurred (quite obviously if you look at my lifestyle) and is the cause of the melanoma and other types of sun damage on my face and body. I am not a redhair/green eyed pale skinned person, I do develop a light tan over time and don’t burn easy. My approach to the sun with my children after obsessive reading and research on sun exposure, melanoma, free radical damage and Vitamin D, is hats at all times to protect faces. Rash shirts when on beach between 10 – 4pm in Australian Sun, swimhats and zinc oxide based sunscreen on faces. I do let my children get some sun on their limbs but I am very careful. I’m going to continue this way because my children are not an experiment, I was the experiment that failed, and because they have a parent who’s had melanoma they are twice as likely to get it themselves.

    • Hi Jayne,

      Sounds like you have had pretty tough time. This article is not saying that sunlight has no relationship to melanoma. What I am saying is that the relationship is not as straightforward as such public campaigns lead us to believe. If somebody says to you that your childhood exposure is the CAUSE of your melanoma, they are kidding themselves. If that was the case, everybody who has had the same exposure would get the cancer. Conversely, if somebody tells you that your children will NEVER get melanoma if you apply enough sunscreen, I would be skeptical. Here is the list of other possible environmental risk factors for melanoma mentioned in scientific literature: exposure to photosensitising drugs (even Nurofen), low antioxidant intake, high intake of polyunsaturated fats, low Vitamin D status, certain types of sunscreens – the list goes on. Sometimes pinning the diseases on one cause is an easy solution but the reality is much more complicated.

      • I don’t believe that sunscreen stops melanoma, I believe staying out of the sun reduces the risk of melanoma. The sunscreen is mainly to protect from the free radical damage and it is only ever a zinc oxide sunscreen. I’m quite sure it was my over exposure to the sun that caused my melanoma. I had the perfect wholefoods childhood, my mother was a ‘brown bread and homemade granola type’, I have never really eaten polyunsaturated fats, only butter and olive oil, even as a kid, good levels of Vit D, no sunscreen use at all, never took drugs as a child, never had nurofen until I was 30 etc etc and I’m sure the list goes on. I’m very open to the reality of the numerous sources for the disease and I don’t think I’m brainwashed by anti sun-cancer advocates. I do think for me, the sun was the primary cause. Personally I wouldn’t use a chemical based sunscreen unless my life depended upon it.

        Cassie, you’ll recognise me on the beach, we’re the ones with the lovely umbrella, hats, rash shirts and a good covering of zinc oxide :) We’ll be nice and cool and enjoying the waves at Belongil until sunset. I will continue to do this until it is proven that this approach in itself causes melanoma.

  5. but someone that is outside fully clothes can still be diagnosed. my husband was diagnosed 2 years ago, with stage 4 melanoma…in the brain.. it is unheard of. but it happened. he’s had 2 tumor removal surgeries at 2 separate times. he was an electrician and worked outside regularly. they believe it entered thru his eyes. since he didn’t wear sunglasses to protect his eyes due to him working. and there is no entry points on the body as far as moles. melanoma isn’t strictly from sun exposure. melanoma is sun exposure, hereditary, skin type, and moles. and can be produced in your eyes and genital areas, but out of all those you can help your chances of being safe by covering up, using sunscreen and staying undercover . other then that, its luck of the draw. but if you know its a risk why wouldn’t you want to be safe and uncomfortable then sorry for the sake of your life? but i guess its the same as smoking.. everyone thinks it’ll never happen to me. unfortunately its becoming a fast growing cancer because no one heeds the warnings. there is no cure. all there is, are trial meds and lots of finger crossing and hope

  6. Interesting! I am a white South-African, living in Holland with a skin type 3. I am also a doctor. I came to the same conclusion a while ago after studying data: South-Africa has lower skin cancer rates than Holland even if all South African skin cancers occurred in whites only.
    Ah.
    Also, sun keeps you healthy and protects against numerous other cancers, partially, and this is not attributed to vit D alone. I have had skin problems solving after getting sun again: there is no way my skin gets the exposure it needs at 53north

    Burn is a problem, tan is not.

    And in regards to cancer differences: white South Africans are of mixed descent, the most common skin types being 3 and 4, 2 is rare and I had to go to Europe to witness my first skin type 1.
    Australians (white) have a stronger English heritage.

    Oh well. At least it will be easy to pick out my half-SA half Spanish kids in day care: they’ll be the ones with brown hair amongst the white blonde Dutch kids….

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