By: Jean Johnson for Wounds1Despite established public education campaigns focused on slathering on sunscreen to prevent skin cancer, debate among members of the medical community continues over where to draw the line between warding off harmful ultraviolet light and letting in the vitamin D – the sunshine vitamin.
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Avoiding Skin Cancer
Fair people with light skin and hair, and blue eyes are most at risk for skin cancers. Also, those who work outside or people who have had sunburns early in life need to be extra cautious according to the U.S. Centers for Disease Control.
Pundits on all sides of the debate advocate avoiding the sun when the harshest rays will hit: between 10 a.m. and 3 p.m. Healthcare providers across the board also do not recommend the use of tanning beds or sun lamps.
Be vigilant and catch signs of skin cancer early. Common symptoms of skin cancers include:
Tiny, painless lump with pearly surface is associated with basal cell carcinoma.
Squamous cell carcinoma usually appears as a tiny painless nodule or patch that is sometimes surrounded by inflammation.
A single dark spot on the skin with irregular border is often a sign of melanoma.
It is not unreasonable to ask your doctor about suspicious moles or skin surfaces. Catching cancer early is worth the extra minute in the doctor’s office.
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Indeed, ever since Michael Holick. M.D., Ph.D. published “The U.V. Advantage” in the 1970s when he was chief of endocrinology, nutrition, and diabetes, and professor of dermatology at Boston University, opposing scholars have brought substantial emotion and passion to the subject.
Holick helped discover how vitamin D works. While he did not advocate sunbathing at high noon in the Arizona sun or visiting tanning parlors, he did advance the idea that moderate exposure to the sun – defined as 15 minute periods several times a week – is beneficial. According to Holick, “The problem has been that the American Academy of Dermatology has been unchallenged for 20 years. They have brainwashed the public at every level.”
‘Brainwashed’ is harsh language. Holick most likely used the word to draw attention to serious flaws he found in state-of-the-art public education campaigns associated with the benefits of using sunscreen.
Perhaps he adopted his stance to combat the vigor with which the drug industry attacked his science and book. The Sun Safety Alliance – a group funded by Coppertone and large drugstore chains – for one, issued the following inflammatory statement: “sunning to prevent vitamin D deficiency is like smoking to combat anxiety.”
Part of what’s at issue is that not only are recommended levels of vitamin D all over the map, the best way to absorb vitamin D is under question as well. In addition to being absorbed by the skin from the sun, vitamin D is found in eggs and oily fish like salmon. It is also routinely added to milk since vitamin D is necessary for calcium absorption.
But, according to dermatology chief at Memorial Sloan-Kettering Cancer Center in New York, Allan Halpern, M.D., most of the vitamin D that the circulation system actually uses to keep the body healthy does not come from the diet. More, Halpern says that supplements tend to use less potent forms of vitamin D and thus might not be effective in increasing blood levels at all.
In 2004, clinical professor at New York University Medical Center, Darrell S. Rigel, M.D., took on what he maintains are mere myths related to sunscreen and vitamin D. First he points out that skin cancer is of epidemic proportions and a disease of no laughing matter.
“As a dermatologist who treats the ravages of skin cancer on a daily basis, it is appalling to me that anyone in good conscience could make the claim that intentional sun exposure – for any length of time – is beneficial,” said Rigel. “The fact is, skin cancer is increasing at an alarming rate, and scientific research confirms that our best defense is avoiding excessive, unprotected sun exposure.”
Rigel refers to the alarming rate of skin cancers, a number that has doubled over the past two decades. Alarmed by this meteoric rise, he goes on to take adamant issue with the idea of “safe sun” (15 minutes of unprotected exposure two or three times a week) as a prudent way to ensure necessary vitamin D absorption.
Rigel added that there are no scientific studies that prove that decreased vitamin D levels lead to increases in other cancers and other diseases. “The claim is based on a study that finds that overall rates are higher in the northeast United States, a location with lower sunlight levels than many other places in the country. Those making this claim conclude that since the Northeast has lower UV levels, this is the reason why cancer rates are higher in this region. However, several studies prove this theory is false. These include studies that show cancer rates are low in the Northern Plains states (areas with the lowest UV levels in the country) and small regional studies (New York State) where cancer rates are highest in areas with industrial pollution and are not related to sunlight levels.
“When we take a close look at these myths and evaluate the facts, the course of action is clear. Until there is science that tells us otherwise, it is imperative that people protect themselves from the sun. Anyone concerned about not getting enough vitamin D should either take a multivitamin or drink a few glasses of vitamin D-fortified milk every day. Given the fact that the U.S. Department of Health and Human Services has declared UV radiation as a known carcinogen, exposing oneself to it for the sake of vitamin D is not the answer.”
But Harvard University’s Edward Giovannucci, M.D., M.P.H., Sc.D., professor of medicine and nutrition, disagrees. In a keynote address before the 2005 American Association for Cancer Research Cancer Society, the researcher suggested that vitamin D might help prevent 30 deaths for each one caused by skin cancer.
Cancers from prostate to lung to lymphoma – and even, paradoxically, cancers of the skin – says Giovannucci, are caused by a lack of vitamin D, and these types of cancer take more lives than does skin cancer.
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Fast Facts about Skin Cancer
At least one million cases of basal cell and squamous cell carcinomas occur each year in the United States, more than twice the number diagnosed 20 years ago.
Based on national cancer patterns between 2000 and 2002, the U.S. National Cancer Institute predicts that 1 in 50 men and 1 in 75 women in the United States will develop cancer in their lifetime.
Basal cell and squamous cell carcinomas are relatively benign, while melanoma is the more serious form of skin cancer more likely to cause death.
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“I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D,” Giovannucci stated in his address to the cancer researchers. “The data are really quite remarkable.” The respected Giovannucci made folks in the audience sit up and take notice. For one, the American Cancer Society’s chief epidemiologist, Michael Thun, M.D., said the society would review its sunscreen guidelines. Also Memorial Sloan-Kettering Cancer Center’s Allan Halpern took more than passing notice. “I find the evidence to be mounting and increasingly compelling,” he said.
For her part, Staci Sylvan of Portland, Ore. had to have a basal cell carcinoma removed from her leg last week and she does not plan on going without her sunscreen in the near future, or ever. “I’m only in my 40s, and this is happening already?” she said. “I’ve been so careful all my life, so I’m sure not going to stop now.”
On the other end of the spectrum, of course, are the thousands of Navajo sheepherders and weavers and Hopi corn farmers and basket makers who have spent centuries under the blazing Southwest sun. According to environmental activist Whit James, Ph.D. of Cortez, Colorado the tribes’ experience helps substantiate the idea that problems with exposure to too much sunlight are attributable to pollution coming from our modern lifestyle.
“The way I look at it, the idea that nature would be set up so humans would need to slop some sort of chemical all over their skin to be safe from the sun, is pretty absurd,” said James. “Look at all those Navajos [who] live their whole lives out in the sun – and don’t give me the age argument because plenty of them lived way into their 80s and 90s.
“Besides, it’s not rocket science to see that skin cancer rates are soaring right here in the last 20 years exactly when the toll on all our cars and other pollution that’s wrecking the ozone layer is finally coming due,” James added. “We ought to look at how we’re fouling our own nest instead of arguing about skin cancer and how to prevent it and whether we’re getting our vitamins. What have we come to anyway? That disease is just a symptom. If you ask me, we’ve got a much bigger problem on our hands.”
