Some Melanoma Survivors Forgo Sunscreen, Still Tan

Evolutionary Need?

Nick Mulcahy

April 08, 2013

WASHINGTON, DC — More than a quarter of Americans with melanoma do not use sunscreen when they go outdoors for more than an hour, and more than 2% still use tanning beds, according to a study presented here at American Association for Cancer Research 104th Annual Meeting.

On a positive note, the researchers found that, overall, melanoma survivors practice more sun protection than Americans without skin cancer; for example, they wear hats with brims and seek shade more often.

Sun exposure is a major risk factor for melanoma recurrence, and sun protection can reduce the chances of a disease return, said lead author Anees Chagpar, MD, MPH, associate professor of surgery at the Yale School of Medicine in New Haven, Connecticut.

The finding that such a large proportion of melanoma survivors did not wear sunscreen "blew my mind," said Dr. Chagpar in a press statement.

"This study does suggest that, despite a diagnosis of cancer, people may not change their lifestyle behaviors," Candace Johnson, PhD, deputy director of the Roswell Park Cancer Institute in Buffalo, New York, who attended the meeting, told Medscape Medical News.

But another melanoma expert thinks that the risky sun-seeking could reflect a deeply embedded human behavior and need — to obtain vitamin D.

"Given the remarkable persistence of unsafe sun-protection practices, even after 'lightening has struck,' it is plausible that there is an 'organic' component to the behavior," said David E. Fisher MD, PhD, director of the melanoma program at the Massachusetts General Hospital Cancer Center in Boston.

The need for ultraviolet light shining on the skin could be "an evolutionarily encoded response," he said in an email to Medscape Medical News.

There has been evolutionary benefit to maintaining vitamin D production through sunlight, said Dr. Fisher.

"About 100,000 years ago, skin exposure to ultraviolet light was virtually the only means of obtaining vitamin D," he explained. However, easily available and inexpensive oral supplements can now replace potentially dangerous ultraviolet light as the vitamin source, he added.

Sunscreen: Good News, Bad News

To "determine whether melanoma survivors observed sun-protection practices more vigilantly than the rest of the population," Dr. Chagpar and her colleagues examined data from the 2010 National Health Interview Survey, an annual survey of the civilian population of the United States.

Of 27,120 adults, 171 self-reported a history of melanoma. More than half (54.8%) of the melanoma survivors were men, and 10.2% were younger than 40 years.

Overall, the melanoma survivors were more vigilant about sun exposure than people in the general population.

Melanoma survivors were more likely than those in the general population to always stay in the shade (15.6% vs 10.5%; P < .001).

In addition, when survivors planned to be outside for more than an hour on a warm sunny day, they were significantly more likely than their counterparts in the general population to wear a baseball cap or visor (31.3% vs 18.4%; P = .028), a wide-brimmed hat (20.5% vs 6.1%; P < .001), or a long-sleeved shirt (12.0% vs 5.2%; P = .003).

Melanoma survivors were also more likely to report always using sunscreen (32.0% vs 17.2%; P = .005). A randomized controlled trial conducted in Australia previously demonstrated that sunscreen reduces the incidence of melanoma, as reported by Medscape Medical News.

Although Dr. Chagpar and colleagues found that 27.3% of survivors reported never wearing sunscreen when they planned to be outside for more than an hour on a warm sunny day, that rate was better than the 35.4% found in the general population. Likewise, the rate of tanning bed use was lower among survivors (2.1% vs 5.5%; P = .009)

However, 15.4% of melanoma survivors also reported rarely or never staying in the shade.

The rate of people who wore long pants or skirts on a sunny day was similar in survivors and the general population (22.2% vs 17.7%; P = .404).

"We now know that a significant proportion of melanoma survivors still could be doing better. This study speaks to what we could do to educate melanoma survivors on how to prevent recurrence," Dr. Chagpar said.

Dr. Chagpar has disclosed no relevant financial relationships.

American Association for Cancer Research (AACR) 104th Annual Meeting: Abstract 1365. Presented April 8, 2013.

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