Mad dogs and Englishmen go out in the midday sun. As it turns out, far too many Britons do: unbelievably, thousands more Britons than Australians are dying from skin cancer. The depressingly wet and grey start to the summer makes it seem incredible that any Briton would suffer from a disease caused by the sun, yet in the last five years there have been 8,100 British deaths from malignant melanoma compared to 4,900 in Australia. Incidence rates for melanoma have increased more than for any other major cancer since the 1970s and it is the third most common cancer in 15 to 39 year-olds. Worst of all, it is largely a preventable and treatable disease.
But how is this possible? Isn't sunburn and prolonged exposure to the sun the major cause of most skin cancers? Even though Britons are famously unimpressed by their climate, surely the one advantage of life on a soggy and sun deprived island is the lack of cancer-causing sunshine?
This used to be true. But then the age of the package holiday dawned. Suddenly everyone could afford to visit sun drenched shores and so it was goodbye Blackpool, hola Ibiza. Bronzed became synonymous with beautiful. Unfortunately the truth is exactly what you don't want to hear: there is no such thing as a healthy tan. A tan is your body's reaction to sun damage and a last ditch effort by your skin to protect itself from further harm.
Skin cells are damaged by ultraviolet radiation (UVA and UVB) in sunlight. Over 80 per cent of our total lifetime sun damage is done before the age of 21, but it usually takes 20 to 30 years for the damage to show. Children tend to spend much more time outside than adults and their skin is also more delicate, so even if you have never left northern Europe, the sheer amount of time you spend outside can be harmful eventually.
However levels of UV radiation are not constant and Britain's favourite holiday destinations have much more of it. UV levels are higher in summer and closer to the tropics. Clouds can shield you from UV radiation, but only when they are very dark and heavy. UV levels are not affected by temperature - contrary to instinct, people don't burn the worst when the sun is hottest, as it is often too hot to stay out. People tend to burn when the temperature is between 18 and 27 degrees Celsius.
UV increases with altitude, so you get more of it the higher you go. UV also reflects off some surfaces. Snow reflects the greatest amount, but sand, white paint, light coloured concrete and even water all reflect UV. You can burn just as easily skiing as sun bathing.
Britain is facing a skin cancer epidemic, because, while nobody is completely safe from skin cancer, some skin types are more prone to the disease - the fairer the skin, the higher the risk. People with red or blond hair and light coloured eyes are most at risk. The British Association of Dermatologists estimates that there are at least 100,000 new cases of skin cancer annually in the UK.
According to Sara Hiom, the co-ordinator of the SunSmart campaign launched by Cancer Research UK, the problem is not that people don't realise there is a link between sun exposure and skin cancer, but that they are not acting on it. This may be because they are not aware how high the risk is, or they are just not taking enough precautions. They are also perhaps not so adept at spotting the early warning signs of skin cancer as Australians are after 20 years of an intensive public awareness campaign.
There are three types of skin cancer. Basal cell carcinoma and squamous cell carcinoma are more common and non-lethal. Basal cell usually starts as a small round or flattened lump that is red, pale or pearly in colour. Sometimes it appears as a scaly, eczema-like patch on the skin. Squamous cell cancer is more serious and appears as persistent red scaly spots, lumps, sores or ulcers, which may bleed easily. These types of skin cancer are associated with long-term exposure to the sun, such as years of working outdoors, playing outdoor sports or living in the tropics. They will probably not kill you, but surgery might be required to remove them, resulting in extra costs to the NHS or patient.
Malignant melanoma is much rarer, accounting for only 10 per cent of all skin cancer cases. However, it is responsible for 80 per cent of skin cancer deaths. Melanomas tend to grow on pigmented patches of skin and on new or existing moles, from where it spreads to other parts of the body.
But if most skin cancers are non-lethal, why worry? And surely two weeks of holiday a year is not a problem? Evidence is accumulating that fair-skinned people who roast themselves on the beach for a couple of weeks a year are more likely to develop the deadly melanoma form of skin cancer than people who are exposed to the sun as part of their daily lives, or have a darker natural skin colour.
In order to avoid skin cancer, you have to avoid the sun. With cheaper foreign travel fares luring Britons to ever more exotic locations, this is hardly likely to happen. But you can sustain sun damage even in Britain. If you have to go out in the sun, try to seek shade or cover up with clothes - any close-weave cotton or linen fabric will do. Always wear a hat with a wide brim and sunglasses, preferably ones that wrap around the face. Even though you should look like you're about to field for England in the Ashes by now, you are still not safe. Sun screen is simply essential - not just on holiday, but every day.
Confusion seems the best word to describe the use of sun screen. Most holiday goers probably wear it, but they don't use it correctly. The fact that they apply it also creates a false sense of security - they think they can stay out in the sun much longer than they really can. SunSmart recommends using SPF (sun protection factor) 15. When dealing with the lower factors, it is true that factor 4 is about double the strength of factor 2, and 8 is double the strength of 4. However, as the factors go up in number, this relationship does not hold true. Factor 30 is not twice as protective as factor 15, but it often costs twice as much. In fact, factor 15 sunscreen offers about 93 per cent protection, while factor 30 offers about 96 per cent protection. SunSmart believes factor 15 is a good compromise between protection and price. And don't be fooled into thinking a higher price means better protection. The cheaper brands offer the same protection as the expensive ones.
A high SPF will not help at all if you do not apply enough of it and most people don't. You have to apply a lot - "real handfuls of it", as Hiom puts it. And you have to keep reapplying: every two hours, and more if you are swimming, sweating or towelling off.
Many people believe using a sun bed is safer than tanning in the sun, and that using one before you go on holiday will help you to avoid burning. A tan will not provide any protection against further damage; it is only equivalent to about SPF two to four. "What worries us most is the growing evidence of a link between sunbed use and skin cancer", says Hiom. "We know a quarter of 16-24 year-olds used a sunbed last year and that even occasional use can result in cancer, eye damage and suppression of the immune system. The only advice people need to know is don't do it."
Of course the best reason for avoiding the sun is preventing premature ageing. Ultraviolet light is by far the major cause of wrinkles and age spots. The cooked lobster look of today will be transformed into the alligator skin look in ten years' time - great if you're a handbag, not so great if you're a human.
Mad dogs and Englishmen go out in the midday sun. As it turns out, far too many Britons do: unbelievably, thousands more Britons than Australians are dying from skin cancer. The depressingly wet and grey start to the summer makes it seem incredible that any Briton would suffer from a disease caused by the sun, yet in the last five years there have been 8,100 British deaths from malignant melanoma compared to 4,900 in Australia. Incidence rates for melanoma have increased more than for any other major cancer since the 1970s and it is the third most common cancer in 15 to 39 year-olds. Worst of all, it is largely a preventable and treatable disease.
But how is this possible? Isn't sunburn and prolonged exposure to the sun the major cause of most skin cancers? Even though Britons are famously unimpressed by their climate, surely the one advantage of life on a soggy and sun deprived island is the lack of cancer-causing sunshine?
This used to be true. But then the age of the package holiday dawned. Suddenly everyone could afford to visit sun drenched shores and so it was goodbye Blackpool, hola Ibiza. Bronzed became synonymous with beautiful. Unfortunately the truth is exactly what you don't want to hear: there is no such thing as a healthy tan. A tan is your body's reaction to sun damage and a last ditch effort by your skin to protect itself from further harm.
Skin cells are damaged by ultraviolet radiation (UVA and UVB) in sunlight. Over 80 per cent of our total lifetime sun damage is done before the age of 21, but it usually takes 20 to 30 years for the damage to show. Children tend to spend much more time outside than adults and their skin is also more delicate, so even if you have never left northern Europe, the sheer amount of time you spend outside can be harmful eventually.
However levels of UV radiation are not constant and Britain's favourite holiday destinations have much more of it. UV levels are higher in summer and closer to the tropics. Clouds can shield you from UV radiation, but only when they are very dark and heavy. UV levels are not affected by temperature - contrary to instinct, people don't burn the worst when the sun is hottest, as it is often too hot to stay out. People tend to burn when the temperature is between 18 and 27 degrees Celsius.
UV increases with altitude, so you get more of it the higher you go. UV also reflects off some surfaces. Snow reflects the greatest amount, but sand, white paint, light coloured concrete and even water all reflect UV. You can burn just as easily skiing as sun bathing.
Britain is facing a skin cancer epidemic, because, while nobody is completely safe from skin cancer, some skin types are more prone to the disease - the fairer the skin, the higher the risk. People with red or blond hair and light coloured eyes are most at risk. The British Association of Dermatologists estimates that there are at least 100,000 new cases of skin cancer annually in the UK.
According to Sara Hiom, the co-ordinator of the SunSmart campaign launched by Cancer Research UK, the problem is not that people don't realise there is a link between sun exposure and skin cancer, but that they are not acting on it. This may be because they are not aware how high the risk is, or they are just not taking enough precautions. They are also perhaps not so adept at spotting the early warning signs of skin cancer as Australians are after 20 years of an intensive public awareness campaign.
There are three types of skin cancer. Basal cell carcinoma and squamous cell carcinoma are more common and non-lethal. Basal cell usually starts as a small round or flattened lump that is red, pale or pearly in colour. Sometimes it appears as a scaly, eczema-like patch on the skin. Squamous cell cancer is more serious and appears as persistent red scaly spots, lumps, sores or ulcers, which may bleed easily. These types of skin cancer are associated with long-term exposure to the sun, such as years of working outdoors, playing outdoor sports or living in the tropics. They will probably not kill you, but surgery might be required to remove them, resulting in extra costs to the NHS or patient.
Malignant melanoma is much rarer, accounting for only 10 per cent of all skin cancer cases. However, it is responsible for 80 per cent of skin cancer deaths. Melanomas tend to grow on pigmented patches of skin and on new or existing moles, from where it spreads to other parts of the body.
But if most skin cancers are non-lethal, why worry? And surely two weeks of holiday a year is not a problem? Evidence is accumulating that fair-skinned people who roast themselves on the beach for a couple of weeks a year are more likely to develop the deadly melanoma form of skin cancer than people who are exposed to the sun as part of their daily lives, or have a darker natural skin colour.
In order to avoid skin cancer, you have to avoid the sun. With cheaper foreign travel fares luring Britons to ever more exotic locations, this is hardly likely to happen. But you can sustain sun damage even in Britain. If you have to go out in the sun, try to seek shade or cover up with clothes - any close-weave cotton or linen fabric will do. Always wear a hat with a wide brim and sunglasses, preferably ones that wrap around the face. Even though you should look like you're about to field for England in the Ashes by now, you are still not safe. Sun screen is simply essential - not just on holiday, but every day.
Confusion seems the best word to describe the use of sun screen. Most holiday goers probably wear it, but they don't use it correctly. The fact that they apply it also creates a false sense of security - they think they can stay out in the sun much longer than they really can. SunSmart recommends using SPF (sun protection factor) 15. When dealing with the lower factors, it is true that factor 4 is about double the strength of factor 2, and 8 is double the strength of 4. However, as the factors go up in number, this relationship does not hold true. Factor 30 is not twice as protective as factor 15, but it often costs twice as much. In fact, factor 15 sunscreen offers about 93 per cent protection, while factor 30 offers about 96 per cent protection. SunSmart believes factor 15 is a good compromise between protection and price. And don't be fooled into thinking a higher price means better protection. The cheaper brands offer the same protection as the expensive ones.
A high SPF will not help at all if you do not apply enough of it and most people don't. You have to apply a lot - "real handfuls of it", as Hiom puts it. And you have to keep reapplying: every two hours, and more if you are swimming, sweating or towelling off.
Many people believe using a sun bed is safer than tanning in the sun, and that using one before you go on holiday will help you to avoid burning. A tan will not provide any protection against further damage; it is only equivalent to about SPF two to four. "What worries us most is the growing evidence of a link between sunbed use and skin cancer", says Hiom. "We know a quarter of 16-24 year-olds used a sunbed last year and that even occasional use can result in cancer, eye damage and suppression of the immune system. The only advice people need to know is don't do it."
Of course the best reason for avoiding the sun is preventing premature ageing. Ultraviolet light is by far the major cause of wrinkles and age spots. The cooked lobster look of today will be transformed into the alligator skin look in ten years' time - great if you're a handbag, not so great if you're a human.
Signs of melanoma
Here is a checklist to help you pick out a mole or dark patch that may be cancerous. See your doctor immediately if:
an existing mole or dark patch is getting larger or a new one is growing (growth or change in moles becomes less common as we get older).a mole has a ragged outline (ordinary moles have a smooth, regular shape).a mole has a mixture of different shades of brown and black (ordinary moles may be dark brown but are all one shade).
The following signs do not necessarily mean that you have a melanoma, but you should still look out for them.
an inflamed mole or one with a reddish edge (an ordinary mole is not inflamed).a bleeding, oozing or crusting mole (ordinary moles do not do this).a change in sensation of a mole, like a mild itch (an ordinary mole is not usually itchy or painful).a mole that is bigger than all your other moles.
To help remember the five points of sun safety, think S.M.A.R.T.
Stay in the shade 11am-3pmMake sure you never burnAlways cover upRemember to take extra care with childrenThen use factor 15+ sunscreen
Cancer Research UK
www.sunsmart.org.uk
