Debunking myths, misconceptions and misinformation about sunscreens: no evidence they cause cancer, but they do expire

Photo illustration from M.D. Anderson Cancer Center

By Gina Van Thomme and Kellie Bramlet Blackburn

MD Anderson Cancer Center

Sunscreen is a hot topic – and not just because it’s a summertime staple!

There are also many myths and misconceptions surrounding sunscreen’s safety, effectiveness and usefulness.

So, if you’ve ever been confused about when – or if! – to use sunscreen, you’re not alone.

We asked MD Anderson Cancer Center dermatologist Anisha Patel about common sunscreen myths. Read on for her answers.

Myth 1: All sunscreens work the same way.
False. Sunscreens can prevent sunburn in different ways:

• Chemical sunscreens: The active ingredients in chemical sunscreens absorb ultraviolet (UV) rays as they hit the skin, Patel explains.
• Physical blocker sunscreens: Physical sunscreens, which are also called mineral sunscreens or sun blocks, use ingredients such as zinc oxide and titanium dioxide to form a barrier on the skin’s surface that reflects UV rays.

Not sure whether to use a chemical or physical sunscreen? Hybrid sunscreens contain both chemical absorbers and physical blockers.

When selecting a sunscreen, Anderson dermatologists recommend choosing a broad-spectrum product with at least sun protection factor (SPF) 30. 'Broad spectrum' means the product protects from both UVA and UVB rays which can lead to sun damage and skin cancer. SPF refers to the amount of UVB rays it blocks.

Myth 2: It doesn’t matter what kind of sunscreen I choose.
False. While wearing sunscreen is always a good choice, each type of sunscreen has instructions that must be followed to ensure your skin is protected.

Sunscreen comes in formats including cream, lotion, spray, powder and stick.

Each type of sunscreen has benefits and limitations. For example, many spray sunscreens are clear and absorb into the skin quickly, but this feature can make it challenging to see if you’ve missed a spot.

Overwhelmed by options? Anderson dermatologists recommend physical blocker sunscreens. Patel says this is because they have the broadest range of UVA and UVB protection.

Whatever type of sunscreen you choose, always review its instructions for information on how – and how frequently – to apply and reapply.

Myth 3: Sunscreen causes cancer.
False. There is no medical evidence that sunscreen causes cancer. However, there is a lot of evidence that UV rays from the sun and tanning beds do.

In the past, some sunscreens were recalled for being contaminated with a chemical called benzene. Benzene is not normally found in sunscreen. This recall doesn’t mean you should stop wearing sunscreen, dermatologists say.

Still, some may feel more comfortable using sunscreens that don't absorb into the skin – that is, those physical blockers sunscreens described above.

Additionally, sunscreen isn’t the only way you can practice sun safety. “There are a lot of sun protective options outside of just the creams and sprays,” Patel says.

Other ways to protect yourself from sun damage include:

• Wearing protective clothing that is dark and tightly woven, with ultraviolet protection factor (UPF) 50+
• Wearing a wide-brimmed hat
• Wearing sunglasses with UVA and UVB protection
• Seeking shade between 10 a.m. and 4 p.m. when sun rays are strongest

Myth 4: I have dark skin. I don’t need to wear sunscreen.
False. Dark skin is susceptible to sun damage.

It takes more sun exposure for darker skin types to get sun damage, Patel says. She explains this is because melanin, which gives skin its color, provides DNA with a small amount of sun protection. Still, this small amount of protection doesn’t prevent sun damage altogether.

“Darker-skinned people can still get a sunburn, still get skin cancers and definitely still get photoaging from UV exposure,” Patel says.

Regardless of your skin color, apply sunscreen liberally 30 minutes before going out in the sun, and don’t forget to reapply every two hours or after swimming or sweating.

Myth 5: My sunscreen is waterproof, so I don’t need to reapply it after swimming or sweating.
False. According to the Food and Drug Administration, there is no such thing as waterproof sunscreen.

There is, however, water-resistant sunscreen. The FDA says these products offer water-resistant sun protection according to the time and SPF level specified on each product.

Heading for a beach day or outdoor workout? Choose a water-resistant sunscreen and follow the product instructions on how often to reapply.

 
Myth 6: My sunscreen is SPF 50, so I don’t need to apply it as often.
False. No matter the SPF number, chemical absorber sunscreens only work for about two hours and should be reapplied after swimming or sweating.

Regardless of the SPF level you choose, you need to reapply with the same frequency, Patel says.

If you have trouble remembering to reapply, Patel suggests using a physical blocker sunscreen. These products don’t rub in or disappear into the skin, so it is easy to determine when to reapply.

“If you can see the white on your face, it's still working,” she says.

Myth 7: There is SPF in my makeup. I don’t need to wear sunscreen.
False. While Patel says that sunscreen in makeup counts, it usually doesn’t provide the recommended SPF levels.

“It's typically only 5 to 15 SPF, and we recommend 30,” she says.

Check that your makeup offers at least 30 SPF, and supplement with additional sunscreen as needed. Finally, don’t forget to apply sunscreen to other exposed areas of your body, and make sure you reapply sunscreen as directed throughout the day.

Myth 8: I only need sunscreen when it is sunny.
False. Sunburn and sun damage may be associated with hot, sunny weather, but they can also occur in cold, cloudy conditions.

“Even when it's cold, sun is getting through the clouds,” Patel says.

While clouds filter some UVB rays, they don’t block UVA rays which are a risk factor for melanoma, she adds.

So even if it’s cloudy or cold, you need to apply your sunscreen the same way you would if it were a warm sunny day.

Myth 9: Sunscreen doesn’t expire.
False. “You cannot rely on expired sunscreen,” Patel says. “Nothing bad is going to happen if you use an expired one in terms of increased toxicity. It just won't work.”

It is also important to store sunscreen properly. Specific storage instructions can be found in the product’s ‘Drug Facts’ section.

For example, if you store your sunscreen in a hot car or in direct sunlight, Patel says the product could degrade earlier than its expiration date.

"You have to look at the storage recommendations. Sunscreen will only last until the expiration date if you keep it within those temperature ranges," she says. "If you go outside of those temperature ranges, the molecules that are protecting your skin will degrade faster.”

Have a sun-safe summer by protecting your skin; here's how

Photo by RawPixel / iStock / Getty Images Plus

By Dr. John D'Orazio

University of Kentucky

Spending time outside in the summer is a great way to stay active, reduce stress and get vitamin D. It’s also important to make sure your skin is protected during your time outdoors.

Too much sun can cause skin cancer — the most common cancer in the U.S.  Most skin cancers are caused by too much exposure to ultraviolet light, which can damage skin cells.

Protecting your skin from UV rays is important all year long and not just during the summer. You can also be exposed to UV rays on cloudy or cool days.

Here are steps you can take to protect your skin from the sun:

Sunscreen: Use a broad-spectrum sunscreen that filters out two types of UV rays: UVA and UVB. It should also have a sun protection factor (SPF) of 15 or higher. Put a thick layer of sunscreen everywhere that will be exposed to the sun at least 20 minutes before going outside.

It’s also important to reapply your sunscreen because it does wear off. If you’re out in the sun for more than two hours or swimming, sweating or toweling off, you need to reapply.

Make sure your sunscreen isn’t expired. It’s shelf life is no more than three years and shorter if it’s been exposed to high temperatures.

Sunglasses: In addition to protecting your eyes from UV rays, sunglasses also protect the more delicate skin around your eyes from sun exposure. Most sunglasses sold in the U.S. block both UVA and UVB rays.

Hats and clothing: Hats with a brim all the way around that shades your face, ears and the back of your neck offer the most protection. Canvas works best and you should avoid straw hats that let too much sunlight through. If you wear a baseball hat, you should also protect your ears and the back of your neck with clothing, sunscreen or staying in the shade.

Long-sleeved shirts and long pants and skirts can also provide you some protection from UV rays. Clothing made from tightly woven fabric offers the best protection as well as darker colors.

Shade: You still need to wear sunscreen or protective clothing even when hanging out in the shade. Staying under an umbrella, tree or other covering can help you reduce your risk of sun damage and skin cancer. Taking breaks in shaded areas is also key on long days outside.

Other ways to stay sun safe include planning activities in the morning or late afternoon to avoid the most exposure to the sun.

Sunburn: A sunburn usually shows up four hours after being exposed to the sun, gets worse for about 24 hours and then fades in three to five days.

Treatment: You can take an over-the-counter pain reliever to help with the pain of a sunburn. A cool, wet cloth can also offer relief as well as applying aloe or moisturizer. It’s important to drink plenty of water to stay hydrated.

If you have blisters, don’t break them. Lightly bandage the area to prevent infection. If more than 15% of your body is sunburned, you’re in pain for more than 48 hours or have a fever of above 101 degrees, seek medical attention.

If you’re sunburned, avoid more time in the sun until your skin has healed.

John D’Orazio, M.D., Ph.D., is division chief for pediatric oncology, hematology and oncology at UK HealthCare and researches skin cancer at the UK Markey Cancer Center.

The science of sunscreens: Sorting out advice and rumors

Slip on a shirt, slop on sunscreen, slap on a hat, seek shelter, slide on sunglasses. (YLE illustration)

By Katelyn Jetelina
Your Local Epidemiologist

Summer is here! While sunscreen may seem like an easy health decision, many people, especially younger and health-conscious ones, have doubts. Sunscreen health advice and rumors are everywhere on social media, and we’re seeing it reflected in national surveys:

• 1 in 7 younger adults think daily sunscreen use is more harmful than direct sun.
• 1 in 4 believe drinking water prevents sunburn.

So, what’s going on with sunscreen? With the help of many people, including Dr. Michelle Wong, an Australian cosmetic chemist, I went down a rabbit hole. Ultimately, it comes down to a general lack of scientific nuance in sunscreen discussions and differing risk tolerance.

Here’s what we know about sunscreen, what we don’t know, and what it may (or may not) mean to you.

First, skin cancer is bad. It is the fifth most common cancer in the U.S. While rates have steadily increased over the past few decades, recent years may suggest rates are plateauing. We don’t know why, but some have attributed it to a new awareness of sun protection, including reducing tanning-bed use.

New cases and deaths from melanoma of the skin over time (National Cancer Insitute, annotated by YLE)

Is sunscreen effective against skin cancer? Yes. But this is hard to study.

Theoretically and at a microscopic level, sunscreen makes sense. It stops burns and prevents microscopic changes from accumulating over time that eventually cause cancer.

When we look at “real world” studies among humans, though, there is mixed evidence of sunscreen’s effectiveness against cancer. Two recent meta-analyses that pooled all these studies found no effect. However, sunscreen use is notoriously hard to measure—many other things could explain the link (i.e., confounders), it takes time to see an impact on cancer, and there is variability in how people use sunscreen.

Australian study of sunscreen effect on skin cancer (Graph from YLE; study discussed below)

If we pull out the most rigorous studies (randomized controlled trials, or RCTs) that followed people over a long period of time, there is a consistent positive effect:

• A well-conducted RCT of adult Australians was followed for more than 15 years and found a 40% lower incidence (876 vs. 996 per 100,000) of cancer among participants randomized to daily sunscreen compared with participants assigned to use sunscreen on a discretionary basis.
• Some populations are at higher risk of skin cancer, mainly because the medications they take make them more susceptible. Among organ transplant recipients—some of the highest-risk people for skin cancer—studies have found sunscreen prevented cancer.

Is sunscreen effective against photoaging? This is a clear yes. Evidence from many studies and different populations, including a large RCT, shows that sunscreen prevents signs of photo-aging, including wrinkles and pigmentation.

 
Do-it-yourself sunscreens don’t work for two reasons:

• Sunscreen developers use special grades of zinc oxide with very small particles, which absorb more UV and can cover a larger area. These powders are also often coated to improve dispersion, while DIY recipes usually specify “uncoated” powders.
• Even with the right ingredients and equipment, sunscreen formulators must optimize the formula extensively to achieve consistently high SPF—sunscreens are considered one of the hardest products to create!

What about the safety of ingredients? Safety is always important; we must ensure benefits continue to outweigh the risks on a population level. A lot has happened regarding sunscreen ingredients in the past few years:

• FDA studies. In 2019, FDA conducted safety studies on four specific ingredients. Public concern escalated after 2019 and 2020 randomized controlled studies confirmed that common sunscreen ingredients, like oxybenzone, were found in the bloodstream. In 2021, the FDA stated two out of 16 ingredients (zinc oxide and titanium dioxide) were considered safe, two were unsafe (thankfully, these aren’t included in U.S. market sunscreens), and the rest needed more data.
• Sunscreen contaminants caused a recall. In 2021 and 2022, a private lab found traces of benzene—a chemical that causes cancer—in some sunscreens. Importantly, benzene was a contaminant, not a sunscreen ingredient.
• Continued research on sunscreen ingredients. Some independent studies have found links between chemical sunscreen ingredients and hormone and reproductive function.

Are these safety signals enough to change population-level behavior? The scientific consensus is “no” given three reasons:

• Most are lab or animal studies. Petri dishes (bacteria, cells, yeast) and animal studies (rats, fish, etc.) differ from ours, so these studies must be interpreted cautiously.
• Dose determines the poison. Animal studies often use very high doses, administered orally. With the right dosage and route of exposure, anything can be a poison, even water.
• Human studies suggest correlation vs. causation. One human study, for example, linked sunscreen ingredients to hormone disrupters in children, but the link was correlational—even the authors stated that many other things could explain the relationship. Another study found more than 96% of people had oxybenzone in their urine. However, fewer than 96% of people use sunscreen, suggesting other environmental sources contribute to levels. Multiple systematic reviews of human studies have concluded there is no support for sunscreen causing infertility, differing hormone levels, body fat, kids’ growth, or cancer.

In other words, just because we can measure something doesn’t necessarily mean it’s harmful. It does suggest that more studies should be done.

The FDA has requested manufacturers test the 12 ingredients with “insufficient evidence,” but there’s a problem: The FDA’s requirements would violate animal-testing bans. So, these older sunscreens may be removed from the US market, even though they are widely used and considered safe in other regions like the European Union, Australia, Japan, and Korea, alongside newer sunscreen ingredients unavailable to Americans (more on the complex regulatory situation here).

In the EU, as a precaution, they have lowered the allowed percentages of a few ingredients, particularly homosalate and oxybenzone. “Unsafe” in the EU means there isn't a 100-fold margin of safety with daily full-body application. These regulatory changes are small shifts to improve the safety of already safe products on a population level.

 
The health policy in the U.S. holds strong: Sunscreen’s known benefits outweigh the unclear risks. Will this change over time? It's possible, but it’s worth noting that the oldest chemical sunscreen ingredients have been used extensively worldwide for over 40 years without clear health risks emerging.

Population-level consensus can be different from individual-level decision-making, though. I still use sunscreen every morning and grab whatever I can for my family while rushing to the beach. Of all the risks we face every day, sunscreen is a very small one to me.

But everyone’s risk tolerance is different. For those who are more hesitant, the good news is that there are options:

• Concerned about effectiveness? Whether you're using sunscreen or not, layers are the name of the game. The Covid-19 Swiss cheese model applies to sun protection.
• Concerned about unclear risks? Check the ingredient list—luckily, many different sunscreen formulas are available.
• Concerned with sunscreen being white cast or heavy? There are two types of sunscreens. A “chemical sunscreen” is likely more suitable for you.
• Concerned with skin sensitivity or oiliness? A “mineral sunscreen” is more suitable.

Overall, keep in mind:

• “Broad spectrum” sunscreen is best. The SPF rating on American sunscreen bottles mostly denotes a sunscreen’s ability to block UVB rays. Importantly, these are the most damaging type—they cause burning, skin cancer, and premature skin aging. Some sunscreens in the U.S. don’t cover UVA rays well. Sunscreens labeled "broad spectrum" have a better UVA/UVB protection balance.
• Higher SPF gives higher protection. You may have seen that SPF 50 blocks 98% of UV while SPF 30 blocks 97%, so there's only a 1% difference. However, this is only true if you apply the correct amount perfectly evenly, which is impossible. If the same amount is applied, SPF 30 will always let 1.67 times more UV than SPF 50.
• Vitamin D can still reach the skin. High SPF sunscreens are designed to filter out UVB rays, the exact type of rays needed to produce vitamin D in our bodies. However, sunscreen doesn’t filter out all of these rays, and sunscreen application is uneven because humans are humans. Many studies show that people who use sunscreen daily can maintain their vitamin D levels. We also get Vitamin D from food sources.

Bottom line: Sunscreen can help fight skin cancer and prevent photo-aging. Given how difficult sunscreen is to study, there are some unclear risks. Uncertainty can be uncomfortable, so it’s unsurprising that there is much contradicting information about sunscreen (and really anything in health). The good news is that options exist, and the best type of sunscreen is one that you will use.

State doctors' group calls for more gun control, repeal of Second Amendment 'sanctuary' law; passes resolutions on many topics

By Melissa Patrick

Kentucky Health News

The Kentucky Medical Association called mass shooting and gun violence "a public-health crisis" and called for more gun control in one of nine resolutions on the topic at its annual convention.

Voting delegates representing the state's doctors also adopted resolutions addressing sex education, abortion care and more at their meeting Aug. 25-27 in Louisville.

Kentucky has the “14th-highest rate of gun deaths” in the nation, according to one of the resolutions.

 

KMA joined several other groups in declaring the public-health crisis, in a resolution that supports "A ban of assault (semi-automatic) weapons and killing-enhancement features, including high-capacity magazines, rapid-fire increases ('bump stocks'), silencers, and guns without serial numbers ('ghost' and 3-D printed guns)."

The resolution also calls for background checks without loopholes, waiting periods and safety training on all firearm transfers (retail, internet, gun-show purchases, lending and gifts); and extreme-risk protective orders ('red flag' laws) "to disarm persons who pose risks of gun violence to self or others."

Before the convention, Alex Acquisto of the Lexington Herald-Leader talked to KMA Executive Vice President Patrick Padgett about how KMA passes resolutions and what it means. 

Padgett said the association, by definition, is an advocacy organization to promote the well-being of patients, doctors and the community at large, and the resolutions represent the consensus of an organization that represents thousands of doctors statewide. Padgett said KMA members regularly conduct grassroots advocacy with legislators about health-related bills.

The group's rules say any KMA member can propose a policy change, which is then reviewed by a group of more than 100 doctors in KMA’s House of Delegates, which votes on resolutions in deliberations that are closed to the public. KMA is a private organization, not a public agency coveregd by the state Open Meetings Act.  

Acquisto notes that the KMA's suggested firearm legislation goes against the long-prevailing views in the General Assembly. 

Other resolutions support creation of a statewide gun-safety office to reduce firearm-related deaths;  eliminating ghost-gun loopholes; supporting legislation that promotes the implementation of "domestic violence prohibition laws;" screening during medical visits for presence of guns in the home; and research and educational campaigns about firearms, including safe storage.

"Gov. Andy Beshear, a Democrat, has called for the legislature to pass  to this end multiple times since he became governor — as far back as 2019 after two mass shootings in El Paso, Texas, and Dayton, Ohio, left dozens of people dead, and again this year, after a gunman in downtown Louisville killed five people," Acquisto reports.

Such laws are not popular "in a state that has historically championed the proliferation of and freedom to possess firearms," she adds. "Beshear’s predecessor, Republican Gov. Matt Bevin, said in 2019 that red flag laws are an 'erosion of our constitutional rights' and signed" into a law a bill repealing the requirement for a separate permit or training to carry a concealed deadly weapon.

"In 2020, a bipartisan bill to enact a red-flag law in Kentucky failed to get traction," Acquisto notes. "Earlier this year, legislators enacted a law making Kentucky a 'Second Amendment Sanctuary' state."

The legislation, which Beshear allowed to become law without his signature, says local and state officials and their employees shall not "enforce, assist in the enforcement of, or otherwise cooperate in the enforcement of a federal ban on firearms, ammunition, or firearm accessories."

One of the KMA resolutions calls for Kentucky to repeal the law, saying it and one to ban local gun laws "substantially weaken protection of our schoolchildren, citizens and police officers from mass shootings and gun violence." 

Abortion resolutions

Last year's KMA meeting, two months after the U.S. Supreme Court overturned federal abortion protections, allowing Kentucky's trigger law banning abortion except to save the life of the mother to become law, "could not reach consensus to take a bold stance in opposition to state laws restricting it," Acquisto reports. 

Five abortion-related resolutions were proposed at that meeting, and most were not adopted. This year, the KMA House of Delegates passed two of three abortion-related proposals. 

The first one "supports the protection of OB/GYN residents in Kentucky to have comprehensive education and training in obstetrics and gynecology," stating that without such training, "residents will compromise the future of OB/GYN health care and failure to incorporate abortion training in the resident curriculum will lead to a generation of physicians ill-equipped to fulfill their duty to care for patients." 

The other resolution calls for "revisions to relevant state statutes that restrict access to abortion-inducing medications for women who experience underlying medical conditions concurrently with life-threatening pregnancies."

That is aimed at 2022 House Bill 3, which "prohibits doctors from providing abortion-inducing medication to patients with certain medical histories, including if they have a history of ectopic pregnancies, are taking steroid hormones for rheumatoid arthritis, or are on a blood thinner medication for a heart condition, for example," Acquisto writes.  

The resolution says “The unintended consequences of HB 3 could adversely impact women and risk their lives during a life-threatening pregnancy.” 

A resolution to support comprehensive reproductive health care for women, including the opportunity to choose a medical or surgical abortion, was not adopted. 

Transgender health care and sex education 

Acquisto reports that last year, before most Republican-controlled states "began outlawing gender-affirming care for transgender youth, KMA adopted a policy supporting access to hormones and puberty blockers, and the preservation of the doctor-patient relationship in such settings, devoid of political tampering. According to the current policy handbook, KMA 'advocates against any prohibition of physicians or other health care providers (from) socially affirming gender identity or discussing evidence-based therapies for management of gender dysphoria with their patients and their parents.' The association also supports behavioral-health options and "non-surgical treatment provided to youth by appropriately trained and experienced health-care providers."

This year, the General Assembly passed Senate Bill 150, outlawing all forms of gender-affirming medical care for trans youth, contradicting the advice of the KMA and all oyther major U.S. medical associations.

None of this year's KMA resolutions addressed gender-affirming care, but two dealt with sex and health education in direct response to SB 150. One says "KMA supports legislation to remove age limits for health education in schools."

The other says "SB 150 . . . has raised the question of whether teaching students human health-related curriculum, including puberty and menstrual health education, is permitted in Kentucky before 6th grade." It amended KMA policy to say the group opposes the sole use of "abstinence-only education by providing information about condoms, birth control, and other means of preventing pregnancy and sexually transmitted diseases," and "supports age-appropriate anticipatory education related to menstruation and puberty for elementary school students," as well as "age-appropriate sexual education in schools to include information on sexual assault, consent communication, and dating violence prevention" and "age-appropriate sexual education in schools to include reference to non-traditional (LGBTQIA) practices for safe sex, in the interests of equality and prevention of sexually transmitted disease."

The resolution says KMA "will work with appropriate agencies, including but not limited to the public-school system, to ensure that sex education is age-appropriate, evidence-based, led by well- trained individuals, and subject to periodic evaluation and improvement." 

Other resolutions 

The House of Delegates also adopted resolutions to :

• Encourage swimming lessons for children, promotion of fences around swimming pools and direct supervision of children around water by a responsible individual, amid increased focus on an increased drowning risk of children with autism.
• Encourage caution in pediatric melatonin consumption and to promote physician-led education to caregivers regarding pediatric use of melatonin. 
• Increase skin cancer prevention, noting that "from 2016 to 2020, Kentucky was in the top 10 states with incidence rates of melanoma." 
• Support efforts to educate health care professionals and the public about the frequency and severity of eating disorders and weight stigma, and stated that it supports evidence-based treatment for eating disorders and the removal of insurance barriers designed to deny or restrict such treatment. 
• Promote efforts to decrease the rate of physicians' moral injury in Kentucky, defined as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to a variety of constraints that are beyond a physician’s control.”
• Support improvements in mental health care services for the postpartum period to improve maternal and infant health outcomes; and supports advocating for funding of programs that aid postpartum depression research.
• Support use of anti-obesity medications if they are safe, effective and have a sustained impact with lifestyle modifications; and to advocate for better access to anti-obesity medications for all patients appropriately prescribed those medications.
• Urge an increase research on the safety and efficacy of Kratom and to support increased regulation on the sale and purchase of Kratom. The resolution states that while Kratom is legal to buy, sell and own in Kentucky, "The opioid and stimulant properties of Kratom make it an option for treating opioid withdrawal, but subsequently comes with risk for abuse, addiction, and overdose." It also supported a resolution to ban over-the-counter sales of Kratom in Kentucky and that it supports increased education regarding its misuse and negative health effects.
• Encourages and support expanding representation of darker skin tones in medical education, especially in printed texts and textbooks. 

Click here for a list of the adopted resolutions and for the "Kentucky Medical Association Gun Violence and Firearm Safety Work Group Report to the 2023 KMA House of Delegates."

As summer arrives, here are tips to protect your skin from the sun

Photo from OJO Images via iStock//Getty Images

By Dr. John D’Orazio

University of Kentucky

As the days get longer and the weather gets warmer, many of us will start spending more time outdoors. Whether you’re planning a beach vacation, gardening, or watching your kids’ baseball games, make sure you take steps to protect yourself and your loved ones from skin cancer.

The three most common forms of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.

Basal and squamous cell carcinomas form on the outermost layer of the skin and are caused by long-term or frequent heavy exposure to the sun.

Melanomas develop in the melanocytes of the skin — the cells that produce melanin and give your skin its color (and will darken and “tan” with exposure to sun). This type of skin cancer is the deadliest. It can be caused by bad sunburns, and those who regularly use tanning beds are also at greater risk for developing it. In fact, all three skin cancers can be caused by ultraviolet rays from the sun or tanning beds.

The best treatment for skin cancer is prevention, ideally beginning in youth and continuing throughout life. Even one bad sunburn during childhood can cause skin cancer issues years later. Here are some skin protection tips that will allow you to be as safe as possible while enjoying fun outdoor activities:

• Use sunscreen. Always use sunscreen before going out in the sun — make it a part of your daily routine. Use a broad-spectrum sunscreen that has a sun protection factor (SPF) of 15 at a minimum. Sunscreen should be reapplied every two hours when you’re outside, and apply more frequently if you’re swimming or even just sweating.
• Stay in the shade, if possible. This will help protect you from unnecessary exposure to excessive sunlight. However, be aware that the UV rays of sunlight can reflect off of bright surfaces — like concrete, sand and snow — and cause skin damage if you’re also not wearing sunscreen.
• Wear a hat and UV-protective clothing. Choose a hat that has a wide brim that shades your face, head, ears and neck. Rashguards are a good choice for children and active adults because they shield the skin from ultraviolet radiation.
• Wear sunglasses. Make sure they’re designed to block both UVA and UVB rays.
• Avoid the brightest time of day. Try timing your outdoor activities during off-peak hours if possible. UV rays are strongest between 10 a.m. and 4 p.m.

Skin cancer can happen to anyone, regardless of skin color. Causes for concern include new spots on your skin, spots that appear different from others, or spots that persist or are changing, itching or bleeding. If you notice any unusual changes in your skin, make an appointment with a board-certified dermatologist.

Dr. Orazio is chief of the Division of Hematology/Oncology in the Department of Pediatrics at the University of Kentucky, which provided this article.

How to use sunscreen to protect your skin, reduce cancer risk

Photo from Harris Dermatology

By Penn State Health

Summer has arrived and with it so have dreams of beach vacations, trips to the waterpark and outdoor activities. After months of winter’s colder temperatures, you’re ready to get outside in search of that warm feel of sun on your skin and the resulting “healthy glow.”

Sure, the sun feels good, but while everyone needs limited sun exposure to produce vitamin D to strengthen bones, unprotected exposure to the sun’s ultraviolet rays can damage skin and increase the risk for skin cancer.

But there’s no need to be a recluse, says Dr. Charlene Lam, a Penn State Health dermatologist. Just be smart about your time in the sun and protect your skin by taking a few preventive steps, including routinely using sunscreen.

How sunscreen keeps you safe

“It is not just the day out at the beach or waterpark when you need sunscreen, but every time you go out – when you get the mail, walk the dog – all of that exposure to the sun can add up to damage and lead to skin cancer, aging skin, dark spots and wrinkles,” she said. “Although there is no single method that protects you perfectly, there are different modalities we can be smart about and adopt into our lifestyle as daily habits.”

One is the regular use of sunscreen, which protects your skin by absorbing or reflecting the sun’s ultraviolet (UV) rays that damage skin cells.

“There are two types: UVB rays, which cause sunburn and play a key role in skin cancer, and UVA rays, which cause skin damage that leads to tanning, aging of skin and wrinkles,” Lam said. “That’s why it’s important to choose a broad-spectrum sunscreen that protects you from both.”

She also recommends choosing a sunscreen with a sun protection factor – or SPF – of 30 or higher. Although high SPF sunscreens protect from burning for longer periods of time than those with lower SPF, they can give the user a false sense of security.

“Sometimes what I see are people who use an SPF 50 will stay in the sun longer and won’t reapply. They end up getting more sun damage, and it defeats the purpose,” Lam said. “If you use a 30, know that you need to reapply every two hours, more if you get wet or wipe it off.”

How to properly apply sunscreen

The best type of sunscreen is the one that you’ll use regularly. Whether you prefer a cream or an aerosol, there are a few tips when it comes to application that can make the difference in its effectiveness. In addition to applying it 30 minutes before you go outside, remember that coverage counts.

“The big thing is to make sure you are using enough. On average, an entire body requires about an ounce or shot glass full for full coverage. A nickel-sized dollop is required for the entire face alone,” Lam explained, adding that with a spray sunscreen, it is important to get an even sheen across the skin and to spread it out. “Typically, a family of four should use one four-ounce bottle per person for a day-long event.”

Don’t forget those sensitive areas, such as the top of your ears, back of the neck, the scalp along the part, tops of your feet and behind your knees.

All skin types deserve sunscreen

Despite what you may have heard, everybody can get sunburned, no matter what type of skin color they have. Men, women and children over six months should use sunscreen, including those who tan easily. The best defense is to use multiple modalities of sun protection, Lam said.

“Protective clothing, hats, sunglasses, avoiding mid-day sun from 10 a.m. until 2 p.m. and seeking shade are all good ways to protect yourself from the sun,” she said. “But shade isn’t a perfect shield. Some UV rays can still reach out, reflecting off water, sand, glass, concrete and snow.”

But protection from sunburn isn’t the most important reason to wear sunscreen.

“Your skin is damaged by sun exposure over your lifetime, not whether or not you burned. If you have skin, you can get skin cancer,” Lam said. “Once you burn, it is a clear indication that you’ve had too much sun. The burn will heal, but the damage is done. The thing is to learn from that burn, and make it your last.”

What are the best sunscreens for children? Los Angeles Children's Hospital has advice.

Skin-cancer rates have spiked 800% among young women; experts advise limiting exposure to sun and tanning beds

New research shows that skin-cancer rates have surged among young women, likely because they use tanning beds, but health experts warn that exposure to the sun's harmful ultraviolet (UV) rays puts us all at risk, so it's important to always take precautions when out in the sun.

The research, presented at the summer meeting of the American Academy of Dermatology, found that between 1970 and 2009, rates of melanoma, the deadliest form of skin cancer, increased 800 percent among women 18 to 39, an AAD news release said.

During a similar time frame, the researchers also found that basal-cell and squamous-cell carcinoma rates also increased, 145% and 263%, respectively.

“Because there’s a delay between UV exposure and when skin cancer appears, most women don’t think it will happen to them,” Dr. M. Laurin Council, a dermatologist and associate professor at Washington University in St. Louis, said in the release. “This data reveals the disproportionate rise in the number of skin cancers in women and the need for further education regarding UV exposure.”

Indoor tanning by Caucasian girls and young women "is of particular focus," says the release, because it is estimated that indoor tanning may cause more than 400,000 cases of skin cancer in the U.S. each year.

"One indoor tanning session can increase a user's lifetime risk of developing melanoma by 20%, squamous cell carcinoma by 67% and basal-cell carcinoma by 29% . . . and this risk increases with each use," says the release.

Council says limiting exposure to UV rays from the sun or other sources like tanning beds is the best way to decrease your risk for skin cancer. She adds that it is especially important to avoid sun exposure between the hours of 10 a.m. and 2 p.m. because that's when the sun's rays are the strongest.

The Centers for Disease Control and Prevention adds that the sun's UV rays can damage your skin in as little as 15 minutes and notes that a tan does not indicate good health, but instead is the skin's response to injury, because skin cells signal that they have been hurt by UV rays by producing more pigment called melanin.

"Every time you tan, you increase your risk of getting skin cancer," says the CDC.

Other suggestions to protect yourself from the sun include wearing protective clothing including lightweight, long-sleeved shirts and pants, a wide-brimmed hat and sunglasses when out in the sun, as well as using a broad-spectrum, water-resistant sunscreen with an SPF of 15 or higher (Council says the SPF should be 30), and apply every two hours, as well as after swimming or sweating

Council also calls on parents to teach their children about the dangers of sun exposure and tanning beds, and their relationship to skin cancer.

In Kentucky , melanoma of the skin, or skin cancer, is one of the top 10 cancers by rates of new cases, at 28.7 cases per 100,000 people.

Summer's here, which means it's time to protect our skin from the sun and keep a regular watch for skin cancer

Chart from Great Plains Center for Agricultural Health; click on it
to view a larger version; to download a full-size version, click here.

Friday, June 1 is the start of meteorological summer, which is a great reminder to make sure you have enough sunscreen on hand and to remember to check your body for skin cancer.

The American Cancer Society says the top cause of skin cancer is exposure to ultraviolet, or UV, rays from the sun or other sources like tanning beds.

To protect yourself from the sun, the ACS recommends wearing clothing and a wide-brim hat to protect as much skin as possible; using a broad-spectrum sunscreen with a SPF of 30 or higher, and to reapply every two hours, as well as after swimming or sweating; staying in the shade if possible; and avoiding tanning beds and sunlamps.

But it's also important to be careful when using sunscreens on children.

Brenda Goodman of WebMD reports on a 14-month-old child who is recovering from a "painful, blistering rash that spread over her cheeks and nose, right where her mom had spread a palmful of Banana Boat Kids Free spray sunscreen."

The U.S. Food and Drug Administration is investigating the case, and told WebMD that it is aware of three other Canadian children who had reactions to the same product.

Dr. Alok Vij, a dermatologist at the Cleveland Clinic, told WebMD that he thought the reaction was something called a photoallergy, which happens when the sunlight combines with a chemical to cause a chemical reaction.

His advice to parents includes: Keep kids out of the sun during the brightest parts of the day, 11 a.m. to 4 p.m.; use sun-protective clothing; use mineral-based sunscreens, like those with zinc or titanium; and avoid spray sunscreens. 

The American Academy of Dermatology reports that one in five Americans will develop skin cancer in their lifetime.

 The doctors at University of Louisville Physicians – Surgical Oncology, in a U of L news release, recommends regular skin self-exams after a shower or bath.They note that it's important to learn where your birthmarks, moles and blemishes are located, and to take note of how they usually look and feel. Family members can examine areas that are hard for an individual to see.

"Using a full-length mirror and a hand-held mirror, check for anything new such as a mole that looks abnormal, a change in size, shape, color or texture of a mole or a sore that doesn’t heal," the doctors advice. "Check yourself from head to toe, including all areas and crevices of the skin."

They also offer these "ABCDE" tips to help you remember what to watch for:

• Asymmetry – The shape of one half does not match the other.
• Border – The edges are often jagged, uneven, distorted or atypical in outline; the pigment may spread into the surrounding skin.
• Color – The color is uneven. Shades of black, brown and tan may be present. Areas of white, gray, red, pink or blue also may be seen.
• Diameter – There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 mm).
• Evolution – Anything that changes over time. It is important to call a dermatologist if you find one of these suspicious characteristics.

And just because you have dark skin doesn't mean you shouldn't check yourself. A 2016 American Academy of Dermatology study, “Racial Disparities in Melanoma Survival,” found that while melanoma incidence is higher in whites, death rates are relatively higher among people of color.

 “Far too often, black, Hispanic, and Asian patients with melanoma cancer tell us they believed that melanoma was only a danger for sun-seeking whites,” says the study report. “But anyone – regardless of skin color – may develop melanoma, in both sun-exposed and sun-protected sites. Not noticing or ignoring a new or changing mole in a sun-protected site can be fatal.”

Most skin cancers are caused by exposure to the sun; here are some tips to protect yourself

Centers for Disease Control and Prevention photo shows protection

By Melissa Patrick
Kentucky Health News

Tanning is not healthy. Despite the perception that a tanned person looks "healthy," tanned skin is actually damaged skin that has been exposed to ultraviolet rays. And it doesn't really matter if the exposure comes from the sun, or a tanning bed, or happens in the winter or the summer; UV exposure is the number-one cause of skin cancer in the United States, says WebMD.

In fact, skin cancer is the most common cancer in the U.S., according to the Centers for Disease Control and Prevention, with the American Academy of Dermatology estimating that one in five Americans will develop skin cancer in their lifetime.

“Repeated overexposure to the sun can lead to premature aging and skin cancers called basal cell carcinoma, squamous cell carcinoma and malignant melanoma, which is the deadliest form of skin cancer.” Dr. Tamar Zapolanski, a dermatologist at the Valley Medical Group in New Jersey, said in a news release.

The CDC notes that basal-cell and squamous-cell cancers, which affect the cells on the outer layer of the skin, are the most common kinds of skin cancer and usually respond well to treatment. Melanoma, the cancer that affects cells that give the skin its color, is much less common, but is more dangerous because it is more likely to spread to other parts of the body if not caught early.

In 2016, 3 percent of new cancers in the United states were melanomas, a rate that has been increasing steadily over the years, says the American Cancer Society, WebMD adds that melanoma causes 75 percent of all skin cancer deaths.

Kentucky Cancer Registry maps show occurrences of skin cancer (left) and deaths from melanoma, by county

In 2013, the most recent year with data available, the CDC reports that almost 72,000 Americans were diagnosed with melanoma, and more than 9,000 died from it. Between 2010 and 2014, 41 out of every 100,000 Kentuckian was diagnosed with a melanoma, and 33 Kentuckians out of every million died from it.

Anyone can get skin cancer, regardless of their skin color, but the risk is greatest for people with fair or freckled skin, light eyes and blond or red hair. Other risk factors include having a family history of skin cancer, having an outdoor job and living in a sunny climate. A history of severe sunburns early in life and having a large number of moles are also risks, says the CDC.

"Cumulative sun exposure causes mainly basal-cell and squamous-cell skin exposure, while episodes of severe sunburns, usually before age 18, can raise the risk of developing melanoma," says WebMD.

Not all skin cancers look the same. Experts say the most common warning sign of skin cancer is a change on the skin, like a new mole or skin lesion, or a change in an existing mole.

info-graphic: American Academy of Dermatology

They also recommend a simple rule to assess for melanoma, called the A-B-C-D-E rule:

• Asymmetry--Does the shape of one half match the other?
• Border--Are the edges of the mole irregular or jagged?
• Color--Does the color have uneven shades of brown, black, tan, red, white or blue?
• Diameter--Is the mole or spot larger than the size of a pea?
• Evolving--Has the mole or spot changed during the past weeks or months?

The CDC offers some tips to protect yourself from the sun:

• Stay in the shade, especially during the midday hours.
• Wear protective clothing on arms and legs.
• Wear a hat with a wide brim.
• Wear sunglasses that wrap around and have UVA and UVB protections.
• Use sunscreen with sun protection factor (SPF) of 15 or higher, and both UVA and UVB protection, even on cloudy days.
• Reapply sunscreen every two hours and after swimming, sweating or toweling off.
• Avoid indoor tanning.

“Sunscreen protects against harmful radiation from the sun by absorbing, reflecting or scattering the sun’s rays on the skin,” said Zapolanski, adding that skin cancer is very treatable if caught early.

Misconception that skin color determines who will get skin cancer is dangerous, medical experts say

Melanoma is often found in hard to see places that
are never exposed to the sun. goldinskin.com

The misconception that people with darker skin are protected from skin cancer is dangerous, says a Rush University Medical Center news release.

While skin cancer rates are higher among white people, blacks, Hispanics and Asians are also at risk of getting a melanoma, which is often caused by genetics and not sun exposure. Melanomas are the most common kind of skin cancer and also the deadliest.

Dr. Arthur Rhodes, the director of the Rush Melanoma Surveillance Clinic, explained in the release that only 10 to 15 percent of melanomas are caused by excessive sun exposure, typically in heavily freckled and sun-damaged skin.

“The misconception that the sun is responsible for all cases of melanoma leads to lower survival rates because of delayed diagnosis, particularly among people of color,” he said.

Sidney Brown, a black man whom Rhodes diagnosed and treated for a melanoma 10 years ago, was one of those people who didn't think African Americans got skin cancer.

Brown said he thought the mole on his nose was just an annoying pimple and never considered that it could be skin cancer, because, he thought, “skin cancer is something white people get.” This misconception nearly cost Brown his life.

Rhodes "explained that once a mole starts growing up, it is also spreading cancer cells down through the body. That can be too late for many, but catching mine in time saved my life,” Brown said in the release.

A 2016 American Academy of Dermatology study, “Racial Disparities in Melanoma Survival,” found that while melanoma incidence is higher in whites, death rates are relatively higher among people of color, says the release.

“Far too often, black, Hispanic, and Asian patients with melanoma cancer tell us they believed that melanoma was only a danger for sun-seeking whites,” says the report. “But anyone – regardless of skin color – may develop melanoma, in both sun-exposed and sun-protected sites. Not noticing or ignoring a new or changing mole in a sun-protected site can be fatal.”

"While less common than other types of skin cancer, melanomas are deadlier, because the malignant cells can spread even though the tumor is relatively small and not bleeding or causing pain or itching," the release says. "This capacity to metastasize underlies the importance of early detection, especially among people of color."

The release notes that some of the most aggressive forms of melanoma may occur in areas of the body that receive little or no sunlight and often occur in difficult-to-examine locations.

“Early diagnosis results in a cure, while delayed diagnosis may be deadly,” Rhodes warns. “Half of all melanomas in non-whites occur on the palms of the hands, soles of the feet, nailbeds, mucous membranes, perianal area, genitalia, and other areas that are not exposed to the sun, areas that are difficult-to-self-examine and commonly ignored.”

Rhodes recommends that everyone should do a monthly full-body self-examination for the presence of new moles, or for any changes to existing moles, including size, shape or color.

Brown has become an advocate for counseling friends and family to pay closer attention to their skin.

"Dark-skinned people think it's nothing," Brown said. "A lot of times we get moles, and we don't think anything about it. Don't accept that it can't be something; go see what it is. Don't say 'Eh, (melanoma is) something that white people get.'"

Doctor discusses myths about sun exposure and sunburn

As the weather grows warmer and more people spend longer periods of time outside in the sun, it's important to understand the dangers of sun exposure. "Ultraviolet radiation is a known carcinogen, which means, similar to cigarette smoking, it can cause lasting damage to the body," said Dr. Holly Kanavy, assistant professor of medicine at the Albert Einstein College of Medicine and director of pharmacology at Montefiore Health System. Kanavy discussed five myths people often believe about sun damage:

Myth 1: Some people believe they only need to protect themselves from the sun during peak hours. Although extra precautions should be taken between the hours of 10 a.m. and 4 p.m., people are susceptible to damage from the sun anytime it's out.

Myth 2: Some people think if children do not get burned, they must be wearing enough sunblock. However, young children are particularly susceptible to sun damage and should wear and reapply SPF 30 or higher sunblock. Hats and sunglasses as well as clothing are also helpful, but wet clothes don't offer much protection from the sun.

Myth 3: Some individuals think sun exposure is required to obtain vitamin D. In truth, it only takes 10-15 minutes of sun exposure several times per week. Some people do not wear sunscreen because they're trying to get vitamin D. However, that isn't necessary because it takes sunscreen about 20 minutes to start working, and people can get their vitamin D intake during that time. Also the vitamin can be acquired through certain foods.

Myth 4: Some people believe that the only important factor to look for in sunscreen is the SPF. However, people should make sure their sunblock protects against both UVA and UVB rays. UVA rays age the skin and can cause skin cancer. To make sure a sunblock protects against both kinds of rays, look for the words "broad spectrum" and ingredients like avobenzone, oxybenzone, zinc oxide and/or titanium oxide.

Myth 5: Some people think sun protection is unnecessary indoors or on cold days. However, temperature doesn't affect radiation, and UVA rays can go through clouds and glass. UVA rays don't cause tanning, but can cause damage.

Kanavy also recommended steps to take after getting sunburn. "Immediately after a burn, take a cool shower and keep the burn moisturized," he said. "Ingredients like vitamin C and vitamin E can help control damage."

Many Americans still don't use sunscreen, which has been proven to prevent skin cancer, the most common cancer in the U.S.

Sunscreen has been proven to reduce the risk for all types of skin cancer and to prevent or delay signs of aging, but most Americans still don't use it regularly, according to a new study by the federal Centers for Disease Control and Prevention.

The study, published in the Journal of the American Academy of Dermatology, found that only 14 percent of men and 30 percent of women regularly use sunscreen both on their face and other exposed areas. It also showed that more than 40 percent of men and 27 percent of women never use sunscreen on their face or other areas of exposed skin when outdoors for an hour or more, Carrie Myers reports for HealthDay News.

"The overwhelming majority of melanomas -- the deadliest form of skin cancer -- and non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun," Dr. Deborah Sarnoff, senior vice president of the Skin Cancer Foundation, told Myers. "That's why daily sun protection is critical," she said.

The foundation recommends that when you are out in the sun you should seek shade, wear protective clothing, including a broad-brimmed hat, wear UV-blocking sunglasses and wear a broad-spectrum daily sunscreen that has an SPF of 30 or higher and is water-resistant,of which you should check the expiration date, Sarnoff told Myers.

The study also found that nearly 40 percent of sunscreen users didn't know whether their sunscreen provided broad-spectrum protection.

"Broad-spectrum means that the sunscreen protects the skin from both UVA and UVB rays. UVB rays are responsible for sunburns, while UVA rays go deeper into the skin, causing sagging and wrinkling. It is believed that both UVA and UVB rays play a role in skin cancer," Myers writes.

"To take advantage of the full protection your sunscreen offers, it should be applied thickly to all exposed skin and reapplied every two hours and after swimming, sweating, and toweling off," Dawn Holman, lead author of the study, told Myers. "Sunscreen is most effective when paired with other forms of sun protection."

Holman recommended products with physical blocks, such as titanium dioxide and zinc oxide, for those who shy away from sunscreens because they fear the chemicals in them. She also told Myers that everyone should avoid midday sun exposure because that is when the UV rays are most intense and encouraged people to check the UV index before going outdoors, saying, "The higher the UV index, the more sun protection you will need."

Skin cancer is the most common cancer in the United States, according to the CDC. The most severe form, melanoma, causes more than 9,000 deaths a year in the United States, Myers reports.

Teens continue to use indoor tanning, in spite of risks; Ky. law lax

Kentucky teenagers are continuing to use indoor tanning in spite of the risks. Though tanning-bed use by children is illegal in 17 states and Washington, D.C., it is allowed in Kentucky. The Kentucky House passed a bill that would have made it illegal for those under 18 to use tanning beds, but it didn't pass the Senate. The law allows those under 14 to use tanning beds if accompanied by an adult, and those 14 to 18 can if they have a parental consent form.

Having a tan is a popular trend for those attending prom and other events like dances and graduation parties, Christine Fellingham writes for The Courier-Journal. "Usually, I go to a tanning bed before a dance," Naomi Popa, a 17-year-old Kentucky Country Day senior and occasional indoor tanner, told her. "I think it all started when one person went. Then everyone started going. If you're the only one who doesn't, you look so pale in comparison."

They continue tanning, even though doing so increases the risk of getting cancer. "Tanning-bed use can increase your risk of skin cancer by 59 percent," said Dr. Tamela Cassis, a Louisville dermatologist. In June the Food and Drug Administration sent a warning that minors shouldn't use tanning beds, and eventually all tanning beds will include a "black box" warning saying that those younger than 18 shouldn't use them, Fellingham notes.

Not everyone will pay attention. "We talk to parents and teens about the dangers of tanning all day long," Cassis said. "The youngest person I've treated to date for skin cancer was 16 years old. It required a wide local excision to cut it out. . . . It has made everyone in the family so much more aware. And like everyone else we see with skin cancer, he wishes he could take back the bad choices he made."

Young people face a lot of peer pressure to be tan because they often associate being tan with being attractive. According to a 2013 American Academy of Dermatology survey, 80 percent of people under 25 said they believe they look better with a tan. "I feel more confident with a tan," Popa said. "My skin clears up; I don't need as much makeup. I think I look better."

According to the academy, 2.3 million teens tan indoors every year, and 71 percent of those who use tanning salons are girls and women ages 16 to 29. In the past 40 years, skin cancer among females has increased eightfold, according to the Skin Cancer Foundation.  (Read more)

FDA issues warning label for tanning bed use by minors; sponsor of bill for a state ban says he will try again

Soon tanning beds will have a "black box" warning that those younger than 18 should not be using them, but some doctors, tanning companies and legislators do not think this will be sufficient to keep minors from tanning. "Consequently, some want a new Kentucky law prohibiting bed use by minors," Annie Garau writes for the Lexington Herald-Leader.

Lexington Herald-Leader graphic

The U.S. Food and Drug Administration announced May 29 new regulations that moved sunlamps from the category of low-risk devices—like dental floss and tongue depressors—to moderate-risk devices. Tanning beds are dangerous because they emit ultraviolet rays like the ones from the sun. These ultraviolet rays not only cause wrinkles and eye damage but also cause skin cancers, including melanoma, which is the most deadly kind of skin cancer, according to the FDA and local doctors.

"There's really no way to get a tan right now without incurring the risk of cancer," said Dr. John D'Orzio, a researcher and pediatric oncologist at Kentucky Children's Hospital. "I don't want to tell people not to go outdoors at all because that would be ridiculous, but the actual ultraviolet radiation from the beds can be up to 10 times more than from standing in the sun." D'Orazio said his biggest concern is that children under 18 have access to the tanning beds. Currently Kentucky only requires "signed parental consent for teens ages 14 to 17 and in-person parental consent for anyone younger than 14," Garau writes.

Mark Wells and Cheryl Ledford, co-owners of Southern Rays Tanning, do not think the new warnings will turn customers away. "There has always been some kind of warning on the beds," Ledford said, "and they haven't stopped people from tanning."

Wells said there are health benefits to tanning, such as increased Vitamin D, the fading of acne and getting a "base tan" indoors to prevent burning outside. D'Orazio disagreed. "A base tan is not going to help you avoid the risks," he said. "You're still getting ultraviolet radiation while you're getting that base tan. Also, it really only takes about one minute of standing in the sun to get enough vitamin D. . . . This is a multibillion-dollar industry. That's a lot of money going into downplaying the negative consequences."

American Academy of Dermatology President Dr. Brett Coldiron said that although sometimes dermatologists prescribe phototherapy as a treatment, "The difference between phototherapy and indoor tanning is that phototherapy is closely monitored and supervised by a dermatologist. This type of medical care isn't provided at an indoor tanning salon, where operators have minimal knowledge about the potential side effects of UV light, and tanning bed lamps have variable amounts of UVA and UVB light."

State Rep. David Watkins, a Democrat and retired physician from Henderson, wanted to prevent Kentucky minors from using tanning beds without a medical prescription, but the Senate Health and Welfare Committee killed his House-passed bill. "I think I'm going to have to work a little harder and make sure my colleagues in the Senate understand that I'm not trying to limit freedoms," Watkins told Garau. "I'm trying to protect some of our most vulnerable constituents." (Read more)

Breakthrough drugs for targeted diseases work wonders, but are very expensive; some see a trend to worry about

Drugs focusing on narrow subsets of broader diseases are now being developed for individuals with specific genetic makeups. This trend prompts questions about who covers the cost, who gets the drugs and which diseases get the investment dollars, Brady Dennis reports for The Washington Post.

The newest "breakthrough" pharmaceutical is a new lung cancer drug named Zykadia, Dennis reports. The Food and Drug Administration released it four months ahead of schedule.

This drug is not designed to treat everyone who has lung cancer, which kills an estimated 160,000 Americans each year, including 3,500 Kentuckians. Kentucky's lung cancer death rate is almost 50 percent higher than the U.S. rate, placing Kentucky first in the nation for new cases and deaths from lung cancer.

Zykadia is designed to treat only about 5 percent of patients who fit into a specific subset of the disease: those who have advanced, non-small-cell lung cancer, and a specific gene mutation that causes tumors to resist other treatment, Dennis writes. For them—and only them—the drug has the proven potential to shrink tumors and extend lives.

“It’s a new world,” Wendy Selig, president of the Melanoma Research Alliance, told Dennis. “We’re segmenting what we thought of as large diseases into smaller populations of patients that are defined by genetic distinctions. . . . The goal is to match the right therapy to the right patient and to do it with minimal collateral damage.”

Since 2011, the FDA has approved numerous new treatments for melanoma, or skin-cancer patients with certain types of genetic mutations, specific cancers and a small proportion of people with cystic fibrosis, Dennis notes.

The FDA told Dennis that almost 40 of the nearly 50 drugs it has designated as potential “breakthroughs” involve targeted therapies. These targeted therapies often offer recipients earlier and better diagnoses, more effective treatments and even possible cures—or at least more time—for people who previously had little hope.

"But the trend toward targeted medicine also is forcing hard questions on regulators, drug makers, insurers and patients alike: Who should pay for the growing number of specialized drugs, which can cost hundreds of thousands of dollars a year? How does society ensure that everyone who might benefit—rich or poor—can receive treatment? What about patients whose specific conditions or mutations have not attracted investment dollars or the attention of researchers, leaving them to watch and hope from the sidelines?" Dennis writes.

Private insurers and Medicare generally cover the high drug costs, which currently account for only a fraction of overall health-care spending, Dennis reports.

But Barry Werth, an author and journalist who has spent decades writing about the pharmaceutical industry, asks, "What happens when targeted drugs become the rule rather than the exception? Will insurers refuse to cover some of them? Will the government ponder rationing them? Will only the wealthy be able to afford the best and newest treatments?"

This scenario could be happening with Sovaldi, a "groundbreaking new treatment" for the estimated 3 million Americans infected with hepatitis C, Dennis reports. Insurers are publicly rebelling against the drug's price of $1,000 per pill, or $84,000 for a 12-week treatment.

"The worry is that Sovaldi is the poster child for a “tsunami of expensive medicines” that collectively threaten to bankrupt the health-care system," John Rother, president of the National Coalition on Health Care, which represents insurers, employers, consumer and religious groups, health-care providers and some drug manufacturers, told Dennis.

“We’ve been able to absorb it so far because there are very few of them and because they are consumed by very small numbers of people,” Rother said of specialty drugs. “[But] if they’re all priced at the same level Sovaldi is, we really won’t be able to absorb it in the current system. It’s not sustainable.”

Edward Abrahams, president of the Personalized Medicine Coalition, an advocacy organization that includes drug makers, medical providers and patient and research groups, told Dennis that the cost of creating targeted drugs cost billions of dollars and often takes a decade or more to develop. Without the ability to recoup those costs, he said, "research will wither."

“As a society, we’re schizophrenic about this,” Abrahams told Dennis, adding that everyone wants to cure cancer and other diseases. “But at the other end, you have to be willing to pay for these products. . . . When you develop a drug for a segmented population, the cost of that drug is likely to be higher than if it worked for everybody.”