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.

Kentucky leads the nation in cancer deaths, but falls short on policies to prevent cancer, especially when it comes to tobacco

Kentucky ranks first in deaths from cancer and has for several years, but falls short in its fight against cancer when it comes to supporting policies and passing legislation to prevent it, according to an American Cancer Society report released Aug. 11.

The latest edition of "How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality" found that Kentucky followed ACS policy recommendations in only two of the 10 issue areas ranked, and showed some progress in two areas, but fell short in six.

How Kentucky measures up.
Red: Falling short  Yellow: Some progress  Green: Doing Well

“We’ve made tremendous progress in the way we diagnose and treat cancer across the country. But to leverage this progress, Kentucky legislators must take advantage of the opportunities to pass evidence-based laws and policies that are proven to save lives and money,” Erica Palmer Smith, Kentucky government relations director at ACS, said in a news release.

The report used a color-coded system to rate states in 10 specific areas of public policy that can help fight cancer, including smoke-free laws, tobacco tax levels, funding for tobacco prevention and cessation programs, cessation coverage, funding for cancer screening programs under Medicaid and restricting indoor tanning to minors.

The report also looked at whether or not a state had increased access to health care by expanding Medicaid under federal health reform to people who earn up to 138 percent of the federal poverty level, had passed laws to increase patient quality of life, had passed laws to ensure oral chemotherapy drugs are covered by insurance the same as intravenous chemotherapy, and whether the state offered a well-balanced approach to pain medications.

Green shows that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark and red shows where states are falling short.

Kentucky fell short for all four tobacco policy measures in the report.

"Tobacco use remains the number one preventable cause of death, so Kentucky’s biggest opportunity to save lives and reduce health care costs starts with addressing the state’s current tobacco control policies," says the release.

The report found that Kentucky's cigarette tax, at 60 cents per pack, is less than 50 percent of the national average of $1.65 per pack. The report recommends increasing cigarette taxes by at least a $1 per pack, and then to use that money to pay for tobacco prevention and cessation program. It also recommends similar increases for all tobacco products.

"Evidence clearly shows that raising tobacco prices through regular and significant excise tax increases, encourages tobacco users to quit or cut back and helps prevent young people from ever starting to use tobacco," says the report.

Kentucky has also been unable to pass a comprehensive statewide smoke-free law and isn't likely to do so under the leadership of Republican Gov. Matt Bevin, who doesn't support a statewide ban on smoking, saying the issue should be decided locally.

That being said, about a third of Kentucky's population is covered by local comprehensive smoke-free policies, and another 10 percent or so live in places that have ordinances with varying exceptions. Kentucky has one of the nation's highest smoking rates, 26 percent.

American Cancer Society map; click on it for a larger image and a more readable legend

Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to the latest Kentucky Health Issues Poll, and have since 2013.

"Smoke-free laws reduce exposure to secondhand smoke, encourage and increase quitting among current smokers and reduce health care, cleaning and lost productivity costs," says the report. "Smoke-free laws also reduce the incidence of cancer, heart disease and other conditions caused by smoking and exposure to tobacco smoke."

Kentucky's tobacco-cessation policies also fell short. The report noted that while all Medicaid programs offer some tobacco-cessation coverage, most have varying restrictions that create barriers, like limits on the length of time a person can use certain services.The report says such barriers reduce utilization.

In addition, the amount of money Kentucky spends on tobacco prevention and cessation programs is only 4.4 percent of the amount recommended by the federal Centers for Disease Control and Prevention. In 2016, Kentucky allocated $2.5 million for tobacco prevention; the CDC recommends the state spend $56.4 million.

"For every $20 Big Tobacco spends on marketing their deadly products, states spend just $1 on programs to reduce tobacco use and save lives," says the report. "States with sustained, well-funded prevention programs have cut youth smoking rates in half or even more, saving lives and reducing state health-care costs."

In Kentucky, high school smoking rates are 56 percent higher than nationwide, and the adult rate is 74 percent higher. The report blames that on lack of "statewide tobacco-control policies" and says the higher rates cost the state more than $2.7 billion a year in health-care costs.

Kentucky also fell short on its control of indoor tanning, ACS said. The report says Kentucky lawmakers missed out on an opportunity in 2016 to pass legislation to protect minors from the dangers of indoor tanning beds. A bill cleared the Senate Health and Welfare Committee, but wasn't heard in the Senate.

The other area in which the state fell short, in ACS's opinion, was state appropriations for breast and cervical cancer screening programs.

Kentucky scored best on policies that centered around access to care. The report said the state has made some progress with its cancer pain control and palliative care policies and was ranked as doing well in the areas of oral chemotherapy fairness and expanding access to care through Medicaid.

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)

Senate committee kills bill to keep minors from using tanning beds

Legislation to ban minors from using tanning beds fell two votes short of passing the Senate Health and Welfare Committee on Wednesday. The bill, which passed the House 61-31, would have prohibited anyone under the age of 18 from using tanning beds. Kentucky prohibits all minors under 14 from using tanning beds, and requires parental permission for those ages 14 to 17.

Sen. Jimmy Higdon, R-Lebanon, told Stu Johnson of  WEKU-FM, "I just can't get to the point where I ban juniors and seniors in high school from using a tanning bed. I think they're of age to be responsible enough to understand the consequences." (Read more)

Sen. Joe Bowen, R-Owensboro, said he didn't "support the bill because it is an example of the government telling people how to live their lives," The Associated Press reports. "He noted his wife had skin cancer in her 20s that was not caused by a tanning bed." (Read more)

Seventeen states and Washington D.C. have laws banning minors from using tanning beds, and 33 states and Washington, D.C., regulate the use of tanning beds by minors, according to the National Conference of State Legislatures. California, Illinois, Nevada, Texas, Vermont and Oregon ban tanning bed use for all minors, with exceptions made in some cases for medical use. (Read more) (American Academy of Dermatology graphic of state tanning laws for minors)

State House panel approves bills to require HPV vaccinations of boys and girls and ban use of tanning beds by children

The state House Health and Welfare Committee approved two bills Thursday to require that boys and girls to be vaccinated for the human papilloma virus before sixth grade and to generally ban use of tanning beds for those under 18. HPV causes cervical and oral cancer, and tanning is a cause of skin cancer.

House Bill 311 would allow parents to withhold consent for the HPV vaccination for any reason. House Bill 310 would bar anyone under 18 from using a tanning bed without a prescription. Under current law, use of a tanning bed by 14- to 17-year-olds requires consent of a parent or guardian.

Gov. Steve Beshear issued a press release praising the bills and the prime sponsor, Democratic Rep. David Watkins, a retired physician from Henderson. "Every year, more than 9,000 Kentuckians succumb to various forms of cancer, making the commonwealth the worst state in the nation for cancer-related deaths," Beshear said. "Last week, I outlined seven major goals to reduce our rate of cancer deaths, as well as improve Kentucky’s other dismal health statistics, by 2019. . . . I am optimistic that House members will look favorably upon these common sense measures to improve the health of Kentuckians and vote for their passage."

Teens are misinformed about risks of tanning beds, and are not being warned at salons

With swimsuit season just around the corner, the American Academy of Dermatology has found that more than 40 percent of people who tan have never heard from tanning salon employees about the dangers of tanning beds. This comes days after the Tanning Bed Cancer Control Act was introduced by U.S. Reps. Carolyn Maloney (D-N.Y.) and Charlie Dent (R-Pa.). It calls on the Food and Drug Administration to reclassify indoor tanning beds and require warning labels on the equipment about the dangers of ultraviolet light.

"Studies have found that UV radiation from indoor tanning beds increases a person's risk of developing melanoma by 75 percent," said dermatologist Dr. Ronald L. Moy, president of the dermatology academy. "Contributing to this problem is the fact that tanning bed facilities currently are not required to verbally warn patrons of the known health risks of ultraviolet radiation and, in some cases, they may be misleading the public by falsely promoting artificial UV light as safer than natural sunlight."

The report found tanning bed users from 14 to 17 are "more than twice as likely to think tanning beds are safer than the sun than older tanners age 18 to 22 ... and more than three times as likely to think that tanning beds do not cause skin cancer," the research-reporting service Newswise reports.

"The FDA currently ranks tanning beds as a Class I medical device, which provides a minimal level of regulation and oversight similar to bandages, tongue depressors, gauze and crutches," Moy said. "That is why it's important that the FDA change the classification of indoor tanning devices to reflect the significant health risks that they pose." (Read more)

Earlier this year in the Kentucky General Assembly, state Rep. David Watkins of Henderson introduced a bill that would prevent children under 14 from using tanning booths. The bill, which was backed by the Kentucky Medical Association and the American Cancer Society, cleared the House's Health and Welfare Committee but went no further.