Vanity, sunscreen fatigue behind the rise in skin cancer

An ominous rise in melanoma cases in recent years shows that many people aren't treating the risk of sun exposure seriously, say medical professionals.

These days "people are really applying a lot less sunscreen," says Dr. Beatrice Wang, director of the melanoma clinic at the McGill University Health Centre. "I'm seeing a lot more sunburns, sun allergies in the office."

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Dr. Wang says that a combination of consumer fatigue, concerns about fashion and a generally blasé attitude about the potential of contracting melanoma are behind this lax attitude to sun safety.

A report released Wednesday by the Canadian Cancer Society (CCS) says that skin cancer rates have increased in the past two decades, especially among those over the age of 50.

The report, which was produced in partnership with the Public Health Agency of Canada, Statistics Canada and provincial and territorial cancer registries, said melanoma is on the rise, and that the main culprit is increased sun exposure.

The sun's dangerous ultraviolet (UV) radiation is responsible for 90 per cent of melanoma cases, the cancer society says. And according to Prithwish De, an epidemiologist with the CCS, Canadians are "protecting themselves less than they used to."

Dr. Michael Dickinson, a pediatrician in Miramichi, N.B., says that based on what he's seen in his practice, "parents and children probably don't protect themselves as much as they could or as much as they should."

But he admits he's "surprised" at the CCS's findings that Canadians are less vigilant than they used to be.

"I think that people are aware that [melanoma] is an issue, although I'm not sure that people fully appreciate how big an issue it is," he says.

More sunburns

The findings of the Canadian Cancer Society are similar to conclusions drawn by the National Cancer Institute in the U.S.

A 2012 report also found that the percentage of adults who reported being sunburned has increased since 2005.

Plus, it said that between 1975 and 2009, the number of new cases of melanoma increased.

Annette Cyr, founder and director of the Melanoma Network of Canada, says that in the 1930s, the chance of getting melanoma was one in 1,500; now, it's one in 50.

She says the reason for the change is our evolving attitude to sun exposure. In short, we bare more skin than previous generations.

But despite greater public awareness of melanoma risk, "there's a lot of resistance to applying sunscreens and re-applying sunscreens," she says.

"People don't like it, because it's greasy and gets all over" your clothes.

Dr. Dickinson says another problem is that many people don't know how to properly apply sunscreen. In order for it to work effectively, he recommends people use an SPF (sun protection factor) of at least 30, and apply it every two hours.

But whether it's using sunscreen or other sun-protection measures such as wearing long sleeves, or donning a hat, many people see these safeguards as "unfashionable," and thus don't do it, says Cyr, who is a melanoma survivor herself.

She says that images in popular culture have conditioned us to believe that bronzed bodies are more attractive, which is why people will risk more exposure to the sun's rays.

The vanity aspect also explains the popularity of tanning salons, although associated health risks have prompted provinces such as Ontario and Quebec to ban access for those under the age of 18.

"We've passed legislation that restricts access for youth, but we still have the adult population at risk, and we need to promote some common-sense sun safety avenues with them as well," says Cyr.

From what she has seen, Dr. Wang says parents are actually "quite vigilant" when it comes to applying sunscreen to their young children. But she says these good habits can fall off once the kids are able to apply their own protection.

"It's just when the kids start getting older and rebelling and seeing that their parents aren't using sunscreen that they don't use it, either," she says.

GPs not trained

Another reason for the poor literacy on sun safety is doctors who do little to promote sunscreen to their patients.

According to a 2013 study of U.S. doctors between 1989 and 2010, and involving more than 18 billion patient visits, sunscreen was mentioned less than one per cent of the time.

Even more telling, perhaps, was a finding that dermatologists mentioned sunscreen in fewer than two per cent of visits.

Cyr says a similar situation exists in Canada. General practitioners are "not really trained in their school to do detection of melanoma," she says.

"When you look at the time frames they have now to do a full physical [exam], they do not, for the most part, do a full check of what you would need to check for skin cancer.

"And many of them wouldn't even know what it was they were even looking at if they saw it."

Dr. Wang has found that when informing patients about the perils of sun exposure, warning them about the risk of melanoma is not nearly as effective as appealing to their fear of aging.

"If I tell them the sun is giving them wrinkles, it seems to be a little more effective in getting them to put on the sunscreen than to say, 'You're going to get skin cancer,' because no one believes they're going to be the one to get skin cancer."