A recent research report on melanoma from the Centers for Disease Control and Prevention received virtually no notice, yet one of the statistics in that report was—at least for me—stunning, and marked a rare public health win.
People in public health know all too well the gap between educating people about cancer risks and seeing actual results. Skin cancer is no different: We have known for many years that the risk of skin cancer is related to exposure to UV radiation, either from the sun of for indoor tanning.
Yet despite widespread efforts to educate people about this very real cancer risk, we haven’t made much progress reducing its frequency—at least until now.
The report found among young white women ages 15 to 24 , the incidence of melanoma has declined an average of 5.5% per year from January 2005 through December 2014. Not 5.5% over those ten years but 5.5 % PER YEAR. That’s remarkable, to say the least.
Millions of people in the United States develop skin cancer every year. The American Cancer Society estimates that in 2018, 91,270 folks (55,150 men and 36,120 women) will be diagnosed with melanoma, the most serious and life-threatening form of skin cancer. In 2018, 13,460 people in the United States are expected to die from melanoma (9,070 men and 4,390 women). Another 87,290 cases of non-invasive melanoma are expected to be diagnosed this year.
Those are frightening numbers. But the new report shows perhaps—just perhaps–at long last we are beginning to see hope that the scourge of melanoma may be started on a downhill slope; one we can only hope will continue for generations to come.
So what changed the trend? Was it education? Or something else?
Sun and UV light exposures are far and away the leading contributor to the development of this sometimes-fatal cancer. And it is UV light exposure in its various forms—including outdoors leading to sunburn and the use of indoor tanning devices—that does the damage.
For years we have watched as survey after survey suggested that we had not made much progress in convincing folks to be safe in the sun. Lots of efforts went into educational campaigns, such as the American Cancer Society’s Slip! Slop! Slap! and Wrap! campaign to remind people to “slip on a long sleeve shirt, slop on the sunscreen, slap on a wide brimmed hat, and wrap on a pair of UV protective sunglasses.”
I can still recall my disappointment several years ago (2012, to be exact) when I read a report from the same Centers for Disease Control with the enchanting title of “Sunburn and Sun Protective Behaviors Among Adults Aged 18-29 Years—United States 2000-2010” which chronicled the fact that 65.6% of whites aged 18-29 years reported at least one sunburn in the past 12 months. With sunburn as the leading risk factor for melanoma, it appeared few were paying attention to the risks.
In another report issued at the same time, about 1 in 3 (31.8%) white women nationwide ages 18-21 reported they had used an indoor tanning device in the previous year The average woman who used indoor tanning did so an average of 20.3 times in the prior twelve months, and 57.7% reported tanning more than 10 times in the previous 12 months. Indoor tanning was especially prevalent in the Midwest and Southern regions of the United Sates.
I think it is fair to say that at that time we weren’t doing well when it came to influencing people—particularly young, white women–that, as noted by the CDC in those reports:
“Indoor tanning is associated with an increased risk for skin cancer,”
“The World Health Organization considers ultraviolet tanning devices to a be a cause of cancer in humans. Exposure to UV radiation, either from sunlight or indoor tanning devices, is the most important, avoidable known risk factor for skin cancer.”
So what happened? What turned to tide, and led to the dramatic decrease in melanoma incidence in those same young white women just a couple of years later?
No one can say for certain, but the CDC in its recent report notes that:
“National surveillance data indicate that use of indoor tanning, which expose users to intense levels of UV radiation, and the prevalence of sunburn, a biological indicator of overexposure to UV radiation, have decreased in recent years, particularly among adolescents and young adults.”
In fact, in November 2009, Howard County MD was the first county in the country to restrict access to indoor tanning facilities, barring minors under the age of 18. Since that time, other cities and local jurisdictions—including the city of Chicago—have followed suit.
According to the National Conference of State Legislatures, as of January 2018, 16 states and the District of Columbia have similar access bans. An additional 26 states have some other form of more limited restrictions. And several states—including Nebraska and Rhode Island—have pending legislation to do the same.
In short, policymakers have taken action on the fact that indoor tanning is harmful to your health. It can cause a cancer that too frequently is fatal, and which had been leading to an increase in risk of serious illness and death for those among us who are youngest and most vulnerable.
Legislation and public interest campaigns have led to awareness, and young folks are taking notice and are changing their behaviors. For example, Minnesota passed a comprehensive indoor tanning statute in 2014. They subsequently found that for 11th grade young women the frequency of tanning dropped from 33% of the population the year prior to the statute taking effect to 9% two years later. That, my friends, is genuine progress. And it shows in the numbers. Maybe, just maybe, a couple of young lives were saved.
Too often we find ourselves resigned to the fact that there is little we can do from a practical standpoint to reduce the burden of cancer. Yes, we can screen for several cancers however many of us find it difficult to keep up with all the recommendations. Yes, we can avoid smoking, lose weight, exercise, you name it. All of these recommendations are important, and all have impact, yet at times it all seems so difficult.
However, it’s important not to give up hope. We can make progress, we can make a difference. We can reduce the burden of cancer. We know that to be a fact.
And now we can add to that fact another notch in the proverbial belt: young women (and men) are seeing a decline in the incidence of melanoma. And looking at the data, this appears to be a trend starting with the youngest among us. While it may not make melanoma and the grief it can cause a thing of the past, this trend, if maintained over time, may well make a dent in the sadness and the sorrow that too often comes along with this diagnosis.
And we must not ignore the fact that it happened because people listened, legislators acted, and kids—with a little guidance and nudge from the older folks—to their credit took up the cause.
Let’s hope they continue to lead the way.