CDC pushes prevention as melanoma rates double

Rates of melanoma, the deadliest form of skin cancer, have doubled in the United States in the past 30 years and will continue to climb unless people minimize exposure to ultraviolet light, according to the Centers for Disease Control and Prevention.

The report comes as rising temperatures send sunseekers outside for the allure of bronzed skin.

But sunbathers are in denial if they don't realize the danger posed by ultraviolet light, said Robin Harris, a professor of epidemiology and co-director of the University of Arizona Cancer Skin Cancer Institute in Tucson. More than 90 percent of melanomas are due to skin-cell damage from ultraviolet radiation exposure. Most of that exposure comes from the sun.

"There's still a belief that 'it's not going to happen to me and this is something I don't have to worry about,' " Harris said.

Getting skin cancer wasn't something Glendale resident Tara Beye, 42, ever thought about growing up in the Valley. "It was the time when everyone put on baby oil outside to tan. We never heard about sunblock,'' she said.

So she was shocked in 2003 when tests on a mole the size of a pencil eraser on her left arm revealed she had melanoma.

Over the next 12 years, she had several surgeries and treatments but the cancer spread to other parts of her body, including lymph nodes and pancreas. Currently, she undergoes immunotherapy at Cancer Treatment Centers of America in Goodyear, a treatment that uses her own immune system to fight the disease. At times she's been so weak, she had to rely on someone for a ride. Today, she is able to drive herself.

Beye became an advocate for skin-cancer prevention. She said she's even scolded people with a sunburn. "It's helped get people in to see their doctors, so I'm glad I've yelled,'' she said and smiled.

Prevention efforts are key toward reversing melanoma rates, the latest CDC report indicates. Without increased prevention, medical experts predict this cancer will escalate during the next 15 years, with 112,000 new cases projected in 2030.

The report states that melanoma rates in the country increased from 11.2 per 100,000 people in 1982 to 22.7 per 100,000 in 2011.

But Arizona experts say the problem may be more acute because cases were underreported here for years and likely were by other states as well.

Arizona experts became suspicious five years ago after analyzing CDC data on melanoma rates in the 2000s. In 2003, Arizona's melanoma rate was 3.6 percent higher than the U.S. That made sense, Harris said, because Arizona's climate is often a draw to spending time outside.

But in CDC reports that followed, the state's rate was never above the country's again. By 2010, Arizona was 4.2 percent below.

Harris said the drop didn't make sense. "We had heard from individual dermatologists in the state that they had been seeing more melanoma cases than they had in the past."

In 2011, the Arizona Melanoma Task Force, a group of researchers, physicians and staff members from the Arizona Cancer Registry, organized to explore the discrepancies. The task force found that medical providers were underreporting cases to the state Department of Health Services.

Tucson dermatologist Nancy Silvis, who chairs the task force, said some medical providers were confused about who should do the reporting, so they never did.

"Any physician involved with diagnosis of a melanoma is required by Arizona law to report it," she said. "This would include the doctor who did the initial biopsy, the pathologist who read it, the surgeon who did the excision."

Jessica Rigler, bureau chief of Epidemiology and Disease Control Services with the Arizona Department of Health Services, said the state is sending out health notices to medical providers to improve reporting and also is working with residency programs to update doctors on the requirements before they start practicing medicine.

Rigler thinks the efforts of the task force have paid off. Arizona's reported melanoma cancer rates went up between 2010 and 2012 — from 15.4 percent per 100,000 to 18.6 percent. Individual cases reported in that same period also rose, from 1,418 to 2,138.

John Ebner, a doctor of osteopathic medicine at Arizona Dermatology in the Valley, agrees that many doctors did not know to report melanoma cases to the state. "The thought was that it was just voluntary,'' he said.

Ebner said he is seeing more cases of melanoma and finding many people don't equate the risk of getting the cancer to their personal behavior. "Many young people don't see that their life will ever end,'' he said, adding that melanomas might not show up until years after overexposure to ultraviolet light.

"The reality is that tan skin is damaged skin," Ebner said. "The tan is your body's way of trying to fight against ultraviolet exposure."

The CDC recommends several cancer-prevention strategies, including reducing UV exposure from both sunbathing and from indoor tanning booths.

Denise Spartonos, the community outreach coordinator for the UA's Skin Cancer Institute, said the institute tries to raise awareness through programs such as Living in Harmony with the Sun, which is celebrating its 10th anniversary. From 5 to 9 p.m. today, the institute will assist visitors to the Arizona-Sonora Desert Museum near Tucson to view the sun and stars through high-powered telescopes, learn about sun safety and the importance of skin-cancer checks.

"We'll have a skin analyzer machine where you can put your face into it and it will show areas of damage," she said.

Effective community skin-cancer programs could prevent an estimated 230,000 melanoma skin cancers by 2030, the CDC reports. Communities are encouraged to help by increasing shade on playgrounds, pools and other public spaces and educating children about sun safety and skin protection.

In Arizona, children in kindergarten through eighth grade can participate in the state's SunWise Skin Cancer Prevention School Program, which provides free curriculum and staff training to schools.

Beye hopes more parents will explain the dangers of the sun and tanning booths to their children and encourage them to wear hats and sunscreen. "If they can get in that habit now, it may save their lives,'' she said. "I wouldn't wish what I have on anyone."

Five steps to help prevent skin cancer

Use sunscreen

Sunscreen, found in lotions, gels, sprays, lip balms and other products, helps protect you from the sun's ultraviolet rays. But it doesn't block all UV rays. Sunscreens with broad spectrum protection (against both UVA longwave and UVB shortwave rays) and with sun protection factor (SPF) values of 30 or higher are recommended. Protect your skin even on overcast days; UV rays can travel through clouds.

Apply sunscreen properly

Read the label. Pay close attention to your face, ears, neck, arms and any other areas not covered by clothing. If you're going to wear insect repellent or makeup, put sunscreen on first. Ideally, about 1 ounce of sunscreen (about a shot glass or palmful) should be used to cover the arms, legs, neck and face of the average adult. Sunscreen needs to be reapplied at least every two hours to maintain protection. Sunscreens can wash off when you sweat or swim and then wipe off with a towel, so they might need to be reapplied more often.

Wear a hat

A hat with at least a 2- to 3-inch brim all around is ideal because it protects areas that are often exposed to intense sun, such as the ears, eyes, forehead, nose and scalp. A dark, non-reflective underside to the brim can also help lower the amount of UV rays reaching the face from reflective surfaces such as water. Don't forget the back of your neck or your ears, where skin cancers commonly develop. Look for a shade cap with about 7 inches of fabric draping down the sides and back.

Wear sunglasses

Find ones that block UV rays to protect the delicate skin around the eyes as well as the eyes themselves. Research has shown that long hours in the sun without protecting your eyes increase your chances of developing certain eye diseases. The ideal sunglasses should block 99 percent to 100 percent of UVA and UVB rays. Darker glasses are not necessarily better because UV protection comes from an invisible chemical in or applied to the lenses, not from the color or darkness of the lenses.

Avoid tanning beds and sun lamps

Many people falsely believe the UV rays of tanning beds are harmless. Tanning lamps give out UVA and usually UVB rays as well. Tanning-bed use has been linked with an increased risk of melanoma, especially if it's started before a person is 30. If you want a tan, try a sunless tanning lotion, which can provide a darker look without the danger.

Source: American Cancer Society