Skin Cancer Gets Serious

   In June I wrote this post regarding the use of sunscreen and the new sunscreen labels, and this post from 2011 is one of many I have written in an effort to educate on the dangers of using tanning beds.
   Last week the US Surgeon General released a 112 page Call to Action in an effort to reduce skin cancer and skin cancer death in the United States - caused by ultraviolet radiation (UV).  According to the report, more Americans are diagnosed with skin cancer each year than all other cancers combined and melanoma, the most common skin cancer in young adults and adolescents, is the most lethal skin cancer, with as many as 9000 deaths attributed to melanoma each year.  
   The acting Surgeon General and the assistant Secretary of Health are both physicians who have treated patients with skin cancer.  Their concern is that in spite of efforts to promote sun protection and reduce intentional tanning, skin cancer incidence and death rates continue to rise, while other cancer rates have declined (e.g., prostate cancer, breast cancer). Skin cancer is expensive to treat, potentially lethal, disfiguring and in most cases PREVENTABLE.
   The Call to Action asks individuals, communities, organizations/employers and policy makers to take specific action in order to meet 5 goals.  The goals are:

• Increase Opportunities for Sun Protection in Outdoor Settings
• Provide Individuals with the Information They Need to Make Informed, Healthy Choices About UV Exposure
• Promote Policies that Advance the National Goal of Preventing Skin Cancer
• Reduce Harms from Indoor Tanning
• Strengthen Research, Surveillance, Monitoring, and Evaluation Related to Skin Cancer Prevention

   The Call to Action includes strategies to reach each of these goals, e.g., schools and businesses could provided shaded areas for outside recreation, health educators, such as myself, could continually promote the use of sun protection products and behaviors, states could ban or limit the use of indoor tanning facilities, health care organizations could offer free skin cancer screenings, researchers, also like myself, could evaluate the outcomes related to these strategies.  
   The 112 page Call to Action is fascinating and contains a lot of important information about most cancer types, the incidence rates of common cancers, sources of UV radiation, risk factors for skin cancer and prevention strategies.  The Call to Action also lists states which have indoor tanning restrictions and details the restrictions themselves. You can read the full report here; in addition, the CDC provides an easy to read, informative booklet (2 pages) that highlights the severity of the problem and what you can do to protect yourself.  Please read and share the booklet.  My post was meant to raise your awareness but it does not contain the level of detail you need to keep yourself and your loved ones safe.
   Remember, there are measures to take while outside, and there are numerous benefits to being outside, even (or especially) in the sunlight.  We cannot, nor should we, avoid being outside, but we can and we absolutely should, avoid tanning beds.

[NB: I cannot speak about sun exposure without reminding you that tanning also accelerates the look of aging.]



Citation:
U.S. Department of Health and Human Services.
The Surgeon General’s Call to Action to Prevent Skin Cancer

.

Washington, DC:
U.S. Dept of Health and Human Services, Office of the Surgeon General; 2014

What does a sunscreen label tell you?

In preparation for discussing the new sunscreen labels, I reviewed a post I wrote a year ago - here - and found that I really don't have new news. The labels do contain new language and unresolved issues are still unresolved.  But at least the labels are now on the products.

I will proceed with the post because as someone who can barely function on cloudy days, sun protection is very important to me.  It is also important because my job as a health educator is to remind people to be safe and smart about their time in the sun.  Evidence does support a link between sun exposure, especially sun burn, and skin cancer and early skin aging.*  (FYI: shoe hide skin is not becoming and your skin will become shoe hide like if you don't protect it.)

When you spend time in the sun:

wear sunscreen, and
make sure that the label says both of these things:

• broad spectrum
• SPF 30 (or more)

It is also good if the sunscreen has a seal from the Skin Cancer Foundation,** of which there are several types:

• Daily Use
• Active
• International
• Traditional

Click here to get the definitions straight from the source, but in case you don't click, I'll provide a brief rundown: the daily use is for people who are exposed to the sun for short bursts of time in their everyday life, for example, going from the car to a store, checking the mail, etc.  Active use is the seal I look for and it is for extended periods of sun exposure while engaging in outdoor recreation, like running, cycling, walking the beach. The international seal is for outside the US and is a little different than the daily and active seal I just described, but it is undergoing a revision so I don't have more details.  Lastly, the traditional seal is for products that block the sun (e.g., glasses, hats) that are not sunscreen.  All products which carry the Skin Cancer Foundation (SCF) seal have undergone rigorous testing (the manufacturer submits data to the scientific advisory committee at SCF). Not all of the products that have passed the 'test' have the seal on their label.  You can search for recommended products, by category here.  Although in my store visit yesterday, I did not see any spray-on products with the seal, I did see some on the SCF website. 

The new label on sunscreen - where the manufacturer uses terms like broad spectrum and includes the SPF factor - may also say that the product protects against skin cancer and early skin aging.  The reason the manufacturers can make this claim (as long as its SPF greater that 15 and broad spectrum) is because the company has to provide scientific evidence to the FDA that the product offers broad spectrum protection and spf 15 or higher, and those two factors have been empirically tested in regards to the protection they offer against skin cancer and early skin aging (think wrinkles). 

In addition, the label will now tell you how long you can wear the sunscreen while swimming or sweating before the sunscreen needs to be reapplied.  In other words, the sunscreen can be water resistant, but that declaration has to come with a time frame that has been tested.

The issue of  whether or not SPF protection over 50 is possible, has not been resolved, nor has the issue about spray-on sunscreens (they may not cover the body completely and may have toxic fumes).  However, any sunscreen with SPF under 15 has to have a warning that it does NOT protect you from either sun damage or skin cancer.  

I echo the sentiments of many others when I say, use lotion not spray, choose between SPF 30 and 50 and reapply every two hours, but I add this caveat.. . unless you are employed as an outside worker, 2 hours of direct sun a day is bordering on too much.  You need more than sunscreen  - long sleeves, hats, sunglasses for example.

I ran out of my sunscreen last weekend.  I had the spray-on kind, but after reading that the concerns about the fumes and full body protection continue, I opted for a lotion this time.  I agree that SPF 30 is sufficient.  I did choose a product with the SCF Recommendation Active.  Here are photos of my label.  Notice the information about how long this lotion is expected to protect me.

You can see the broad spectrum and SPF declarations and that this lotion is water resistant with the 80 minutes in parenthesis.  I have read that it might be a good idea to avoid oxybenzone, so I like that this product is free of it.  (Oxybenzone may have endocrine effects (related to hormone secretion/disruption)).  I later noticed that this compound is in the sunscreen lotion I recently purchased for my face. This  bothers me.  However, there is no scientific consensus on oxybenzone risks and               many dermatologist still                                                                       recommend it.  Read more here and here.)

The SCF seal is on the back of the bottle.  In the section that begins, Sun Protection Measures, is the language about sun exposure and risk for cancer and early skin aging and how products with broad spectrum and spf + 15 can protect against this risk.

*Epstein, J. H. (1983). Photocarcinogenesis, skin cancer, and aging. Journal of the American Academy of Dermatology, 9(4), 487-502.

**I read in a newspaper article that the companies who wish to submit their product information for a test to receive the SCF seal, must pay a fee or make a donation.  I do not know if that is true, but I have emailed a contact person at the SCF to find out. Meanwhile, the other information about broad spectrum and SPF language is by law and regulated by the FDA.

Really - the Sunscreen Laws are Here

On June 14th of 2011, I wrote this post and referred to another I had written in 2009 - both were about the changes in how sunscreen products in the United States could be labeled. Alas, the day has arrived (or will next month) - and most of what I told you in those past posts is now law.  There is one great exception - one great, unfortunate exception which speaks to the power of industry and the discretion of the FDA.  [this is of special concern to me because the same thing is happening with the law that mandates nutrition disclosures at restaurants... the law was passed years ago, and the FDA has the responsibility and the authority for the final rule but industry is pushing back hard... yet, so are scientists, so maybe this time the changes will be in our favor - she said in a major side bar]

The unfortunate label change no go for sunscreen is the ban on claiming SPF - sun factor protection - greater than 50.

First let me tell you what did survive from the original law:
No company can advertise its sunscreen as waterproof (sweat proof, or call itself a sun block).
I thought that all sunscreens would have to provide UV A (the kind most associated with cancer) and UV B (associated with burning) protection, but I just double checked the FDA website and now I am as confused as ever by their final rule (I am also losing faith in this government agency).

Anyway, instead of everyone having to provide both forms of protection, only those that do can call themselves Broad Spectrum.  Bottom line:if the product says Broad Spectrum and is SPF 15 or higher - that is the one you want to buy.

Broad Spectrum sunscreen protects against both types of UV Rays.

Mass confusion continues over what SPF actually means.  I will do my best to explain it in a moment, but science tells us that for a product to offer adequate protection the values should be between 15 and 50, but 30 is likely sufficient.  There is no evidence to support that SPF over 50 makes a difference, makes a clinically important difference, but the industry of sunscreen makers is still fighting to use the higher numbers.

As I understand it, the amount of time that a person can be in the sunlight, unprotected without beginning to burn is quite individualized.  It depends on the time of year, where you are physically located and your skin's pigment (fair or olive, e.g.).  It does not have anything to do with whether or not you have a 'base tan!'

SPF is related to the time it takes you to burn.  So whatever that time is, say I start to burn after 30 minutes because of my olive skin - if I use SPF 15, 15 x 30 = 450 or just over 7 hours.  I could be in the sun for over 7 hours wearing SPF 15 with reasonable assurance of not being burned (UVB protection) and as long as I have on Broad Spectrum SPF 15 - I should also be protected from the UVA rays during that time.

If I chose a 30 SPF, then I could stay in the sun longer (30 x 30) without beginning to burn.  
If I were a fairer skinned person, I might begin to burn in 15 minutes, and the math would be different.  SPF 15, 15 x 15 = 225 minutes so almost 4 hours;  SPF 30, 30 x 15 = as above.

Key to this protection is that the lotion be applied thoroughly and in a sufficient amount.  Any time one sweats, goes in the water and/or towels off, the lotion needs to be reapplied. Therefore, the labels advise that you reapply every two hours.

Sunscreens that are sprayed on may not be as effective.  The research is still pending (due to the body coverage issue) and there may be concern about breathing the fumes from the spray.

It is also important to limit your time in the sun, regardless of protection - 7 hours in full sun would be dangerous.  The best protection comes form hats, glasses, clothes and shade. 

 Of course, some time in the sun is necessary for Vitamin D production  - YAY!

Once again I link you to the Skin Cancer Foundation for more information.  I am sending you to the page with a sun safety quiz!  You better get a 100!

TWO Years and One Week Later - Sunscreen Label Laws

On June 7, 2009 I wrote this post to alert you to some concerns regarding sunscreen and misleading claims, terms and advertising on the labels.  I told you that the FDA would be issuing guidance and law on how sunscreen could be categorized and labeled (I did not know that this had originally been discussed some 30 years ago).  Today, June 14, 2011, these changes are official and making the cable, Internet news and print news.  

The important things to note from today's announcement and as referenced in the archived post are these:

There is a difference between protecting someone from getting a sunburn and protecting them from premature aging (wrinkles) and cancer.  Not all sunscreens can prevent cancer and wrinkles and the FDA has made it mandatory for companies who want to make a label claim for cancer and premature aging  - to have their products tested.

Only products that protect against UVA (sunburn) and UVB(cancer/wrinkles) rays can claim this protection.  The type of product that does this is called "broad spectrum" and that will be the phrase for YOU to find on the label.


A product that does not offer broad spectrum coverage at >15 SPF (up 50 SPF) cannot make this claim.   


The bottles and sprays will not be able to boast being waterproof, sweat proof or a sunblock and will come with a drug facts panel.  


All labels will also have to state the conditions under which the product offers this protection - including that they  need to be reapplied every two hours - the SPF number is not a reference to the amount of time it protects.

If the product has a SPF of less than 15 it actually has to provide a warning to you that it does NOT protect against skin cancer or early aging from the sun.


What this tells me is that there is strong evidence that the sun causes wrinkles and skin cancer!  If you recall - sunburn is a risk factor for later cancer occurrence, so you would want a product that included protection for all three.


Sadly - this law, which has been in limbo for decades, has a one year implementation phase - so NEXT summer you can expect these changes. 


And as I did during my first post - I want to encourage you to visit the Skin Cancer Foundation website for their report on this new rule and for important information regarding skin cancer.  As they remind in their post - sunscreen is only a part of this - hats, glasses, t shirts are others.  Hats, guys - not visors... that was another post :)

Dare I have any hope about the food labeling laws happening before 2014??  

From those who know

In a recent post I clarified the real risk of skin cancer but the low comparative risk of dying from it as compared to other cancers. 
That does not mean it isn't a real and increasing threat to young white women.  The significant rise in cases is likely due to tanning beds which persons did not have access to before the 1980s.

This article in the USA Today notes that 35% of girls who are aged 17, use tanning beds.  As we discussed in the last skin cancer post, many who use indoor beds also sunbathe. 

A few women who have been diagnosed with melanoma are speaking out about their experiences.  Social marketing research shows that serious messages about real health threats delivered by persons that are like the message target, can be persuasive.

The rate of 8700 deaths a year from this disease noted in the USA Today article is the same statistic noted on the American Cancer Society website.

[the main risk for skin cancer has been sunburns at early ages - one or two severe events can lead to the cancer - but it usually takes decades to develop. with this new threat,  it is important for parents to protect their children when they are young, but also when they are teenagers. if parents cannot prevent their children from going to tanning beds, and we can't outlaw them, then the next best thing may be national laws against tanning for persons under the age of 18]

Skin Cancer Survey Triggers Questions.

I started this blog(site) because I like to go beyond headlines and explain things to people from a health educator stand point. That passion is one of the reasons I  went back to school.  I want to improve my skills in reading, evaluating, and reporting research.  In time, I could be making my own  headlines.

Well, it seems that my critical thinking has improved, though it doesn't necessarily lead to better explanations of research articles. In fact, tonight I found myself going back and forth chasing down all sorts of validity issues with the survey results presented in this article.



I have spoken out about the dangers of tanning and tanning beds in the past. I do not question the results of this study that young white women tan too much and that the risk for melanoma is increased by this use.


My first questions were about the survey itself. (I just completed a course about survey design research).
We can see that 3800 women ages 14 thru 22 responded to the survey. It was an online survey and it was meant for white women. The survey results summarized in the link above are as follows:  of those women who responded, 32% have visited a tanning salon and 25% of that number do so once a week. The article also states that 81% of the women tan both indoors and outdoors - this is unclear, but I think that it is 81% of the 32%. You can do all that math.


So how were the surveys disseminated? How did the research agency target them? Who didn't respond? In survey research, we always want to know if there is something different about those who did not respond. Also the results noted much higher use in the older girls, older being 18-22. Some places have limits on the use of the beds by age - so that is important to note when giving results. Anyways - I could not find those answers - no sample characteristics or research design is provided - the study is not published in a journal which leads me to believe it was more like a little poll.


Then I looked at this 75% increase from the use of the beds. The American Cancer Society provides the rate of risk by various age groups for the ten most common cancers - you can see it here. If we look at life time risk of melanoma for women, it is 1.79. Thus the 75% increase, would be 1.79 + (1.79 * .75) = 3.13. That is a 3 %  lifetime risk of this type of skin cancer, if you use tanning beds. I got a little shock when I looked at the top of the cancer chart - our lifetime risk for getting cancer of ANY type is 50% for males and 33% for females.
But again, if you go down the column on the right - 1 in 56 (the average melanoma risk) is about the fifth highest cancer incidence for women -  the top is breast cancer at a 1 in 8 chance (1.2%).


As I was searching for information, I saw where the state or city of NY is attempting to ban the beds or ban them for girls under the age of 18. The legislator behind the bill has been a lifeguard and has had melanoma. He was quoted as saying that melanoma was the most common cancer. That is not true and I cannot figure out where it is coming from, because the CDC had the same statement, but the same real cancer numbers as the ACS.


By number of new cases per year and cases of death per year, melanoma falls quite short of being the most common. It comes after lung, colon, breast and prostate.  I have shared this cancer chart with you in the past, but take another look.  The only thing I can think of is that melanoma is the most prevalent. Meaning people keep being diagnosed with it and not dying from it so that at any given time it is the cancer that most Americans have. Make sense?


And to my dear math friend who reads my blog - if I did that 75% thing wrong PLEASE correct me :)

I have a very early flight tomorrow and have no idea why I am still sitting at my desk - but I will log off now and dream of my day at the beach tomorrow ...

UV Awareness

July has been recognized for national UV Awareness. For this reason I encourage you to revisit the following two posts.

http://yourhealtheducator.blogspot.com/2010/04/vitamin-d-sun-good-bad-extra.html

http://yourhealtheducator.blogspot.com/2009/06/suncsreen-vitamin-d-and-skin-cancer.html

I also bring this to your attention with renewed interest as one of my friends, and a loyal reader, recently saw a dermatologist who emphasized much of what was said in the above posts.

Ultraviolet radiation from the sun reaches us in both UVA and UVB rays. Though they do not penetrate the skin at the same intensity, they are both cancer causing and both can lead to premature or accelerated aging and they damage our eyes. When choosing a product for protection, whether its a lotion, lip balm, window or tee shirt, there are certain terms, numbers and chemicals that are considered necessary for adequate coverage.

For example:
The Skin Cancer Foundation suggests that we look for a "sunscreen with an SPF of 15 or higher, plus some combination of the following UVA-screening ingredients: stabilized a avobenzone, ecamsule (a.k.a. Mexoryl™), oxybenzone, titanium dioxide, and zinc oxide."

SPF is the term used to let you know how long the product will keep the skin protected from reddening. When your skin begins to redden you are putting yourself at risk for DNA damage which can effect aging acceleration and cancer incidence. My friend Melanie shared that her physician encouraged the use of sunblock over sunscreen. The Skin Cancer Foundation has recommendations for both. The SCF website can provide the information you need to choose a product and they have a good sized list of products that have their seal of approval.

I expect to spend some time with the lists and the many categories for choosing my skin protection and my glasses. I may even consider upgrading my hat. I want you to go to their website because they are they experts, not me.

OK - get on that - protect your skin now- you will be glad that you did!

Tan Tax - outrage

"Study after study has shown that sunbed tanning increases the risk of both melanoma and nonmelanoma skin cancers." This statement comes directly from the website of The Skin Cancer Foundation of the USA. Similar concern is noted on the website of the World Health Organization. I have no misgiving about these statements. In graduate school I worked on an awareness campaign regarding the dangers of tanning beds.

This was NOT the post I had planned for today, in fact, that post is already written and on standby because when I was reading the paper with dinner I became incensed. The WSJ has an article in today's paper that discusses a new tax that is now in effect. The tax was written into the Health Care Reform Act and will basically raise the cost of a tan by 10%. There are some exemptions to the tax. If a gym offers tanning in the monthly rate of all memberships then it is not taxed, but if it is an extra that members pay for as they use it - it is taxed. Owners of little tanning shops will be taxed. In the WSJ piece the reporter noted that fitness centers might use this exemption as a way to encourage people to join their gyms. The gym member would have access to tax free tanning. A person quoted in the story said something about it being wrong to try to keep people from becoming healthy. I have no idea what he meant. Yes, exercise improves health - tanning - NO SIR. Oh yes, and in the article it mentioned that people were trying to get more tans in before the price went up. OH MY GOSH> You may be able to view the article here.

The idea for taxing the tan SHOULD be based in the theory that higher prices for a tan would be a deterrent and thus have the potential to reduce the number of cases of melanoma. That was not mentioned in the article. No mention of radiation from tanning beds and the link to cancer was made. I was just aghast and thus had to change my blog.

Please - if you are a tanning bed user- let this be the reason you give it up. Learn more about the link to cancer from The Skin Cancer Foundation.

Vitamin D - the sun - the good, the bad, the extra

Yesterday afternoon, my coworkers and I were taking a little stroll and along the way we discussed Vitamin D benefits, the sun and the risks to our health from sun exposure. I told them that I was very careful now to also cover my head to keep the sun from frying my hair and my scalp. We reminisced about putting lemon juice and oil treatments in our hair and I shared that I used to be excited about the red highlights that I would gain each summer. One of the women I work with who was not walking with us yesterday actually had a biopsy taken recently because of a suspicious area on the top of her head. The other day at the pool, she had on a visor NOT a hat - and she is one of the reasons I wear a hat. I have been keeping sunscreen on my face as well, since a wise, older running buddy pretty much besought me to do so – for wrinkle prevention! That got my attention the most. In the last year I can say that I have been paying more attention to other people’s habits and how they are aging – both internally or physically and externally – meaning their looks. I live in Florida so there are a lot of people to observe!

Smoking and sun exposure are clearly the biggest age accelerators with regard to skin. Inactivity is the greatest ager with regard to functional ability.

About a year ago, I blogged about sun exposure and that the FDA was looking at labeling changes for sun screens – I expect that the label rules will be finalized during this year, 2010. I believe that they will be as previously suggested – 50 SPF cap and removal of the phrases sun block and water proof.

The benefits of Vitamin D also remain constant in the literature. They are bone health, heart health, mood enhancement and reduced risk of some cancers. It is said that 15-30 minutes of sun exposure two to three times a week would generate the right amount of vitamin D for health. There is a raging debate within the field of dermatology however and very few will ever recommend that one gets Vitamin D from the sun.

The irony is this – my friends and I discussed this Monday and the WSJ had a feature piece on it Tuesday. In that article there is a good explanation of UVA and UVB rays. It is the UVA that DO accelerate aging by penetrating the skin and damaging the tissue enough to cause sagging – OM GOSH – and the UVB is more often the cause of skin cancer. Tanning booths, which I have been 100% in favor of banning since 2006 – have a lot of the UVA – want to tell those 20 something girls that they will look old before their time – they will likely be more worried, just as I am, about looking old than getting skin cancer.

There are many factors involved with regard to sun exposure – the individual complexion, the geographical location – etc. Burning is certainly the biggest concern for the DNA damage that precedes skin cancer, but to be clear – the browning of the skin is also a symptom of damage.

Finally, Vitamin D is available in supplement form and many people would benefit from taking it. Next time you are at the doctor’s office you might inquire about this.

The extra for you is this link to another article which lists some factors that seem to be the most serious risks for melanoma. Melanoma is the rarer skin cancer, but the lethal one. The dermatologist who is featured here is a professor at NYU.

One (good) disease leads to another

Not at all a good disease, just a play on words. I am speaking about Parkinson's Disease today as a popular press headline caught my attention. The news story got much of the study correct, except that is states the research as "confirming" a link between Parkinson's and Melanoma. In fact, the study supports the link, and it supports previous research, but in the actual journal submission, the researchers do make a note about caution when interpreting the results which implies anything but a confirmation. The warning has to do with the data that was reviewed in that it wasn't all collected in the same manner.

Still, let me share a few things in case you are unawares. Parkinson's Disease is often associated with tremors and gait disturbance and is more complicated than a similar condition called essential tremor (ET is a progressive neurological disorder as well). Parkinson's is chronic and does worsen over time, i.e is progressive, but it is also degenerative in that the symptoms become disabling. In PD the patient may also have problems with thinking and speech.

Parkinson's disease does not have a definitive cause and is often considered idiopathic - meaning there is not clear cause! It does involve a lack of the neurotransmitter dopamine - it just isn't known exactly why the cells that produce dopamine die off in these persons. The most common treatment is with a drug called levodopa which the body turns into dopamine. Dopamine helps with movement, thinking, emotions and feelings of pleasure.

For some time, there has been concern about a higher than normal incidence of the most serious skin cancer, melanoma , in patients with PD. (other skin cancer types are basal cell and squamous cell) There has been previous research of the issue with two theories. One is that for some reasons PD patients are just more prone to it (making me think maybe dopamine is a protective factor?) or the medicine to treat it was itself putting the patient at risk.

The study from the University of Nebraska Medical Center found the four fold increase of melanoma with PD persons as compared to similar non PD persons and did not think it was from levodopa. I found a better report in a medical magazine and will link it here.

However, in educating myself about this condition and seeing that the levodopa was considered suspect at some point, I want to use that as a teaching point. If you find yourself needing a prescription medication and it has one of those warnings about avoiding sunlight - you might want to take that a little more seriously.

All Sun is Harmful?

This is an important post. My title is a little play on words associated with tobacco smoke. We, as health care professionals, are very clear in saying that there is no safe level of tobacco smoke... period. It appears that there is no safe level of unprotected sun exposure either. This is a new message. It is important because as harmful as the sun may be, its creation of Vitamin D is health promoting.

In the past week a statement regarding sun exposure and vitamin D was released by both the American Academy of Dermatology and The National Council on Skin Care Prevention. Both challenge an idea from only three or four years ago that I myself promoted. The old message was that 10 to 15 minutes of sun exposure would provide adequate D without putting the person at risk for skin cancer. That is no longer the last word.


I was also under the impression that sunscreen did not prevent the natural absorption and synthesis of ultraviolet light to vitamin D. I was wrong on that all along. As it is not considered safe to be exposed to any amount of sunlight without protective lotions (spf 15 and up) clothing and sun glasses, other sources of Vitamin D are to be utilized.

There are other risk factors for vitamin D deficiency which include older age, obesity and having dark skin. All of us are encouraged to talk to our physicians about how to get enough vitamin D and physicians are encouraged to study the issue so they can make the recommendations.

It is hard to get Vitamin D solely from your plate unless you are eating foods that have it added to them. Milk is of course the most popular source for the vitamin, as it is fortified. (fat content of milk does NOT effect calcium or D). The USDA nutrient data base does not yet list foods in order of Vitamin D content as it does with other nutrients, however, a project is under way to find those foods and supplements because " Vitamin D is among the highest ranked nutrients of public health significance and is, in part, the subject of recent publications published by the Institute of Medicine, National Academy of Science. " The data gathering is supposed to end this fall. I am very much looking forward to that.

Eggs and fish are other sources of vitamin D.


No matter how the vitamin D arrives, sun, food or supplement it still goes through two changes in the body before becoming usable. In case you are wondering, the process is called hydroxylation and one occurs in the kidney and the other in the liver.


Please note that there is an upper limit on vitamin d intake, meaning there is a level of which toxicity occurs. At this time, some experts, including the ones I respect, do advise at least 1000 IU of Vitamin D-3 for adults with up to 2000 IU as safe. Children under 18 and infants also need vitamin D though the recommendation is 400 IU. It is said that they too can have up to 1000 IU a day. Absolutely discuss any supplementation with your child's pediatrician.


The take home message is this. We must avoid unprotected sun exposure and we must get adequate vitamin D intake. I think that many of us do not take the risk of skin cancer seriously. I DO not and I know better. I think I am a bit like a smoker who rationalizes not quitting by saying, "well I used to smoke 2 packs a day". My rationalization for not always wearing sunscreen or hats or glasses, has been, "Yes, but I used to lay out with motor oil." In both cases, better isn't best. All smoke and all unprotected sun exposure are to be avoided.

Again, the vitamin D supplement that is recommended is called D-3 or cholecalciferol.

Suncsreen, Vitamin D and Skin Cancer

When I was in grad school I did a little research project on tanning bed use and created a campaign to discourage it. I found it, find it, intriguing that white women in America believe that they will look thinner, richer and prettier with brown skin especially when our country has struggled with racism or prejudice against people of color.
It is also interesting to put this in a cultural perspective as in China, I have read, mothers will present their daughters for marriage and claim pure white skin as a significant positive attribute.

Whether or not you think tanned skin attractive, too much sun and too many burns, especially on fair skin, can lead to skin cancer. According to the Skin Cancer Foundation, more new cases of skin cancer occur each year than any other cancer. Skin cancer has a low death rate, but a high rate of disfigurement. Ironic if one ends up with scars on their body in an effort to achieve their perception of beauty.

Please go to this website for important information on skin cancer and free skin cancer screening - http://www.skincancer.org/

Now some sun is a good thing as we need it to create and or synthesize vitamin D. I need sun because it moderates my mood. I just love the sun. Ten minutes of sun a day is considered safe without sunscreen by some professionals. There is not a consensus however.

Sunscreen can be helpful but not all sunscreen is the same. The FDA has been working on labeling changes for sunscreen and this was reported in an article from WebMDHealth earlier this week.

First know that UV radiation has several parts but both UVA and UVB can cause cancer. One is more related to aging the skin and damaging the eyes while the other causes the reddening and burning of the skin. Both cause DNA changes and can lead to both non melanoma and melanoma cancers.

With the new rules, no sunscreen is going to be able to state that it provides more that 50 SPF unless it can prove so in evidence based clinical trials. No sunscreen maker will be able to say that its product completely blocks the sun, is waterproof, sweat proof or offers all day protection. The label changes have been deliberated for some time and the manufacturers will have 18 months to comply once the rules are final. The labels are also going to provide advice on skin cancer prevention, such as wearing protective clothing and reapplying sunscreen often.

I would say then, if you are spending a lot of money for a product that is claiming over 50 SPF and some of the other aforementioned claims, you might save your money.

Here is the link to the article that prompted my post:
http://www.webmd.com/skin-problems-and-treatments/news/20090521/fda-wrapping-up-sunscreen-label-changes?src=RSS_PUBLIC&print=true