Your friend grew up in Southern California. Or Florida. Or the coastal area of South Carolina. Or Australia. Every birthday party—hell, almost every weekend—was marked at the beach. Being a risk-oblivious youngster, your friend was not always cognizant of cancer hazards or diligent about sunscreen. Sometimes he remembered the Coppertone. Sometimes he left it in his gym bag or at his mom’s house. Now that he’s an age where he's considering his health, he’s starting to worry: Did all those days spent shirtless under ultraviolet rays, living out a Sublime song, put him at risk for skin cancer?
There’s no sugarcoating this: Ultraviolet radiation, which is present in sunlight, causes DNA damage and genetic mutations, making it a major catalyst for skin cancer. About 95 percent of cases of melanoma, the most aggressive and deadly kind of skin cancer, are attributable to UV-ray exposure. Skin cancer is the most common type of cancer in fair-skinned populations, and the incidence and mortality rates of it are increasing. About one in five Americans will develop skin cancer during their lifetime.
As for whether or not youth is some kind of pivotal period that decides one’s risk for skin cancer, the data is more nuanced than once thought. Some ’80s-era campaigns for UV radiation awareness aimed at kids and parents flung out the frightening figure that 80 percent of a person’s total accumulated lifetime sun exposure occurred before age 18, because of all the outdoor activities associated with childhood. More recent studies have put that figure closer to 25 percent.
A 2015 study from Brigham and Women’s Hospital and Harvard Medical School found that those who soaked up a lot of sun before age 20 may have an increase in risk of melanoma and that UV exposure during those early years presented special danger of developing that kind of skin cancer. Lifetime sun exposure is also a factor in developing non-melanoma types, like basal cell carcinoma and squamous cell carcinoma, but the age at which the person is exposed matters less. Adulthood and youth exposure seems to have the same impact; days spent hanging out with the other retirees on the golf course count just as much as a stint as the captain of the high school volleyball team for non-melanoma skin cancer.
If your sun-soaked friend is assessing his particular chances of someday finding a death-heralding mole, he should tabulate more than just his number of afternoons spent poolside. It’s only one factor. “Skin cancer risk is linked to genetics, skin type, and sun exposure patterns,” says Robin Evans, a dermatologist and clinical instructor at the Albert Einstein College of Medicine in New York City. “A family history of skin cancer increases one’s risk, fairer skin types have a greater risk, and individuals who have gotten a lot of sun exposure over their lifetime are at greater risk.”
Particularly, he should think back to how often he got a major sunburn. Even a smattering of severe burns during one’s youth can be a sign of cancer risk. The 2015 Brigham and Women’s Hospital/Harvard study found that participants who experienced one to four blistering sunburns from age 15 to 20 had about a 60 percent greater chance of developing melanoma than those who had no serious sunburns during those years.
The tendency to lobster-ize is important because it shows one generally does not fare well under UV radiation. Sunburns “reflect not only the degree of sun exposure but also are a reflection of the other important risk factor, namely skin type,” Evans says. “Fairer-skin individuals are higher risk for a sunburn, so individuals who have gotten multiple sunburns have a higher risk for skin cancer than darker-skin-tone individuals who have gotten a lot of sun but never burned.” That is to say, getting sunburns isn't in and of itself a cause of cancer, but rather a sign that you have some of the risk factors.
Researchers agree that a well-pigmented epidermis is better protected than Caucasian skin against the harmful aspects of sunlight. Increases in skin cancer rates might be due to white people migrating to climates sunnier than the cloud-covered, rain-soaked European landmasses on which they genetically evolved. However, nonwhite sunbathers had a greater chance of sunburn in one very recent study, perhaps because of the perception that they did not need sunscreen. Also, melanoma has been shown to be rarer but deadlier among African-Americans.
Even if that 80 percent figure has been revised, youth tends to be one’s literal season in the sun, when people spend the most time in backyards and on soccer fields and such. So by the time you can legally drink, you probably have a history of sunburns or UV exposure to look back on and use to consider your increased risk.
“Think about teens and college years,” Evans says. “Once people start working, sun exposure greatly diminishes. So the bottom line is you can never take a deep breath if you have gotten a lot of sun, and particularly if you have gotten a lot of sunburns.”
The Worst That Will Happen
Skin cancer can be deadly, particularly if not detected early. More than 4,000 Americans will die of skin cancer in 2018, a vast majority of them from melanoma. Treatments can be intense. Joshua D. Zuckerman, of Zuckerman Plastic Surgery in New York City, says he often performs reconstructions for people who survived skin cancer, and some cases are made worse by a period of inaction.
“Two severe cases I treated involved patients who waited months or years to visit a physician while a mole or lesion grew and changed color [and] appearance,” Zuckerman says. “In one case, a young lady was forced to undergo a significant reconstruction affecting a large portion of her forehead, and in another case, I was forced to amputate a patient's toe.”
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What Will Probably Happen
Lifetime accumulation of UV radiation is just a factor for a common disease, so we can’t say all the fair-skinned beach bum kids are marked for melanoma. Obviously, millions of white people who love to soak up sun do not develop severe skin cancer. Otherwise, all those people who still fill amphitheaters for Jimmy Buffet would be dead.
And skin cancer patients have good prognoses in most cases. According to the American Academy of Dermatology, basal cell and squamous cell carcinomas, the two most common forms, are highly curable if detected early and treated properly. Even melanoma has between a 97 and 99 percent five-year survival rate if detected early.
There are steps your friend can begin taking for better skin care and monitoring. Mary L. Stevenson, a dermatologist and micrographic surgeon at New York University's Langone Medical Center, recommends that fair-skinned individuals with a history of sun exposure see a dermatologist annually for a skin-cancer screening. “Then based on risk factors, including history of atypical moles or history of skin cancer, your dermatologist can help recommend appropriate skin-cancer screening needs,” she says.
She tells her patients to check their own skin, using the ABCDE mnemonic device, a criteria dermatologists commonly pass on to their patients for self-monitoring: check if a lesion is asymmetric, has irregular borders, has different colors within it, is of a large diameter, or is evolving. She adds that the use of sunscreen starting even at the age of 50 can prevent the formation of non-melanoma skin cancers.
What To Tell Your Friend
A lifetime of accumulating ultraviolet radiation via sunlight can cause skin cancer. A childhood spent surfing, swimming and cruising town in convertibles puts him at increased risk, particularly if he’s light-skinned and experienced painful sunburns. He can still wise up now and be more consistent using sunscreen and keep track of abnormal moles and lesions. Also, skin cancer is very common and treatable if found early, so even if you’ve dialed up your risk for it, it’s not the most dreadful health hazard. There is still a good chance that worst thing you did to your skin in your youth is actually that tattoo from junior-year spring break.
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