Friday, March 28, 2008

An advertisement campaign that promotes skin cancer

"Go get a tan. Your body will thank you… indoor tanning beds are a great way to get a healthy dose of vitamin D (and a tan, while you’re at it).”

So says the Indoor Tanning Association.

Defying established medical knowledge and common sense, the Indoor Tanning Association is claiming that UVA ultraviolet rays do not cause melanoma.

This kind of outrageous claim by a pro-tanning organization would usually be easy to ignore – but unfortunately they are getting quite a bit of attention. Today they published this full page ad (.pdf file) in the New York Times, where they brazenly claim ‘…there is no compelling scientific evidence that tanning causes melanoma’ and imply that campaigns to promote skin cancer prevention through avoidance of tanning are all ‘hype’.

According to ABC News, this morning Sarah Longwell (a spokesperson for the organization) told Good Morning America that “there is nothing dangerous about getting a tan.”

Unfortunately all of this is rubbish.

Now, it is true that sunlight is important to help your body to produce vitamin D. However, since the advent of vitamin D fortification of foods, the typical American diet contains plenty of vitamin D already, and rickets (vitamin D deficiency) has become rare in this country.





Courtesy MedicaLook.com




The ultraviolet rays in sunlight, however, are thought to be a major cause of melanoma, the most deadly form of skin cancer. This article provides a nice overview of the topic, including describing the ability of UVA to directly damage DNA.

Since summer is coming, I’d suggest that if you’d like the tanned look without the risk, there are sunless tanning alternatives you can look into. No matter your skin type, the American Academy of Dermatology recommends daily use of a sunscreen with an SPF of 15 or greater. Further information about skin cancer, including the ABCDs of melanoma, can be found here.


Courtesy, Philip A Bryant Melanoma Foundation


Or as Dr Benabio puts it: “Your natural skin color, even if ‘pasty’ is beautiful.”

In sum, the International Tanning Association's ad campaign is irresponsible and dangerous. I'm not sure I can say it enough. Please don’t allow your desire for a tan to put you at risk for a preventable cancer.

Some helpful resources:
SkinCancerNet’s article on skin cancer prevention
The ABCDs of melanoma detection
NCI’s free booklet on melanoma (.pdf)

9 comments:

Anonymous said...

Hey! I've been reading your site for a couple of weeks. I am a MD/PhD hopeful and want to end up some day in peds oncology. I was shocked to read your post today! My undergrad research is in melanoma and boy can I say WOW! I can't believe there is a group out there that would try to disprove the UV-cancer effect on skin. I can't wait to try to explain this to all of my sun-bathing friends.=/
Thanks again,
Kristen

Anonymous said...

I can't believe someone thought this was a good idea. Why did the new york times publish that kind of ignorance?

Jen said...

I can't believe that they can get away with that. After watching my mom struggle with malignant melanoma for 13 years before her death due to undetected skin cancer, that's heartbreaking.

What's even more depressing is my 12 year old daughter telling me the other day that she couldn't wait for summer to get a "tan", even though she's been indoctrinated since day 1 about suncreen.

rlbates said...

Great post, Dr David!

Doctor David said...

Kristen- I'm glad you've enjoyed reading my blog. Peds Oncology is a wonderful field, and we can always use more folks with a research bent.

Jen-Thanks for the comment. Hang in there with your daughter... The pressure to tan is immense, especially in adolescents. Maybe sunless tanning will satisfy her desire to be bronzed without risking melanoma.

chartreuse said...

I'm in full agreement with you that tanning is not healthy and increases the risks of skin cancer.

However, I believe that your comments about Vitamin D are uninformed. There is now good evidence that in North America a substantial proportion of the population has low Vitamin D levels. Using the low incidence of rickets is a straw man argument: just because a child has enough Vitamin D to prevent rickets does not mean that they have an optimal level. In addition, adults with low Vitamin D are not going to develop rickets. ;)

Many family doctors are now including Vitamin D levels in their standard bloodwork for annuals physicals and finding that very substantial proportions of their patient population have low Vitamin D.

As I said, I'm in full agreement with you that the solution to this is to use Vitamin D supplements or increase the amount of Vitamin D enriched foods in one's diet, and not to tan. But that still doesn't mean that the average person has enough Vitamin D.

I only found out about this because my own family doc tested my Vitamin D and found that they were very low.

Mary said...

Hey, I have "pasty" skin...it gives pale a bad name. But ANY natural skin color is a hundred times more beautiful than cancer. I have been showing my blinding white legs (not to mention the rest of me) covered by level 45-60 sunscreen, for years! People make comments, but hey, I'm 32 with virtually no wrinkles yet. And a little teasing builds inner strength. ;) To be honest, walking around on a beach without trying to color over who I am is quite...liberating.

I think what Chartreuse said about Vitamin D deserves some thought. My ob/gyn has made it a practice to test her patients' vitamin D levels, and she told me that more than half of them are testing low these days. I ended up not getting mine tested, but I bet if I did, I am low. The sun and I do not get along too well! And I try to take a vitamin and eat veggies everyday, but I'll admit to not being the best at it.

Doctor David said...

Chartreuse and Mary, you both raise an interesting point about appropriate vitamin D levels. Certainly the absence of rickets does not mean sufficient vitamin D, I'll concede that. For a really excellent discussion on vitamin D physiology and appropriate levels, take a look at this site:

http://courses.washington.edu/bonephys/opvitD.html

Fortunately, we're all in agreement that tanning is not the solution to a low vitamin D level.

hoosierville said...

http://www.dana-farber.org/abo/news/press/2007/guardian-of-the-genome-protein-found-to-underlie-skin-tanning.html

Guardian of the genome" protein found to underlie skin tanning
May also influence human fondness for sunshine

David E. Fisher (right) with Rutao Cui
A protein known as the "master watchman of the genome" for its ability to guard against cancer-causing DNA damage has been found to provide an entirely different level of cancer protection: By prompting the skin to tan in response to ultraviolet light from the sun, it deters the development of melanoma skin cancer, the fastest-increasing form of cancer in the world.

In a study in the March 9 issue of the journal Cell, researchers at Dana-Farber Cancer Institute report that the protein, p53, is not only linked to skin tanning, but also may play a role in people's seemingly universal desire to be in the sun — an activity that, by promoting tanning, can reduce one's risk of melanoma.

"The number one risk factor for melanoma is an inability to tan; people who tan easily or have dark pigmentation are far less likely to develop the disease," says the study's senior author, David E. Fisher, MD, PhD, director of the Melanoma Program at Dana-Farber and a professor in pediatrics at Children's Hospital Boston. "This study suggests that p53, one of the best-known tumor-suppressor proteins in our body, has a powerful role in protecting us against sun damage in the skin."

In a study published last year, Fisher and his colleagues found that ultraviolet (UV) radiation from the sun causes skin cells called keratinocytes to make and secrete a hormone called α-MSH, which attaches to nearby skin cells called melanocytes and spurs them to produce skin-darkening pigment called melanin. The chain of events within keratinocytes that leads to α-MSH production, however, was a mystery.

Investigators knew that α-MSH is created when another protein, known as pro-opiomelanocortin (or POMC), is split apart. They also knew that the amount of POMC within cells rises sharply when they're exposed to UV rays. But they didn't know what caused the POMC to increase.


This image shows skin which either contains p53 (normal, "+/+") or was genetically engineered to lack p53 ("-/-") before and after exposure by ultraviolet light (UV). Whereas normal skin becomes pigmented (as indicated by the dark arcs of pigment within skin cells), skin cells lacking p53 fail to induce the pigment/tanning response. Photos by Rutao Cui, Dana-Farber Cancer Institute.
One possibility was p53. When Fisher and his colleagues examined the section of the gene for POMC that promotes production of the protein, they found it meshed nicely with p53 — suggesting that when p53 docks there, it revs up POMC production. Additional evidence came when the researchers exposed human and mouse keratinocytes to UV radiation: After six hours, levels of both POMC and p53 were far higher than normal, and the level of pigment-stimulating α-MSH was 30 times above normal.

Further experiments clinched the case for p53's role in tanning. When researchers inserted p53 into keratinocytes, POMC levels rose dramatically. When they delivered UV radiation to mice whose keratinocytes lacked p53, POMC production was not induced and the mice did not tan.

The implications of the research go beyond tanning. A common skin condition, especially among the elderly, is the development of small, dark spots that are unrelated to sun exposure. The spots arise when groups of cells begin producing pigment in response to repeated stress or irritation of the skin. Although not dangerous, the condition can be a cosmetic problem, depending on its location.

"Our research offers a potential explanation of how this condition — known as post-inflammatory hyperpigmentation, or age spots — occurs," Fisher says. "We know that it occurs as a result of stress, and p53 is a classic 'stress' protein, going into action when cells experience stress-related DNA damage. What we've learned about p53 suggests that it may trigger the hyperpigmentation process."

There is even the possibility that p53 protects against skin damage in a second — and previously unsuspected — way. The protein not only causes skin to tan in response to sunlight, it may also underlie people's desire to spend time in the sun.

The same process that causes POMC to produce α-MSH also leads to the production of β-endorphin, a protein that binds to the body's opiate receptors and may be associated with feelings of pleasure. "Even as p53 is causing skin to tan during sunlight exposure, it may also affect neuronal circuits," Fisher says. "These proteins may provide an explicit link between the regulation of tanning and of mood. It raises the question of whether p53-mediated induction of β-endorphin is involved in sun-seeking behavior, which often increases skin cancer risk."

The study's lead author is Rutao Cui, MD, PhD, of Dana-Farber and Children's Hospital. Co-authors include Hans Widlund, PhD, Erez Feige, PhD, Jennifer Lin, MD, Dara Wilensky, Vivien Igras, and John D'Orazio, MD, PhD, formerly of Dana-Farber and Children's and now at the University of Kentucky College of Medicine; Scott Granter, MD, of Dana-Farber and Brigham and Women's Hospital; Claire Fung, MD, of Massachusetts General Hospital; and Carl Schanbacher, MD, of Brigham and Women's.

The research was supported by a grant from the National Institutes of Health, and the Doris Duke Charitable Foundation.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.