SUICIDE BY SUNLIGHT? - PART TWO The Conclusion

This week we conclude our discussion of the American Cancer Society's ad campaign which emphasizes the alleged dangers of sunlight and skin cancer.

Some might argue that it is important to warn people to avoid sunlight exposure, and to screen for skin cancer, since melanoma is such a deadly disease. But this argument is flawed, not least because the exact nature of the association between sun exposure and melanoma is uncertain. As Dr. Barry Kramer, associate director for disease prevention at the National Institutes of Health, put it: "It's just not that simple."

Dr. Marianne Berwick, an epidemiologist at the University of New Mexico, has done extensive research on this very issue, and has authored 75 PubMed-listed articles on melanoma. She led a 2005 study, published in the Journal of the National Cancer Institute, showing that people who received a lot of sun exposure up to the time of their diagnosis actually had better survival rates than those who received little sun exposure. That's right, better. The study concluded: "Sun exposure is associated with increased survival from melanoma" (Berwick 2005).

As early as 1990, Cedric Garland and his colleagues showed that people who are regularly exposed to ultraviolet radiation because of their occupation have a decreased risk of developing melanoma. The reason for this might be that a tan blocks the further penetration of ultraviolet rays, so there is less free radical production. Another reason might be that people who spend much time in the sun produce an abundance of vitamin D, which exerts a protective effect. Other studies have shown that people who consume a lot of fat and alcohol have an increased risk of melanoma, while those who eat foods high in vitamin D, carotenoids, and protein and carbohydrate have less risk. So melanoma may have more to do with the hot dog and the beer you consume in the bleachers this summer than with the suntan you get by sitting there.

Admittedly, there is a continuing debate over the role of sunlight in melanoma, but there is at least as much evidence that sunlight can be protective as there is to show that it is directly harmful. For that reason, many doctors consider the ACS advertisements to be a gross over-simplification of a complicated issue.

"We do have some pretty good evidence that sunscreen will reduce your risk of the less lethal forms of skin cancer," Dr. Kramer told the New York Times. "There's very little evidence that sunscreens protect you against melanoma, yet you often hear that as the dominant message."

ACS concedes that their campaign has a deliberately alarmist tone. According to Dr. J. Leonard Lichtenfeld, who is the deputy chief medical officer at the ACS, "We have taken some license in taking that message and using it the way we've used it," he said, "because that's the way to get the message to our target audience."

The financial relationship between ACS and Neutrogena has also raised red flags for some experts. "When people see an American Cancer Society public service announcement," said Dr. Lisa Schwartz, co-director of the Outcomes Group at the Veterans Affairs hospital in White River Junction, Vt., "They expect it to reflect the best evidence. We don't want people who have a financial interest to be telling you the benefit of doing something."

Dr. Lichtenfeld of the ACS denied any inherent conflict of interest in the advertising campaign, asserting that Neutrogena did not influence the cancer society's message on skin cancer. But if that were really so, why would the ACS fail to take into account the many reputable scientific studies showing a lower incidence of melanoma when people are regularly exposed to sunlight?

Dr. Kramer, of the National Institutes of Health, also disputed the advertisement's claim that skin cancer is "almost always curable if you catch it early." Screening seems to be the ACS's knee-jerk solution to just about everything malignant. But as Dr. Kramer cautions: "There's no high-quality evidence that shows that skin cancer screening prevents deaths...For all the increase in diagnosis at early stage, we haven't changed the risk of dying. We're curing people who didn't need to be cured in the first place."

Dr. Lisa Schwartz says getting a sunburn should not be a cause for panic. "You're taking a small risk and raising it somewhat," she said, "but it's still a small risk." These are reassuring words in an age when even a slight exposure Old Sol is seen in some quarters as tantamount to suicide by sunlight.

The American Cancer Society says that it prides itself on providing the most up-to-date, accurate information about cancer-related issues, research, and news. As part of this effort, they are also committed to dispelling what they call "the cancer-related rumors and myths that are often spread through the Internet, email, and everyday conversation." They are particularly keen on exposing so-called "myths and half-truths about cancer." In that case, here are a few "myths and half-truths" that the ACS might consider investigating:
The myth that, left untreated, many cases of skin cancer will prove fatal.
The half-truth that exposure to sunlight has been conclusively proven to increase one's risk of melanoma.
The myth that screening for melanoma has been proven to extend survival.
The questionable ethics of alarming the public with willfully misleading advertisements, secretly paid for by a prominent sunscreen manufacturer.
The myth that one can take money from profit-oriented corporations without becoming entangled in their business goals.


--Ralph W. Moss, Ph.D.