Sunshine and Skin Protection

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Recently gang, I was delighted to speak on iRadio about the importance of protecting our skin as we move into the summer months and greater sun exposure day to day. For those of you reading who also live in Ireland, you’ll know that that those days can be few and far between, even in the summer, but as you’ll see in this article, we still have to be mindful of our skin regardless. Plus, many people go on holidays to sunnier locations, more commonly during the summer, so it’s really important to be sun and skin aware on all counts.

This week I attended the summer Public Health Conference, and the talk on Skin Cancer Prevention was brilliant. This week, we launched Ireland’s first National Skin Cancer Prevention Plan, which I’ve linked here, and have used it as a reference for updated data for this article. The talk also highlighted these figures from a recent survey of the Irish population on the topic of skin cancer prevention, which surprised me, and reinforced my desire to talk about this issue on the blog this week:

  • 50% of Irish adults have gotten a sunburn in the past year
  • 64% said a tan made them feel ‘healthy’
  • 34% said getting sunburned was ‘worth it’ to get a tan!

Note – it is not worth it, as you’ll see from the article below! But it does reflect some aspects of the sun culture we have in modern society in Ireland – a prioritisation of aesthetic appearance from a tan over long-term skin protection.

I’m going to structure this article in the way I did the interview with iRadio, because they asked a LOT of really awesome and relevant questions, and it’s a nice digestible way for you guys to take home the main points from an article on this topic. So, let’ get into it!

Skin cancer is the most common cancer in Ireland and we have the highest reported rates in Europe. Why do you think that is? Is it because of our typically fair skin or that we don’t use sunscreen as much as we should? 

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Skin cancers are the most commonly diagnosed cancers among Caucasian populations, with ultra violet radiation (UVR) the most well documented risk factor in this context. In Ireland,  there are over 11,000 new cases of skin cancer diagnosed each year, and this is project to more than DOUBLE by 2045 – but most of these are PREVENTABLE. When we talk about skin cancer we break it up into two main types – melanoma, and non-melanoma skin cancer. So of those over 11,000 new cases per year, approximately 9,700 are non-melanoma skin cancers and 1,000 are melanomas. By far, non-melanoma skin cancer (NMSC) is the most common and take up the majority of our skin cancer diagnoses year on year. Both types differ in terms of where on the body they present, what treatments are needed, how they spread and how quickly. In addition, there are several subtypes of both NMSC and melanoma. For NMSC, big two subtypes people might have heard of are basal cell carcinomas (BCCs), and squamous cell carcinomas (SCCs).  BCCs often appears as a bump or discoloured patch of skin that does not heal, usually a pearly-white colour or ‘waxy’ looking and may contain visible blood vessels, and the discoloured patch of skin is flat and scaly and can have either a flesh-coloured or brown appearance. SCCs appear as a firm red lump or a flat, scaly and crusted scab-like lesion that does not heal. Here is a link to the Health Service Executive website for more detail on those descriptions here.

In terms of why –  there are lots of risk factors for all skin cancers, but if we stick to the two major sub types, we know that there are variations between these two, in that some risk factors matter more for NMSC and others for melanoma, and vice versa. Exposure to UV radiation (either via sun exposure or artificially via sunbeds) is responsible for 95% of skin cancers, and it’s the most important risk factor to know about. UV radiation comes in the form of UV A, B and C – we get exposed to UV A and B via sunlight, and the DNA damage that occurs as a resulted of unprotected UV exposure is the reason why it increases our skin cancer risk.

In addition,  skin type, and to a lesser extent, hair and eye colour can increase our skin cancer risk. Most of the Irish population have what we call ‘Celtic skin type’ where we freckle and burn easily. We also find it hard to tan, and either don’t or do so very minimally – this is known as ‘type 1 skin’. The scale of skin types go from 1 to 6, and incorporate your skin colour and how your skin reacts to UV exposure. Most Irish people are skin type 1 or 2, and our skin type is genetically determined, so it doesn’t change if we burn or tan. Other risk factors include – numbers of moles and freckles, family history, and certain pre-existing medical conditions (for example, certain conditions and/or medications which cause a person to be immunosuppressed and less able to handle DNA damage that occurs as a result of UV exposure). What I’ve detailed there isn’t an exhaustive list, but it’s a good place to start in terms of what risk factors we most need to be aware of on a basic level.

And as we’ve said, exposure to UV radiation via sunshine or sunbeds is the number one risk factor we need to get on top of, and we definitely aren’t optimising our preventive efforts against UV radiation and the resultant risk to skin cancer at the individual or population level. But don’t worry, that’s what this article aims to share with you!

From a risk point of view, there are particular groups in the population that were highlighted in the talk I attended this week who are deemed to be particularly vulnerable to unprotected UV radiation exposure, either by virtue of their overall exposure to it or due to their personal characteristics:

  • Children – especially during the first 10-15 years of life, when UV radiation exposure actually contributes a disproportionately large risk to the person’s skin cancer risk later in life
  • Outdoor workers
  • Those engaging in outdoor leisure activities
  • Sunbed users

So, when should we be applying sunscreen then? Just during the sunny weather or all year round?

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The Irish Cancer Society advises as part of their SunSmart Code, that when in Ireland we should get into the habit of protecting our skin every day from April to September, whatever the weather. So, definitely not just during sunny weather, as we know those days are few and far between in this country! Even in spring and autumn, when the weather is still cool, UV levels can high enough to cause damage to our skin and increase our skin cancer risk. The Irish Cancer Society also advises us to know the UV index, which is a key part of being sun smart. When the index is three or higher, you need to cover up, seek shade and apply ‘broad-spectrum’ sunscreen with an SPF of 30.  The UV Index is available on Met Eireann’s website and is also published in newspapers each day. I’ve popped a link right here!

How do you use sunscreen? Is there a certain factor we should be using? And how much and how often?

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Okay, so there’s a few key points here that I’ve learnt from the SunSmart Code by The Irish Cancer Society (link to their website here), which I’ve summarised and bullet-pointed for you guys below. There are lots of different types of sun protection – creams, lotions, gels and sprays – all of which work but only if they are of good quality and are used properly!

  • Use a ‘broad-spectrum’ sunscreen that protects against UVA and UVB; – ensure you use an SPF (sun protection factor minimum of 30 and if you go on their website, you’ll see certain logos they advise to look for, for UVA protection.
  • Apply your sunscreen to dry skin 20 minutes before going outside.
  • Be extra careful of those areas that do not get much sun – they will burn more easily! Common areas that we often forget about is our back, backs of arms, legs. We forget how much we cover up!
  • The amount of sunscreen that’s needed to cover the body of an average adult is around six full generous teaspoons of lotion.
  • It’s recommended that we use a measure of half a teaspoon of sunscreen to cover each arm, the face, neck and ears. Use a measure of one teaspoon for each leg, the front and the back of the body.
  • Reapply every two hours.
  • Check the use-by date of the products you buy, and store below 30°C.
  • Choose a water-resistant type if sweating or you are involved in water-sports – and if you’re on holidays and go swimming, you HAVE to reapply remember! Do not use the sun to ‘dry you off’- you will just ensure you end up with sunburn instead. Not ideal!
  • Always check for the UVA logo on the bottle of the sunscreen product you buy.

How else can we protect our skin from the sun?

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So, this is a really good point, because we all sort of know we ‘should’ be wearing sunscreen, and that’s a great rule to live by, but there’s also lots of other ways to be sun savvy besides being smart about applying your sunblock. These include:

  • Getting shade. Remember, some UV rays can pass through windows. For the most part, car, home and office windows block most UVB rays but less of the UVA rays, so if you’re spending a lot of time working or driving with a lot of sun through the window, you need to be protected
  • Time it right. UV rays are the most intense between 11am and 3-4pm, so limit sun exposure during this time.
  • Slip on some clothes! Remember, stretched, wet or very old thread fabrics let more UV rays through. Dark clothes, those made with linen, cotton and hemp let less UV rays through. A hat can also be a great way to protect the scalp, especially if not much hair there, and if it’s a big wide brimmed hat you have, this might help protect your shoulders and neck too.
  • Sunglasses! These are absolutely crucial to protect our eyes and long-term vision. Make sure those you buy have UV protection and have adequate eye cover

What would you say to someone who is determined to tan in the sun, or use sunbeds? How can we change attitudes and behaviour?

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I was delighted we covered this area in the interview, as it is so important to address, but can be challenging to do. First and foremost, to anyone reading this article who does use sunbeds – using sunbeds is not a safe way to get a tan. It exposes your skin to large amounts of UV rays that age your skin and increase your risk of skin cancer. In Ireland we control use of sunbeds and prohibit this for those under the age of 18. However, for those above this age who use sunbeds, we have to continue to do our best to inform them of the very serious risk they are putting themselves at for skin damage and skin cancer, and as much as possible try to persuade them away from using these facilities. It may seem like a short-term win aesthetically to use a sunbed but in the long term the risk of skin cancer is of course not worth it – it is far too high a price. In addition, the UV rays delivered in sunbeds can be significantly stronger than tanning in the sun, which means that’s also true for the skin cancer risk that results. In terms of tanning in the sun, doing so without protection, as we’ve discussed, significantly increases the risk of skin cancer down the road, and is a big no-no. Plain and simple.

What should someone do if they’re concerned about changes in their skin?

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This is a crucial point to finish on. If you’re concerned about changes in your skin that you or someone else has noticed, head straight to your GP to get your skin checked out. It’s very important to do so, as the majority of skin cancers can be very treatable if caught early enough, and in addition, the different types of skin cancer can present quite differently so its never a one-size fits all in terms of how skin changes might look. The Irish Health Service Executive has a great webpage on what symptoms and signs to look out for in terms of the most common skin cancer types – I’ve linked this page here.

Finally, with regard to melanoma, this is the most dangerous form of skin cancer, so, just like us ladies need to check our breasts, we ALL need to know our moles! We need to look out for changes in our moles, and the British Association of Dermatology has a great ABCDE pneumonic to guide you in checking out your skin. Noticing any of the ABCD signs indicate you should head to E to get checked out – an Expert!

  • A – Asymmetry – the two halves of the area may differ in shape
  • B – Border – the edges of the area may be irregular or blurred, and sometimes show notches
  • C – Colour – this may be uneven. Different shades of black, brown and pink may be seen.
  • D – Diameter – most melanomas are at least 6mm in diameter, so report any change you notice in size, shape or diameter of your moles to your doctor.

Remember gang – if in doubt, check it out!

And that’s a wrap! I hope you found this post helpful and informative guys and are feeling up to date and ready to be sun smart this summer. As always, leave a comment with any thoughts you have on this post, and you know where to find me, @theirishbalance on Instagram/Twitter/Facebook!

Ciara 😊 x

 

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