The Sunday Times 18 August 2013
Phoebe Drinkwater, a 22-year-old music graduate, grew up holidaying in the hottest parts of America, Australia and the Mediterranean. She admits she stopped using sunblock when her parents assumed she was old enough not to need telling. Although not a sunbather, she got burnt on numerous occasions and, at 19, developed an ugly purple mole on her arm. Ironically, despite the fact that the mole rapidly grew to the size of a chickpea and bled copiously when damaged, her biggest problem was getting any doctor to believe her instinct that it was something nasty.
“They kept saying it was nothing to worry about, but when I finally got it checked, they discovered it was an advanced, life-threatening tumour. Then things moved very fast,” she says. The cancer had spread to her armpit. She has had three operations and been left heavily scarred. Having had to postpone her degree course, she now faces check-ups four times a year for the next decade. “If I got sunburnt on holiday, I never gave it a second thought,” she says. “People most definitely should.”
Unfortunately, Drinkwater is not alone. Rates of malignant skin cancer continue to rise, and the disease is showing a sinister new trend of hitting ever younger people. In the past, it could take a lifetime to build up the level of burn-related damage to cause cancer, and it affected mainly outdoor workers. Now, it is increasingly affecting teenagers, and, according to researchers, most of those are from the affluent social classes. The latest data from Public Health England reveal a 75% increase since the late 1980s, with the number of victims under 40 doubling to about 1,300 a year.
This trend has nothing to do with the thinning of the ozone layer, mystery chemicals in the environment or overenthusiastic diagnosis. It is simply down to the budget- airline revolution and our inability to resist bargain sunshine. It is these short bursts of exposure to intense levels of ultraviolet (UV) radiation that are believed to overload skin-repair mechanisms.
A recent research project investigated the behaviour of pale-skinned Danish tourists on a winter holiday in Tenerife. The scientists were dismayed to find that decades of “slip-slop-slap” and “safe in the sun” messages had not made a blind bit of difference. In the study, funded by the European Union, dermatologists monitored the behaviour of 25 apparently sensible volunteers aged 29-51, during a week-long trip to the subtropical Canary Islands. The volunteers agreed to wear wristwatch-style electronic UV monitors, but were otherwise given no instructions. All of them proceeded to strip off as fast as possible, exposing up to 85% of their bodies to as much sun as they could get. All attempted to stay in the sun for most of their waking hours and were prostrate on the beach or at the poolside for 88% of the time, between noon and 3pm. Just over half of them used sunscreen on the first day. Most used sunscreen only after they had been burnt, but dabbed it on so sparingly, it was of little use. However, it still gave them a false sense of protection, as the UV monitors recorded the most dangerous levels of sun exposure when sunscreen had been used. The end result, published earlier this year in the British Journal of Dermatology, was that the group got almost half their annual total UV light exposure in a single week, a colossal burden on skin-repair systems.
“We don’t think our volunteers’ behaviour was very different to any other group of sun-seeking holidaymakers,” says Antony Young, professor of experimental photobiology at King’s College School of Medicine in London, who co-authored the study. “The increase in malignant melanoma in young people may well be due to the rise in them taking cheap flights for short breaks.”
His view is echoed by Tony Chu, professor of dermatology at Imperial College London: “A study in America showed the incidence of melanoma was directly related to the availability of cheap holidays in sunny places,” he says. “If you go to any resort abroad, you can spot a Brit a mile away. They start lily white and rapidly look like boiled lobster. People don’t seem to understand that in strong sunshine, you need factor 50 to prevent burn.”
The Teenage Cancer Trust, which handles many of the 150-200 new cases a year among young adults, believes that most parents are fairly diligent about protecting their children from the sun. “The problem is, once children reach independent adolescence and are meant to put on their own sunscreen, they just don’t bother,” a spokesman said.
Applying sunscreen, however, remains a messy business, and until cosmetic companies develop an effective pill, high levels of melanoma will stay with us. But it is not going to happen quickly. Scenesse, an implantable treatment to stimulate the skin’s protection mechanisms, which is currently under safety review, will be available initially on prescription only to people with severe pigment disorders.
The prevailing view is that using drugs to tinker with skin-signalling pathways in healthy people may well cause more trouble than skin cancer itself. Until then, the message is clear: wear sunscreen.