Most patients who survive a cancer scare listen carefully to their doctor's advice and make changes to their lifestyle or diet to avoid a second brush with the killer disease.
But one startling study by the American Association for Cancer Research shows that one in four people who have had melanoma -- a cancer of the skin -- does not use sunscreen when outside for more than one hour.
The findings, announced on Monday at the AACR’s annual meeting in Washington, also showed that 2 percent of melanoma sufferers still use tanning beds – something that has been shown in several other studies to lead to skin cancers.
“We expected melanoma survivors to be extraordinarily protective since we know sunlight exposure and tanning increases the risk of a second melanoma,” said Dr. Anees Chagpar, the study’s author. “But what was interesting was that over one quarter said they didn’t use sunscreen. That blew my mind.”
The AACR study was based on the results of the 2010 National Health Interview Study, which asked a cross section of the U.S. population an array of health questions. Chagpar, who is an associate professor of surgery at Yale School of Medicine and director of the breast center at Smilow Cancer Hospital at Yale-New Haven, said her team concentrated on 171 people who said they had a melanoma history, from the 27,120 respondents in the national survey.
Chagpur said she found that generally, skin cancer survivors did better at protecting their skin by using sunscreen, and wearing hats and long sleeves, than people who have never had a melanoma. But she was shocked that 15.4 percent of melanoma sufferers reported rarely or never staying in the shade, while 27.3 percent said they never used sunscreen. Among the general public, 35.4 percent reported never using sun protection.
The study showed 2.1 percent of melanoma survivors even said they had used a tanning bed in the previous year, compared to 5.5 percent of the general public.
According to the American Cancer Society, melanoma is the fifth leading killer of men and the seventh of women among cancers. The Skin Cancer Foundation said that from 1970 to 2009, the incidence of melanoma increased by 800 percent among young women and 400 percent among young men. An estimated 76,690 new cases of invasive melanoma will be diagnosed in the United States in 2013, it said, and an estimated 9,480 people will die of melanoma this year.
Dr. Jack Jacoub, medical oncologist at Orange Coast Memorial Medical Center in Fountain Valley, Calif., said he found the numbers surprising.
“They say something about American society and you wonder if patients have been properly counseled.”
But Jacoub also said: “There is a fairly large emphasis on beauty in this country…tanning is a reflection of good health, too -- the California lifestyle, you wonder if people know the dangers but choose to ignore them.”
Dr. David Fisher, head of dermatology at Massachusetts General Hospital, said: “It is shattering to see the data, those are high numbers.”
He said, however, that studies show there might be an instinctive desire among humans to seek the sunlight as a source of vitamin D – a phenomenon that has increased in recent decades as the global population has become more mobile. Northern people with fair skin, which is more sensitive to ultra violet rays, have populated sunny places like Australia, Israel and California, where rates of melanoma are high.
Dr. Ali Hendi, a clinical assistant professor at Georgetown University Medical Center, said he sees seven or eight cases of skin cancers every day. “If they are caught early, they are essentially curable,” he said.
“(But) We need to do a better job of educating people, as there is still a public perception that there is such a thing as a healthy tan.
“Every commercial, especially those that want to attract young people, is usually set on a beach or around a pool.”
Hendi, who is also a spokesman for the Skin Cancer Foundation, said data show “people can be hooked on tanning. Sunshine can have a euphoric effect on the brain like other addictive substances.”
Chagpur, the study’s author, said a person with a melanoma was nine times more likely to develop a second skin cancer and she was at a loss to explain why skin cancer survivors would continue risky behavior after a diagnosis. “Maybe it is part of the phenomenon of addictive behavior,” she said, comparing it to lung cancer sufferers smoking. “I don’t have any scientific proof, but I bet there’s a proportion of lung cancer survivors who continue to smoke.”
Psychologists appeared divided on the reasons for such behavior. Dr Tony Farrenkopf, a clinical psychologist and chairman of psychology at the Good Samaritan Hospital in Portland, Ore., said it appeared to result from addiction to sun and also a popular culture in which a tanned look equals being healthy. “One of the parameters of addiction is engaging in high-risk behavior. Addicts try to rationalize their behavior, but they know it’s a lie.
“Another parameter (of addiction) is lack of control – a sense that ‘I gotta have it,’” said Farrenkopf, who grew up in Germany where sunbathing was part of a health culture. “It feels so good, and there was that George Hamilton look – tan was healthy,” he said, referring to the perpetually bronzed Hollywood star.
A third reason for melanoma sufferers to avoid warnings about sunlight might be a feeling of resignation. “They say: ‘I already got it, what other harm can it do?’ and that’s not true,” Farrenkopf said.
But Margaret Backman, a retired clinical psychologist and author, who specializes in health issues, did not believe recidivist skin cancer patients were necessarily hooked on the sun.
“Maybe with cigarettes, but tanning is not addictive,” she said. “It’s more denial…and fear of death.
“People minimize the seriousness of it. They think it’s not true, or that it’s not so bad.”