An entire generation of women has grown up schooled on the critical importance of sunscreen. So why are more of us being diagnosed with skin cancer than ever? (Photo: Coliena Rentmeester)
Because I spent the first 18 years of my life in south Florida, I learned early that people either love the sunshine or are, like me, shade-seeking vampires. My mother was in the first group—a member of the baby-oil-and-reflector club—until she was diagnosed with malignant melanoma, the most aggressive form of skin cancer, at age 23 (she found a second melanoma in 2000; both were removed with surgery). I wore her diagnosis like a permanent wide-brimmed hat throughout my childhood, knowing that my risk of developing one as well was significant. I did my eighth-grade science-fair project on skin cancer. I never let myself tan. (My prom makeup artist had to pull my foundation shade, alabaster, out of storage: “I have never used this on anyone in Miami before!” he marveled.) I stood out like a fir among palms.
But it wasn’t just my pallor that made me the odd girl out; my ardent commitment to sun protection did, too. I wore dorky cover-ups at the pool and performed sunscreen-application ambushes on my friends. There was a disconnect between what I knew—that all UV exposure, at the beach and during a normal day, contributes to premature aging and skin cancers—and what my perfectly smart peers were doing. Hitting the beach after school was a common social activity, as was indoor tanning. Nothing could stop them from baking.
So why is it so hard to get young women, my friends included, to quit tanning, both outdoors and in? The main reasons are as simple as they are intractable: Many young women love the way a tan looks—and the way the sun feels. “If you can’t tone it, tan it” is a phrase I’ve actually heard from a handful of friends. “In my research, people say it makes you look healthy, thinner, and outdoorsy,” says Joel Hillhouse, an associate dean of research at East Tennessee State University in Johnson City, who specializes in skin cancer and tanning. And when someone regularly tans, they’re hooked on that warm, happy, energized feeling. UV exposure releases endorphins, which is possibly why people with seasonal affective disorder or low serotonin levels are more likely to be frequent indoor tanners. A recent study even found a genetic link to tanning addiction. “When someone is tanning, you see changes in the brain in the same area associated with other addictive behaviors,” says Brenda Cartmel, a senior research scientist at Yale School of Medicine and the author of the study. “After all, one hallmark of addiction is that you continue with the same behavior even though you know it’s harmful.” Combine that endorphin rush with all the things we regularly associate with summer—white bikinis, rooftop pools, BBQs—and it’s hard to see the sun as evil. “Our relationship with the sun is inherently ambivalent,” says Ellen Marmur, an associate clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. “The sun gives us energy, and it has amazing healing properties. It’s not all bad. But it’s hard to know the balance.”
Here’s what we do know: Skin-cancer rates have been on the rise for 30 years, despite decades of lectures about sunscreen. Skin cancer is the most common cancer in this country. Nearly 5 million Americans are treated for the disease each year, and the incidence rate is up 300 percent from 1994. Indoor tanning alone is linked to 419,000 cases of skin cancer a year in the U.S. Though melanoma represents only a small percentage of diagnoses, it can spread fast and be lethal, and it’s the most common form of cancer among young adults aged 25 to 29. Between 40 and 50 percent of all Americans who reach age 65 will develop a basal-cell or squamous-cell carcinoma. It’s a misconception that these are never deadly; they’re sometimes fatal and can be disfiguring. “The rise in skin-cancer rates boils down to UV exposure,” says Dawn Holman, a behavioral scientist in the division of cancer prevention and control at the CDC and a lead writer of the Surgeon General’s Call to Action to Prevent Skin Cancer. “If we can decrease that, we can decrease the number of skin cancers.”