- Sunbathe in peace - for now
- A respected team of academics has infuriated health campaigners
by rejecting their advice to holidaymakers to keep out of the sun.
- The epidemiologists say that warnings about the risk
of skin cancer are preventing people from indulging in a simple human pleasure
which boosts happiness, improves levels of Vitamin D and may even reduce
the chance of coronary heart disease. Skin cancer rates are increasing
in Britain, with malignant melanoma killing about 1,200 people a year.
But the academics argue today that this death rate is low compared with
the country's major killers.
- "There is evidence that the potential benefits of
exposure to sunlight may outweigh the widely publicised adverse effects
on the incidence of skin cancer," they wrote in the British Medical
Journal. "For many people the small absolute increase in risk of melanoma
could easily be outweighed by the effect of reduced sunlight on mood."
- But campaigners were dismayed by the article. Christopher
New, skin cancer campaign manager for the Health Education Authority, said:
"It has taken many years to change people's attitudes to sunbathing.
We are very disappointed with this controversial article. It has scant
supporting evidence and it runs the risk of undoing many years of good
- The dispute arose on the hottest day of the year so far,
and with a forecast of more sunshine to come. The Bristol team of epidemiologists
says that avoiding the sun will do little to decrease an individual's risk
of malignant melanoma, the most deadly of the three types of skin cancer,
though it might improve the national statistics for the disease.
- Prof George Davey Smith and Prof Stephen Frankel wrote:
"Even if reducing exposure to sunlight reduces the incidence of melanoma,
its effect on overall mortality will be slight, as the number of deaths
postponed will be small. In 1995, the deaths of 697 men and 698 women in
England and Wales were attributed to malignant melanoma. Even the most
forceful campaign could be expected to prevent only a few of these deaths."
- In comparison, they said, coronary heart disease killed
139,000 people in 1995 and there is some evidence that sunlight reduces
the chance of a heart attack. Because these figures are so much higher,
they argued, "even a modest protective effect of exposure to sunlight
could result in a substantial reduction in mortality".
- They added: "People find lying or sitting in the
sun enjoyable and relaxing. This subjective sense of well-being may be
important in itself in improving the quality of a person's life."
Sunshine stimulates Vitamin D production, which may be the reason for the
effect against heart disease and which also strengthens bones. Depression
and suicides have been linked with lack of sun, they said.
- But Jean King, director of education for the Cancer Research
Campaign, said: "We're not asking people to live in caves, but skin
cancer is a very nasty disease which kills people in their 20s and 30s.
This is extremely unhelpful. There's a very clear and agreed public health
message on this issue which we should be careful not to undermine. I don't
think they have produced nearly enough evidence for saying that the health
benefits of sun exposure outweigh the harmful effects."
- Prof Jonathan Rees, a dermatologist at Newcastle University,
said: "The facts of this are that ultraviolet is the major known cause
of skin cancer. If we all lived underground the rate of cancer would be
much lower so in one sense it is a preventable tumour. The question is
how should people alter their lives? That is where it gets tricky. Our
response should be proportionate to the risk. Death from skin cancer is
less than one per cent of all mortality.
- "It is not a nice way to die. It is horrific. But
there is no equation that allows you to trade that risk against all the
happiness so many people get from running around in the sun and having
their kids play on the beach in Majorca." He said the anti-sun message
left many people scared. Sunscreens were helpful in protection, he added,
but very few people could afford to apply them at the required amounts.
- It is not disputed that exposure to sun increases the
risk of skin cancer. It is believed that the riskiest types of exposure
are sunburn, particularly during childhood, and intermittent exposure -
such as office workers taking two-week holidays in the sun. Such intermittent
exposure is thought to increase the risk of malignant melanoma by 70 per
cent, while sunburn is supposed nearly to double the risk. But studies
of sunburn and cancer have been disputed because people with skin cancer
are more likely to remember having had sunburn.
- The mechanism by which sunshine leads to malignant melanoma
is not fully understood. Some people are more at risk, for example if they
have red hair and freckles, but the full genetic predisposition is not
understood. One paradox which has been difficult to explain is that people
who work in the sun appear to have a reduced risk of melanoma.