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CancerCare Manitoba Foundation is using a special UV camera to show how the sun's rays can damage your skin and increase your risk for cancer. Are you at risk?

From left: Darlene  Karp, Dianne Wickenden, Bertha Klassen and Valerie Denesiuk.
Dana Kreutz says she wasn't expecting CancerCare Manitoba's UV camera to pick up as much skin damage as it did (right).
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How a UV camera works

How to apply sunscreen

How to choose a sunscreen

Practice safe sun

Winnipeg Health Region
Wave, Summer 2015

Dana Kreutz was not happy.

The 26-year-old woman had just had her photograph taken with a special digital UV camera during an event at Assiniboine Park.

Operated by the Kick Cancer Street Team, the camera is a powerful awareness tool provided by CancerCare Manitoba Foundation. It is designed to detect melanin, a brown pigment that is associated with skin damage caused by overexposure to ultraviolet radiation from the sun that cannot be seen by the naked eye. The more melanin visible in the photo, the more damage to your skin.

In Kreutz's case, the camera revealed more skin damage than she was expecting. 
"The photo showed that I had lots of sun exposure," she says. "There were melanin clusters, and that's not good. I was pretty surprised, and I wonder what the rest of my body looks like, because I've been pretty good about putting sunscreen on my face."

Well, perhaps not that good.

Upon reflection, Kreutz admits she can be lax about reapplying sunscreen. "You're sitting on a patio in the sun for hours and you don't reapply. You don't think about it at the time," she says.

That's going to change now that Kreutz can see just how important that sunscreen, along with other protective measures, can be. "It's something I'll give a little more thought to," she says.

And that is the reaction CancerCare Manitoba Foundation is hoping for. Each year, it sends its UV camera team to various events throughout the province in a bid to raise awareness about the potential problems associated with overexposure to the sun, including wrinkling skin and an increased risk for skin cancer.

And although the camera is not a diagnostic tool and the images it produces are not a predictor of cancer, they do catch people's attention, says Elizabeth Harland, Sun and UV Safety Co-ordinator for CancerCare Manitoba.

"People really react to seeing the damage," she says. "Whenever I ask people if they protect their skin from the sun, the most common answer I get is, 'Not as much as I should'."

Ultraviolet radiation from the sun is broken down into three categories or frequencies: UVA, UVB and UVC. 

UVC rays aren't a huge concern because they are largely blocked by the earth's ozone layer. The real damage is caused by UVA and UVB rays.

UVA rays penetrate into the deeper layers of the skin, causing aging and wrinkling. Studies indicate UVA rays also initiate and exacerbate the development of skin cancer. Although less intense than UVB rays, UVA rays are present year round and can penetrate glass and clouds.

UVB rays are responsible for burning, tanning, and the acceleration of skin aging. Although they do not penetrate as deeply as UVA rays, they also play a significant role in the development of skin cancer.

The three main types of skin cancer are basal cell, squamous cell and melanoma. Basal and squamous cell cancers are the most common, and the most treatable. Melanoma, while less common, is the most deadly.

"More than 90 per cent of skin cancers are caused by exposure to UV radiation from the sun," says Dr. Debjani Grenier, a medical oncologist at CancerCare Manitoba. "Prevention is key."

Which is why people must guard against too much sun exposure.

"There's no such thing as a healthy tan," says Dr. Marni Wiseman, a dermatologist and Chair of the Skin Cancer Disease Site Group at CancerCare Manitoba.

People who do spend too much time out in the sun without protection will often get sunburn, an indication that the DNA in your skin cells has been damaged by too much UV radiation. A painful sunburn just once every two years can triple your risk of melanoma.

One of the big challenges in getting people to recognize the potential dangers of skin cancer is that it is a relatively slow-developing disease. People, especially young people, who get too much sun today, may not pay for it until tomorrow. The result is that behaviours are hard to change.

"Young people think skin cancer is an obscure problem that won't happen to them," says Wiseman. Yet the statistics suggest more people are developing skin cancer all the time.

In Manitoba, an estimated 190 people will develop melanoma in 2015, including 110 men and 80 women. Among younger people across Canada, melanoma is one of the most common cancers. Between the years 2006 and 2010, melanoma was the fourth most common cancer among 15 to 29 year olds. Melanoma was also the fourth most common type of cancer among 30 to 49 year olds.

Melanoma is also one of the fastest-growing cancers in Canada in terms of increasing incidence, along with thyroid and liver, rising by 2.3 per cent for men and 2.9 per cent for women each year between 2001 and 2010.

In Manitoba, rates for basal cell and squamous cell carcinomas have tripled during the last 50 years, but the increase in the rate of melanoma is even more dramatic. Rates of melanoma have increased 15-fold since 1960.

A number of factors may be contributing to the rise in skin cancer rates, including favourable attitudes towards sun exposure and tanning, the popularity of vacations in tropical destinations, ozone depletion, and an aging population, as greater sun/UV exposure happens over time.

"People have a broad idea that UV exposure is important in skin cancer development, but even though we have the knowledge, people still don't practise safe sun behaviour," Wiseman says. "It's so shocking when you go to the beach and see people lying there in the sun. What they're doing is causing their own cancer. It's really frustrating, actually."

When it comes to protecting yourself against the sun's harmful rays, CancerCare Manitoba recommends a multi-pronged approach.

"Sunscreen is just one of four ways to protect yourself, says Harland. "You should also seek shade, cover up, and avoid peak hours, which are typically from 10 a.m. until 4 p.m.," she says.

Wiseman agrees, adding that people should think of sunscreen as an additional protection, as opposed to a license to spend more time in the sun.

"People know what sunscreen is, but they're not using it appropriately. They're using it to increase their sun exposure instead of using it as an extra level of protection," she says.

There are two basic types of sunscreens: those with chemical filters and those with physical filters. Sunscreens with chemical filters work by absorbing UV light. Those with physical filters, such as zinc oxide and titanium dioxide, work by reflecting the light.

Not all sunscreens are created equal, says Wiseman. "Some sunscreens have better UVA and UVB filters than others, and some of these filters are more photo stable than others," she explains, adding that a broad-spectrum, or full-spectrum, sunscreen provides protection from both UVA and UVB rays.

A key factor in choosing a sunscreen is the sun protection factor (SPF) rating. The SPF rating is based on how long it takes for the sun to burn skin that's been treated with sunscreen, as compared to skin that hasn't been treated.

Harland says if you develop a burn after being in the sun for about 20 minutes, using a sunscreen with an SPF rating of 30 should theoretically prevent reddening for about 600 minutes (20 minutes X SPF 30), or about 10 hours.

But while that may be the theory, she says no one should expect sunscreen to last more than a few hours without re-application. "There are so many variables that affect the effectiveness of sunscreen… On a hot day you sweat and the sun screen can get rubbed away," she says.  

Choosing a sunscreen can also be confusing because the SPF rating system doesn't bear a proportional relationship to protection levels.

For example, a sunscreen with an SPF 15 rating is theoretically capable of blocking about 93 per cent of UV rays, according to the Skin Cancer Foundation. But a sunscreen with double the rating - SPF 30 - will block 97 per cent - only four percentage points more, while a sunscreen with an SPF 50 blocks out 98 per cent.

The best advice, Harland says, is to look for a sunscreen that is water-resistant, broad-spectrum and has an SPF of at least 30. This type of sunscreen includes those with chemical or physical filters. And most suitable sunscreens will carry the Canadian Dermatology Association logo, which means the product has met the association's standards for sun protection.

In addition to buying the right type of sunscreen, it is important to apply it properly. "People use, on average, one-third of the amount of sunscreen they're supposed to use," says Harland. "You need a teaspoon for the face and a palm full for each arm and leg," she says. "If you're using spray sunscreen, make sure you rub it in, and make sure you reapply all sunscreens after sweating and swimming. Don't miss any spots on your skin."

While Canadians tend to think of sunscreen more often during the summer months, it should be used year-round. Sand, water, snow and concrete reflect sunlight, intensifying the sun's rays 12 months a year.

When it comes to protecting your kids, sunscreen can be safely used on children as young as six months. But it is also important to keep younger children in the shade as much as possible.

And don't think you are totally safe just because you are in your car. "People can get some exposure through their windshields while driving, so they should take the same precautions as if they were outside," says Wiseman.

Another important point to remember is that not all people are equally vulnerable to skin cancer. You may have a higher risk if you were sunburned as a child, have fair skin, light-coloured eyes and blonde or red hair, freckle easily or have many moles. Those with a family history of skin cancer, or who have had precancerous lesions, are also at greater risk. A personal history with cancer can be a factor as well.

"A person with a previous melanoma has a much higher risk of another melanoma," Wiseman says.

She recommends scheduling regular annual check-ups with your family physician, ensuring that each appointment includes a thorough skin check.

Meantime, keep an eye out for moles and other skin growths that bleed, are of an irregular shape, are itchy, or change in size, shape, colour, or height. Not all skin cancers are dark - some have no colouring at all. If you see anything that concerns you, contact your doctor or dermatologist immediately.

"The majority will turn out to be benign, but it's important to get checked out," says Wiseman. "Be diligent in assessing your skin. The majority of skin cancers are curable, but some can be life-threatening."

Holli Moncrieff is a Winnipeg writer.

Wave: March / April 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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