The Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS) announces the opening of a docket to obtain information from the public on preventing skin cancer through the reduction of UV exposure. The information obtained will be used for an anticipated Office of the Surgeon General response to the public health problem of skin cancer.
They invite comments and information on environmental or systems strategies; interventions that reduce exposure to UV radiation; and national-, state-, tribal-, territorial-, community-, organizational-, and individual-level actions.
They claim use of sun protection is low, while excessive sun exposure, indoor tanning, and sunburn are common. HHS/CDC and the Office of the Surgeon General are interested in receiving information on the following topics:
- Barriers to reducing UV exposure from the sun and from indoor tanning devices, and;
- Evidence-based strategies to reduce UV exposure in the population by increasing the use of sun protection and reducing tanning behaviors.
You can find how to submit your commentary here: https://www.federalregister.gov/articles/2013/08/05/2013-18766/preventing-skin-cancer-through-reduction-of-uv-exposure
Or you can submit commentary online here: http://www.regulations.gov/#!docketDetail;D=CDC-2013-0014
The Vitamin D Council is disappointed in the unbalanced sun exposure message that the Office of the Surgeon General is headed toward. There is emerging evidence that lack of sun exposure and subsequent vitamin D deficiency are leading to many diseases and illnesses.
While skin cancer does need attention, so do many other diseases that show a relationship with lack of sun exposure, including multiple sclerosis, colon cancer, breast cancer and more. Thus, it seems prudent and more evidence-based to promote a sun exposure message that takes skin cancer, multiple sclerosis, colon cancer, breast cancer all into account.
We implore Vitamin D Council members to submit commentary. Dr Cannell submitted his commentary. He wrote:
Dr Cannell’s commentary
“Preventing Skin Cancer through Reduction of UV Exposure,” by J. Ronald Campbell, Director, Division of Executive Secretariat, Centers for Disease Control and Prevention.
Federal Register / Vol. 78, No. 150 / Monday, August 5, 2013 / Notices (Notice Posted: 08/05/2013, ID: CDC-2013-0014-0001.
This document entirely disregards the role of sunlight in making vitamin D. In fact, Dr. Campbell does not mention vitamin D in the document. The importance of vitamin D in human health is hard to overstate.
Hossein-Nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013 Jul;88(7):720-55.
First, I will discuss melanoma. Dr. Campbell claims there is a melanoma epidemic, without mentioning it is an epidemic of stage one disease, that is, more melanoma is being diagnosed by pathologists but not by oncologists. In fact a growing number of experts think the melanoma epidemic is a “midsummer’s night dream.”
Levell NJ, Beattie CC, Shuster S, Greenberg DC. Melanoma epidemic: a midsummer night’s dream? Br J Dermatol. 2009 Sep;161(3):630-4.
Swerlick RA, Chen S. The melanoma epidemic: more apparent than real? Mayo Clin Proc. 1997 Jun;72(6):559-64.
If melanoma were caused by chronic sunlight exposure, then melanoma — like squamous cell skin cancer — would be more common in outdoor workers than indoor workers, and melanoma would be more common — like squamous cell skin cancer — in sun-exposed areas of the body. However, neither is the case.
Rivers JK. Is there more than one road to melanoma? Lancet. 2004 Feb 28;363(9410):728-30. Review.
Don’t misunderstand me; sunburns clearly increase the risk of melanoma, especially blistering sunburns. However, as with other cancers, genetics play a more important role in causing malignant melanoma, especially the number of moles you have.
Shenenberger DW. Cutaneous malignant melanoma: a primary care perspective. Am Fam Physician. 2012 Jan 15;85(2):161-8.
When the author talks about the association of sunlight with non-melanoma skin cancer, he fails to discuss the increased risk of 12 internal cancers that are associated with reduced sunlight exposure.
Lin SW, Wheeler DC, Park Y, Cahoon EK, Hollenbeck AR, Michal Freedman D, Abnet CC. Prospective study of ultraviolet radiation exposure and risk of cancer in the U.S. Int J Cancer. 2012 Apr 26.
In 2012, van der Rhee and colleagues reported the following:
“The evidence that chronic (not intermittent) sun exposure decreases the risk of colorectal, breast, prostate cancer and lymphoma is accumulating and gradually getting stronger. We therefore think that, particularly in countries with moderate climate, intermittent sun exposure (and sunburn) should on the one hand be discouraged, because of skin cancer prevention, while on the other hand (moderate) chronic sun exposure possibly should be advised.”
van der Rhee H, Coebergh JW, de Vries E. Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies. Eur J Cancer. 2012 Dec 10.
On its website, Cancer Research UK reports that “by enjoying the sun safely and avoiding sunburn, people can reduce their risk of skin cancer and enjoy the beneficial effects of the sun.” In 2005, Cancer Council Australia was the first national cancer council to recognize a balanced recommendation in a statement titled, “Risks and benefits of sun exposure.”
Also, sunlight appears to have independent non-vitamin D benefits for humans. This year, Liu and colleagues reported that sunlight lowers blood pressure with a mechanism other than vitamin D production.
Liu D, et al. UVA lowers blood pressure and vasodilates the systemic arterial vasculature by mobilization of cutaneous nitric oxide stores. Journal of Investigative Dermatology, 2013. Abstract 1247.
Dr. Becklund and Professor Hector Deluca of the University of Wisconsin were the first to discover that vitamin D retarded progression of an animal model of multiple sclerosis called “experimental autoimmune encephalomyelitis” (EAE). While vitamin D suppresses the progression of EAE, continuous treatment with artificial ultraviolet radiation (as in sunbeds) works even better. He concluded that ultraviolet light was likely suppressing EAE independent of vitamin D production, and that vitamin D supplementation alone cannot replace UV light in an animal model of MS. If true in humans, it means that UV light contains something good in addition to vitamin D.
Becklund BR, Severson KS, Vang SV, DeLuca HF. UV radiation suppresses experimental autoimmune encephalomyelitis independent of vitamin D production. Proc Natl Acad Sci U S A. 2010 Apr 6;107(14):6418-23. Epub 2010 Mar 22.
Finally, what about the recent study that showed those with non-melanoma skin cancer were much less likely to get Alzheimer’s disease (OR=5)?
Robert RS, White RS, Lipton RB, Hall CB and Steinerman JR. Nonmelanoma skin cancer is associated with reduced Alzheimer disease risk. Neurology. 2013 May 15.
This is a very one-sided document.