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Monday’s medical myth: we’re not getting enough sun

Myths abound about UV radiation and its effect on our health. We hear that sun-protection has triggered an epidemic of vitamin D deficiency; being tanned protects you from sunburn; a tan looks healthy…

During summer, most of us get adequate vitamin D from just a few minutes of daily sun exposure. AveLardo

Myths abound about UV radiation and its effect on our health. We hear that sun-protection has triggered an epidemic of vitamin D deficiency; being tanned protects you from sunburn; a tan looks healthy; and “old” skin doesn’t need to be protected from the sun like “young” skin does.

Myth, myth, myth, myth.

What is beyond doubt is that Australia is the world’s skin cancer capital, yet skin cancer is the most preventable of all common cancer types.

There were 11,000 cases of melanoma diagnosed in Australia in 2008. Deaths from melanoma and non-melanoma skin cancers combined in 2007 (the latest mortality data) totalled just under 1,800. And each year, around 400,000 non-melanoma skin cancers are treated by Australian doctors, costing taxpayers hundreds of millions of dollars.

Many of these patients might have thought their sun exposure was doing them good.

While some sun exposure is vital to good health, Australians in most parts of the country only need a small amount. UV radiation here is harmful to fairer skin types compared with UV levels in most other parts of the world populated predominantly by Europeans. The harms of sun exposure in Australia far outweigh the risks of vitamin D deficiency.

During summer, most of us get adequate vitamin D from just a few minutes’ daily exposure to sunlight on our face, arms and hands, on either side of the peak UV periods – before 10am and after 3pm.

In winter in the southern parts of Australia, where UV radiation is less intense, people need about two to three hours of sunlight spread over a week. In winter in northern parts of the country, you can still maintain adequate vitamin D levels by going about your day-to-day activities, so there’s no need to deliberately seek UV exposure.

Sun protection can reduce your risk of skin cancer at any age. gwoodford

Some groups are at higher risk of vitamin D deficiency, such as naturally dark-skinned people, those who cover their skin for cultural reasons, osteoporosis patients, people who are housebound and babies and infants of vitamin D deficient mothers. People in these groups should talk to their doctor about whether they need a vitamin D supplement.

The point is, we can all get our vitamin D without the risk of sunburn.

Does a suntan protect you from sunburn? In most cases, no. A tan can offer very limited protection, but no more than SPF4 (the lowest sunscreen rating), depending on your skin type. A tan does not protect from DNA damage, which can lead to skin cancer.

What about the idea that a tan looks healthy? Although there is a cultural association between tanning and outdoor activities, the reality is that in most cases a tan is a mark of damaged skin. It may not be obvious at first, but over time tanned skin becomes more visibly wrinkled and in many cases patchy and discoloured, compared with skin that has been protected from harmful UV radiation.

People of northern European descent have skin that has not evolved to be suitable for exposure to the Australian sun’s intense UV radiation, so a tan is neither natural nor healthy.

Then there’s the myth that UV damage to skin occurs predominantly in childhood. Although babies and young children have more sensitive skin than adults, UV damage to your skin at any age increases your risk of skin cancer.

A suntan offers very limited sun protection. andy atbondi

One of the world’s most comprehensive studies of sun protection among adults monitored 1,600 people in sunny Nambour, Queensland with an average age of 49 and found that those who regularly used sunscreen over four-and-a-half years developed significantly fewer squamous cell carcinomas. Over ten years, the group applying sunscreen also developed half as many melanomas as the control group.

So sun protection can reduce your risk of skin cancer at any age.

That’s why it’s important to slip (on a shirt), slop (on some sunscreen), slap (on a hat), seek (shade) and slide (on your sunglasses), knowing you’ll be reducing your skin cancer risk while in most cases still getting enough incidental sunlight for good health.

Join the conversation

24 Comments sorted by

  1. Sara Blake

    Aspiring Plant Pathologist

    Thank you for this article Ian. It seems timely considering there seems to be an advertising push, like with most vitamins, towards taking a daily Vitamin D supplement. As a resident of Tasmania, it seems to be advertised as even more pertinent that one takes a supplement. However a nutritionist friend recently had her D levels assessed as being in the 70s ( sorry, I'm not familiar with what the measurement is) and her GP said she was well above the normal/recommended 40 mark. Can you advise what the recommended Vitamin D levels are, if indeed one exists? I recall being told by my own GP that you should have a Vitamin D level of at least 70...

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    1. Diana Taylor

      retired psychotherapist

      In reply to Sara Blake

      Thanks, Ken Harvey, for the info you supplied. I have been baffled as to why my Vitamin D levels are low when I spend a lot of time outside. It seems that at my age (70) we simply do not process sunlight into vitamin D the way we did as kids. This fact should be common knowledge amongst us senior citizens.

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  2. Sue Ieraci

    Public hospital clinician

    The problem seems to be our societal habit of taking very specific research findings and taking them both in isolation, and to the extreme.

    Sunburn causes skin cancer, so we ban children from playing outside without hat and sunscreen.

    No sun is bad, so we recommend supplemental Vitamin D.

    Someone says excess carbohydrates are bad, so we cut out all "carbs".

    Someone notes we eat too many "empty calories" - then sugar becomes "a toxin".

    In each case, it is the excess that harms. There are a multitude of intricately entwined factors that affect our health and longevity. The only rational approach is balance.

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  3. Mick Mills

    Brain sturgeon

    I think that the article's title is misleading.

    There may be many 'myths' relating to the sun exposure, but as there are a lot of people in Australia with low vitamin D levels and the sun is the main source of vitamin D then they probably ARE "not getting enough sun".

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    1. Bruce Forsaith

      Individual

      In reply to Mick Mills

      Mick, I totally agree.

      I pursued the article because of the title.

      Other than an aside to exposure sufficiency re: vitamin D, there is nothing to explain the problem.

      I got annoyed that the author used that title merely to push another barrow.

      The 'issue' of vitamin D ought receive a proper article on The Conversation.

      Cheers

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  4. Robyn May

    PhD candidate

    Why then are so many of us being diagnosed as being vitamin D deficient? My conservative GP recommended I take vitamin D tablets as blood tests have shown I have very low levels, I am fair skinned, and do have sun exposure most days. I know many other women in the same situation. I understand some links have been found between low vitamin D levels and cancer, so I take the vitamin D rather than take the risk. Are the vitamin D blood levels set too high, or do some of us just have a problem with absorbtion?

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    1. Sean Alexander

      Jack of all

      In reply to Robyn May

      A few comments here have inferred or mentioned a "problem" with Vitamin D deficiency. Can anyone provide some stats as to whether there IS or not?

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Robyn May

      Here is a good reference about worldwide Vit D levels:
      http://link.springer.com/article/10.1007%2Fs00198-009-0954-6?LI=true#page-1
      "Global vitamin D status and determinants of hypovitaminosis D"

      It's worth reading through the whole paper to get the details.

      In short, it says:
      - Vit D levels vary widely around the world
      - The main risk factors for deficiency are: "older age; female sex; lower latitude; winter season; darker skin pigmentation; factors that determine sunlight exposure, such as clothing and cultural practises; dietary habits; and national policies of vitamin D fortification."
      - "Skin pigment and cultural practises seem to override the effect of other factors, including latitude, as is evidenced by the higher
      vitamin D levels in Northern as compared to Southern Europe"

      The authors make particular mention of increasing longevity (ie increased number of elderly in the community) as a factor in the rising incidence.

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  5. May Stevenson

    Horticulturalist

    Exposure to the sun and adequate vitamin D levels are associated with a reduction of risk of over 15 types of cancer, lower risk of heart disease,protection from type 2 diabetes, female infertility and high bad cholesterol.

    High levels of sun exposure are associated strongly with fairly harmless non melanoma skin cancers, but the association between sun exposure and Melanoma is not strong. Melanomas mostly occur on non sun exposed parts of the body and are more frequent in people with indoor jobs. There are even some studies that link lower sun exposure with higher melanoma risk.

    Vitamin D deficiency is almost epidemic in Australia, the balance of risk seems to be in favour of more sun not less to me.

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  6. elizabeth merrilees

    AOD Clinician

    thank goodness there are well informed readers here willing to counter the ill informed writings of an oncologist! clearly Ian Olver and the Cancer Council are just rabbiting on in ignorance.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to elizabeth merrilees

      Good point, Elizabeth. Our post-modernist world, where all views are considered equal, and knowledge/training seem to be held in disdain, provides lots of traffic for The Conversation.

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  7. Gary Cassidy

    Monash University

    A couple of years ago I was very surprised to be told by my doctor that I had very low vitamin D levels that required supplementation. At the time I was spending a reasonable amount of time outdoors, although I would always slip, slop, slap.

    During a recent follow up my levels were low, although not requiring supplementation. My doctor advised more sun exposure.

    Although anecdotal, on both occasions two different doctors told me that it is common for them to see patients with low vitamin D. The doctor That I saw more recently told me that low vitamin D was associated with a variety of health complications.

    So I suppose the title doesn't apply to me?

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  8. Shelly LaPlant

    logged in via Twitter

    First of all, tanned skin DOES protect you from sunburn. I have had such severe sunburns in my life. So bad that I have avoided the sun for the majority of my adult life. I have never been able to be in the sun for more than 15 minutes without enduring a burn. The result of my sun avoidance is Vitamin D deficiency, 11ng/ml to be exact. To make a long story short, I tanned to bring up my Vitamin D level, which I did. In a matter of a few months my level was at 75 ng/ml. The unexpected benefit was…

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  9. Steven Cremonni

    logged in via Facebook

    Australia's Cancer council generates it's revenue directly from the sale of chemical sunscreen. The expect all of us to act like sheeple and treat the sun as if we were vampires. Sorry, I'm not drinking that cool-aide. At 58 years old I have never used chemical sunscreen...I have a mild but healthy looking tan, I have high Vitamin D levels and my dermatologist tells me I have the skin of a man 10 years younger.
    Don't you get it folks...it's all about money.
    Do your own research and exercise moderation. Simple, logical, common sense.

    ps....indoor workers have 6 to 10 times more skin cancer than those who work outdoors.

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    1. Ian Clarke

      Director, Pacific Strategy Partners

      In reply to Steven Cremonni

      As a matter of fact, the Cancer Councils don't make much money from sunscreen. They do a lot of research in cancer incidence & prevention, and its also a fact that the incidence of melanoma is relatively high in Australia due to sun exposure. Vitamin D may also be an issue for some people, but can be fixed with a supplement or with a little more sun exposure, as noted by Ian.

      Also, a tan does protect you from sunburn, but not from the DNA damage that causes skin cancer.

      Finally, the damage from UV is cumulative, and a disproportionate amount occurs when under 18 (melanoma incidence for those who emigrate to Australia as adults is lower), while vitamin D deficiency is more an an issue among older people.

      So, keep the kids out of the sun but make sure grandpa is spend some time outdoors ....

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Steven Cremonni

      "Australia's Cancer council generates it's revenue directly from the sale of chemical sunscreen."

      Thinking about that assertion, do you really think that is an important source? Take a look at the Cancer Council website. Their priorities include not only sun exposure but also nutrition and physical fitness, smoking cessation and a range early detection strategies. Their funding combines government grants and private donations/bequests.

      In the Cancer Council shop, you can buy swimwear, hats, beach umbrellas, rashies, car window-tinting and sunglasses as well as (relatively cheap) sunscreen.

      Oh - and a hint about statistics. Indoor workers may have more skin cancer (in absolute numbers), but what proportion of all workers work outdoors? You need not just the numerator, but also the denominator.

      If you want to fight corruption in the world, there are bigger fishes to fry than the Cancer Council selling cheap sunscreen.

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  10. sharon burns

    retired

    I only work with stats...............states accountant............
    97% of all cancers are from people who have never tanned indoors or outdoors
    60% are for men over the age of 50 who work in doors and hardly see the sun.
    So in the US 8000 die a year from skin cancer
    3% who tanned = 240 people die a year
    In Canada 900 die a year only 8 have ever tanned...
    please open up your eyes...We need the sun...

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    1. Sue Ieraci

      Public hospital clinician

      In reply to sharon burns

      "I only work with stats...............states accountant............"

      But if your stats are different from those of the oncologist, who only works with cancer stats, whose should we believe?

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    2. sharon burns

      retired

      In reply to sharon burns

      the state I posted are right..
      Came from an accountant web site where they had web sites US and Canada cancer staticts etc to prove it..

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  11. sharon burns

    retired

    I just read 98,000 die a year from doctors mistakes in the US every year. Then the real stats were confirmed on the NBC news..
    So I have a 10 fold chance of dying by mistake then skin cancer!!!
    I will take my chances..
    Stats do not lie doctors do!!!!!!!!

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    1. Sue Ieraci

      Public hospital clinician

      In reply to sharon burns

      So if you do get skin cancer, Ms Burns, you won't seek medical care?

      Since you are so interested in statistics, what is the rate of adverse events leading to death as a proportion of all medical occasions of service? Surely you need a denominator as well as a numerator?

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