Can Ultraviolet-Induced Changes Be Prevented? If So, How?

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Skin cancers in which UVR exposure plays an important role are the most common form of cancer. In 1978, there were more than 500,000 new cases of skin cancer. This is probably a substantial underestimate for 1989, because the number of office visits for NMSC has increased more than 50 percent in the past decade while the overall increase in office visits has only been 11 percent. Therefore, it is imperative to consider ways to minimize the deleterious effects of UVR.

What measures can be taken to diminish the risk of UVR exposure? There is considerable information that can serve as a basis for developing a policy of "low-risk" behavior.

• First, susceptibility to UVR damage can be reduced through use of proper clothing made of tightly woven fabrics with long sleeves, long pants, wide-brimmed hats, etc.
• Second, a significant reduction in certain types of UVR damage can be achieved through the proper use of physical and chemical sunscreening products. Maximum photoprotection is afforded by chemical sunscreens with SPF ratings of 15 or higher. Although most sunscreens on the market today are appropriate for UVB protection, combination sunscreens that are effective against UVB and at least part of the UVA spectrum are preferable. Waterproof sunscreens should be selected by swimmers and those who perspire sufficiently to wash off nonwaterproof products. Daily use is recommended during appropriate times throughout the year. Sunscreens should be applied before exposure, with frequent reapplications thereafter.
• Third, one must strive to enhance behavior that limits sun exposure. Data exist to suggest that 50 percent of an individual's total lifetime UVR exposure occurs by 18 years of age. Therefore, parental education with subsequent direction of the behavior of children is important during childhood. Modified schedules for outdoor activities at school, camp, daycare centers, or the beach should be considered whenever possible so as to minimize UVR exposure. Time of day and time of year have a major impact on the extent of UVR exposure. For example, on a sunny day in June between 10:00 a.m. and 3:00 p.m., fully 60 percent of the daily UVB radiation reaching the Earth's surface arrives during this period. If exposure during this time could be minimized, a significant reduction in the number of NMSC's would almost certainly occur. Adults and children should limit their exposure during this peak period of UVR.
• Fourth, one must be aware of photosensitizing medications and chemicals because it is known that these can exacerbate the effects of UVR exposure.
• Fifth, the adverse effects of intentional UVR exposure must be considered. All evidence indicates that UVR-induced suntanning, whether from natural or artificial sources, is harmful to the skin.

There is a critical need to educate the public about all of these factors, consideration of which will show that the low-risk strategies described above are compatible with normal, active lives.

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