I appreciate we are in the depths of winter and many of us are not fortunate enough to be able to head off to sunny climes at this time of year. However, it is a good time to plan ahead. I say this because we had a rather glorious summer last year in the UK and may well again this year so maybe our attitudes to sun exposure may have to change to reflect this. This is especially important in our children as childhood sun exposure is linked to the development of malignant melanomas and basal cell carcinomas in adult life.
It is interesting that the October 2018 issue of the British Journal of Dermatology published two articles; an article on childhood sun exposure during a beach holiday and also a research letter on the adoption of the Australian SunSmart programme in New Zealand primary schools.
What were these two articles actually looking at?
The first article looked at the effects of a 12-day Baltic beach holiday on vitamin D levels and skin DNA damage in 32 healthy Polish children.
[Narbutt J, Philipsen PA, Lesiak A et al. Children sustain high levels of skin DNA photodamage, with a modest increase of serum 25-hydroxyvitamin D3, after a summer holiday in Northern Europe. Br J Dermatol 2018;179:940-50.]
The research letter described an online electronic survey of primary schools’ adoption of SunSmart sun protection policies and practices in New Zealand.
[McNoe BM, Reeder AI, de Lange MP. SunSmart schools: a New Zealand skin cancer primary prevention intervention blueprint for primary school settings. Br J Dermatol 2018;179:963-4.]
What did the first study show?
In the first study, the children were on a 12-day beach holiday in the Baltic. The children were aged between 8-10 years and typically spent between 6-7 hours per day outside. The children spent time on the beach and wore hats and boys wore shorts and the girls wore bikinis. 56% of the children wore T-shirts to protect their shoulders and back and the most common SpF used was 30. The children applied the sunscreens themselves.
81% reported sunburn more than once on any body site. There was a modest increase in vitamin D levels in all children but these levels had declined by October. More importantly, there were significantly greater changes in DNA damage in all children.
What did the second study show?
1243 primary schools in New Zealand were invited to partake in the online survey looking at the adoption of SunSmart policies. More SunSmart accredited schools completed the survey than non-accredited. SunSmart accredited schools were better at completing the minimum criteria for SunSmart accreditation, except in the areas of shade provision and planning outdoor events.
What are the minimum criteria for SunSmart accreditation?
The basis for any SunSmart policy revolves around the five areas of ‘Seek shade’, ‘Slip on sun protective clothing’, ‘Slap on a hat’, ‘Slop on a sunscreen’, ‘Slide on sunglasses.’
This includes the compulsory wearing of a sun protective hat , ie one that protects the face, neck and ears such as a legionnaire’s hat, broad rimmed hat or bucket hat but not a visor or a peak/baseball cap. Sun protective clothing must be cool, loose fitting and of dense weave fabric.
Sunscreens should be of an SpF 30, either provided by the school or brought in with the child. It must be a broad spectrum, water resistant sunscreen and the sunscreen must be applied at least 20 minutes before going outdoors and be re-applied every 2 hours and there must be reminder notices in place around the school.
The whole school should be informed of the sun protection policy and staff should be role models in wearing sun protective hats. Any children not wearing a hat outside must play in shaded areas. Sun protection should be considered in all planning for outdoor events and the school should provide sufficient shade for any activities taking place outside such as eating lunch outside or outdoor classroom activities.
It’s rather a big ask of our schools. Should we bother?
Well, as the article points out, the entire school day (9am to 3pm) falls within the periods of highest clear-sky UV radiation (10am to 4pm). We don’t have the rates of melanoma that are present in New Zealand but if our summers continue in the same vein as this year, then our rates will rise.
The Cancer Council in Victoria together with the Victorian Health Promotion Foundation first funded the SunSmart campaign in Victoria, Australia in 1988 and it is estimated to have prevented 43,000 skin cancers and 1,400 deaths from skin cancer in Victoria between 1988 and 2011.
In addition, though the incidence of melanoma in Victoria continues to rise, the incidence of skin cancers in those aged under 40 years is falling showing that changing the behaviours of the young can effect disease prevalence.
So what can we do?
Skin cancer rates are on the rise in the UK. However, I struggle to apply enough sunscreen on my children before they leave for school in the summer months and I know that as they get older, turning up at school plastered in thick sunscreen is definitely not a ‘cool’ thing.
However, I’m a firm believer that the good foundations of any behaviour need to start at home. If a 12-day beach holiday in Northern Europe can generate more DNA damage in the skin of our children than vitamin D and if being ‘SunSmart’ can reduce your child’s exposure to excess UV radiation whilst outside, and thereby their future risk of skin cancer, then we, as parents, can start the ball rolling and maybe we’ll make a difference here in the UK too.
Dr Sandy Flann, Consultant Dermatologist.