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 Play it Safe in the Sun

 Skin cancer is the most common of all cancer types. 
 
The good news is that there is a lot you can do to protect yourself and your family:

Sunscreen
- Generously apply water-resistant sunscreen with a sun protection factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays to all exposed skin. Re-apply every two hours, even on cloudy days, and after swimming or sweating.

- Products with an SPF of 15 or higher that also contain avobenzone (Parsol 1789), ecamsule, zinc oxide, or titanium dioxide are likely to be effective against UVB and most UVA rays.

- Check for an expiration date. Most sunscreen products are no longer as effective after 2 to 3 years. 

- Be sure to apply the sunscreen properly. Most recommend applying sunscreen generously to dry skin 20 to 30 minutes before going outside so your skin has time to absorb the chemicals. When applying it, pay close attention to your face, ears, hands, and arms, and generously coat the skin that is not covered by clothing.

- If you're going to wear insect repellent or makeup, apply the sunscreen first.

- For high-glare situations, a higher SPF sunscreen or zinc oxide may be used on your nose and lips.

- Be generous. About 1 ounce of sunscreen (a "palmful") should be used to cover the arms, legs, neck, and face of the average adult.

- Products labeled "waterproof" may provide protection for at least 80 minutes even when you are swimming or sweating. Products that are "water resistant" may provide protection for only 40 minutes. Remember that sunscreen usually rubs off when you towel yourself dry, so you will need to reapply.

- Sunless tanning products, such as bronzers and extenders provide very little protection from UV damage.

Cover up
When you are out in the sun, wear clothing to protect as much skin as possible.

- Dark colors generally provide more protection than light colors, and tightly woven fabric protects better than loosely woven clothing.

- Dry fabric is generally more protective than wet fabric. 

- A typical light T-shirt worn in the summer usually protects you less than sunscreen with a sun protection factor (SPF) of 15 or higher. A few companies in the United States make sun-protective clothing.
 
- Wear a hat with at least a 2- to 3-inch brim all around is ideal because it protects the neck, ears, eyes, forehead, nose, and scalp. Straw hats are not recommended unless they are tightly woven.

Wear sunglasses that block UV rays

- Research has shown that long hours in the sun without protecting your eyes increase your chances of developing cataracts and other eye problems. The ideal sunglasses do not have to be expensive, but they should block 99% to 100% of UVA and UVB radiation. Check the label to be sure they do. Some labels may say, "UV absorption up to 400 nm." This is the same as 100% UV absorption. Also, labels that say "Meets ANSI UV Requirements" mean the glasses block at least 99% of UV rays. Those labeled "cosmetic" block about 70% of the UV rays. If there is no label, don't assume the sunglasses provide any protection.

- Darker glasses are not necessarily better because UV protection comes from an invisible chemical applied to the lenses, not from the color or darkness of the lenses. Look for an ANSI label.

- Large-framed and wraparound sunglasses are more likely to protect your eyes from light coming in from different angles. Children need smaller versions of real, protective adult sunglasses - not toy sunglasses.

Seek shade when appropriate

- The sun's rays are strongest between 10 a.m. and 4 p.m. Limit direct sun exposure during midday

- Be extra careful in the water and on the slopes. UV rays reach the ground throughout the year, even on cloudy days. UV rays can also pass through water, so don't think you're safe if you're in the water and feeling cool. Be especially careful on the beach and in the snow because sand and snow reflect sunlight, increasing the amount of UV radiation you receive. 

- Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun. Sunburn and tanning are forms of skin damage, and long-term exposure to UV rays causes prematurely aged skin, wrinkles, loss of skin elasticity, dark patches (lentigos, sometimes called "age spots" or "liver spots"), and pre-cancerous skin changes (such as dry, scaly, rough patches called actinic keratoses). 

Avoid tanning beds and sun lamps

- Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.

You need to be especially careful in the sun if you:

- have lots of moles, irregular moles, or large moles
- have freckles and burn before tanning
- have fair skin or blond, red, or light brown hair
- were previously treated for skin cancer
- have a family history of skin cancer, especially melanoma
- live or vacation at high altitudes (UV radiation increases 4% to 5% for every 1,000 feet above sea level)
- live or vacation in tropical or subtropical climates
- work indoors all week and then get intense sun exposure on weekends
- spend a lot of time outdoors
- have certain autoimmune diseases, such as systemic lupus erythematosus (SLE, or "lupus")
- have had an organ transplant
- take medicines that lower your immunity
- take oral contraceptives (birth control pills)
- take tetracycline, sulfa drugs, or certain other antibiotics
- take naproxen sodium or certain other non-steroidal anti-inflammatory drugs (NSAIDs)
- take phenothiazines (major tranquilizers and anti-nausea drugs)
- take tricyclic antidepressants
- take thiazide diuretics (medicines used for high blood pressure and some heart conditions)
- take sulfonylureas (a form of oral anti-diabetic medication) 
 
What is skin cancer?

Skin cancers are divided into 2 main types: keratinocyte cancers (basal and squamous cell skin cancers) and melanomas.

Basal and squamous cell skin cancers are the most common cancers of the skin. They develop from cells called keratinocytes, the most common cells in the skin. Both basal cell and squamous cell cancers are found mainly on parts of the body exposed to the sun, such as the head and neck, and their occurrence is related to the amount of sun exposure over a person's lifetime. These cancers (especially basal cell cancers) rarely spread  elsewhere in the body and are less likely than melanomas to be fatal.

Melanomas, which are far less common, are cancers that develop from melanocytes, the cells that make the brown pigment that gives skin its color. Melanocytes can also form benign growths called moles. 
 
Melanomas can occur anywhere on the body, but the trunk is the most common site in men, and legs are the most common site for women. Melanoma is almost always curable in its early stages, but if left alone it can spread to other parts of the body, where it can be very hard to treat.

What is ultraviolet (uv) radiation?

There are no safe UV rays. Ultraviolet (UV) rays are a form of invisible energy given off by the sun. Ultraviolet radiation is divided into 3 wavelength ranges:

- UVA rays cause wrinkles and are thought to play a role in some skin cancers.
- UVB rays are mainly responsible for direct damage to the DNA, and are the rays that cause sunburns. They are thought to cause most skin cancers.

Check the UV Index 

If you plan to be outdoors, you may want to check the UV Index for your area. The UV Index usually can be found in the local newspaper or on TV and radio news broadcasts. It is also available on the EPA's Web site at www.epa.gov/sunwise/uvindex.html. The UV Index number, on a scale from 1 to 11+, is a measure of the amount of UV radiation reaching the earth's surface during an hour around noon. The higher the number, the greater the exposure to UV radiation.

Examining your skin

It's important to check your own skin, preferably once a month. Finding possible skin cancers doesn't require any x-rays or blood tests - just your eyes and a mirror.

A self-exam is best done in a well-lit room in front of a full-length mirror. You can use a hand-held mirror for areas that are hard to see. A spouse or close friend or family member may be able to help you with these exams, especially for those hard-to-see areas like the lower back or the back of your thighs.

The first time you inspect your skin, spend a fair amount of time carefully going over the entire surface of your skin. Learn the pattern of moles, blemishes, freckles, and other marks on your skin so that you'll notice any changes next time. Any trouble spots should be seen by a doctor. Follow these step-by-step instructions to examine your skin:

_ Face the mirror: Check your face, ears, neck, chest, and belly. Women will need to lift breasts to check the skin underneath. 

- Check the underarm areas, both sides of your arms, the tops and bottoms of your hands, in between your fingers, and fingernail beds.  

- Sit Down: Check the front of your thighs, shins, tops of your feet, in between your toes, and toenail beds.

- You will need a hand mirror for your thighs, back, and scalp.

- Look at the bottoms of your feet, your calves, and the backs of your thighs, first checking one leg and then the other.

- Use the hand mirror to check the buttocks, genital area, lower back, upper back, and the back of the neck. Or it may be easier to look at your back in the wall mirror using a hand mirror.

- Use a comb or hair dryer to part your hair so that you can check your scalp.

What should I look for?

Basal cell cancers and squamous cell cancers are most often found in areas that get exposed to a lot of sun, such as the head, neck, and arms, but they can occur elsewhere. Look for new growths, spots, bumps, patches, or sores that don't heal after 2 to 3 months.

Basal cell carcinomas often look like flat, firm, pale areas or small, raised, pink or red, translucent, shiny, waxy areas that may bleed after a minor injury. They may have one or more abnormal blood vessels, a lower area in their center, and/or blue, brown, or black areas. Large basal cell carcinomas may have oozing or crusted areas.

Squamous cell carcinomas may look like growing lumps, often with a rough, scaly, or crusted surface. They may also look like flat reddish patches in the skin that grow slowly.

Both of these types of skin cancer may develop as a flat area showing only slight changes from normal skin.

Actinic keratosis, also known as solar keratosis, is a skin condition that is sometimes pre-cancerous and is caused by too much sun exposure. Actinic keratoses are usually small (less than ? inch), rough spots that may be pink-red or flesh-colored. Usually they develop on the face, ears, back of the hands, and arms of middle-aged or older people with fair skin, although they can arise in younger people or on other sun-exposed areas of the skin. People with one actinic keratosis usually develop many more.

Some can grow into squamous cell cancers, but others may stay the same or even go away on their own. Because they can turn cancerous, such areas should be looked at regularly by a doctor. Your doctor can then decide whether these areas should be removed.

Melanomas

The "ABCD rule" is an easy guide to the usual signs of melanoma. Be on the lookout and tell your doctor about any spots that match the following description:

A is for ASYMMETRY: One half of a mole or birthmark does not match the other.
B is for BORDER: The edges are irregular, ragged, notched, or blurred.
C is for COLOR: The color is not the same all over and may include shades of brown or black, or sometimes with patches of pink, red, white, or blue.
D is for DIAMETER: The spot is larger than 6 millimeters across (the size of a pencil eraser), although melanomas can sometimes be smaller than this.

Another very important sign of possible melanoma is a change in the size, shape, or color of a mole or the appearance of a new spot. Some melanomas do not fit the ABCD rule described above, so it is very important to tell your doctor about any changes in skin markings or new spots on your skin.

Other warning signs are:

- a sore that does not heal
- spread of pigment from the border of a spot to surrounding skin
- redness or a new swelling beyond the border
- change in sensation -- itchiness, tenderness, or pain
- change in the surface of a mole -- scaliness, oozing, bleeding, or the appearance of a bump or nodule a mole that looks very different from your other moles

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Colon Cancer Can Be Prevented
Watch 'Bottoms Up,' a short, humorous video that can serve as a great colon cancer screening reminder for your friends and loved ones, so feel free to download and the share the video now.

Although colon cancer is the third most common cause of cancer death in both men and women in America, it is preventable, treatable, and beatable.

So what can you do to prevent colon cancer? If you’re 50 or older, the answer is simple: Get screened. You may need to get tested earlier than age 50 if you have a family history of colon cancer, so talk to your doctor about getting tested.

Enjoy this hilarious column by Dave Barry and send a colon cancer screening reminder to others to encourage them to get screened, too. And, click here to watch a colonoscopy.

In addition to screening, there are steps everyone can take to reduce the risk of colon cancer and many others types of cancer, too. It’s important to maintain a healthy weight and lifestyle by eating a healthy diet, drinking alcohol only in moderation, exercising most days of the week, and not smoking. More information is also available anytime at www.cancer.org/colon.


7 Ways to Reduce Your Cancer Risk

Researchers say if we stopped using tobacco, grew thinner, exercised regularly, avoided diets rich in red meat, and ate diets rich in fruits and vegetables, we would prevent 70 percent of all cancers. Here are 7 steps -- all within your control -- that you can take to reduce your cancer risk:

 1: First and foremost, don't use tobacco in any form.

Smoking is the single most preventable cause of death - with 400,000 Americans dying every year from their own cigarette smoking, and an additional 26,000 - 73,000 nonsmokers dying each year from exposure to secondhand smoke. Smoking kills more people than alcohol, AIDS, card accidents, illegal drugs, murders, and suicides COMBINED!

Of the roughly 416,000 kids who become daily smokers each year, almost a third will ultimately die from it. Smokers lose, on average, 13 to 14 years of life because of smoking. Smoking damages nearly every organ in the human body. It is linked to at least 15 different cancers and accounts for some 30% of all cancer deaths, and 90% of all cases of lung cancer - the leading cause of cancer death in both men and women. Yet, one in five Americans still lights up. And, nearly every adult who smokes (almost 90 percent) took his or her first puff at or before the age of 18.

What's in a cigarette?
Every time you smoke a cigarette, you inhale more than 60 carcinogens. Here are just a few of the ingredients Big Tobacco has snuck into cigarettes to, among other things, make them more addictive:

Tar -  the same thick black substance used to pave roads and driveways. Smokers can inhale as much one cup of tar a year.
Formaldehyde -  used to preserve dead animals, like the frogs dissected in biology classes
Cyanide - the main ingredient in rat poison
Lead - found in some kinds of paint and feared for its ability to cause mental retardation in children
Acetone - a common ingredient in paint and nail polish remover. Have you ever spilled nail polish remover on a table and watched it eat away the varnish?
Ammonia - a household cleaner that takes your breath away when you get too close to it
Carbon monoxide - the pollutant in your car's exhaust
Hydrazine - a chemical used in jets and rocket fuel
Radiation - That's right - polonium-210, one of the world's most radioactive poisons. Big Tobacco is not to blame for putting it there; it's a natural contaminant of tobacco. But Big Tobacco is to blame for knowing it was there and keeping it a secret in order to avoid "waking a sleeping giant," as a Philip Morris memo put it. A recent study by the Mayo Clinic and Stanford University states that polonium exposes smokers of 1.5 packs of cigarettes a day to as much radiation as they would receive from 300 chest X-rays a year.

Think because you don't smoke you're safe?  Wrong!
Scientific evidence shows that there is no "safe" level of exposure to secondhand smoke. Secondhand smoke is classified as a "known human carcinogen," and each year about 3,000 nonsmokers die of lung cancer caused by secondhand smoke.

In the United States alone, second-hand smoke each year is responsible for:

- An estimated 35,000 deaths from heart disease in non-smokers who live with smokers 
- 150,000 to 300,000 lung infections (such as pneumonia and bronchitis) in kids younger than 18 months of age
- Increases in the number and severity of asthma attacks in about 200,000 to 1 million children
- More than 750,000 middle ear infections in children

Call to quit - today!
If you or someone you love uses tobacco, call 1.800.ACS (227).2345 to get the help you need to quit. Or, visit www.cancer.org/smokeout.


2. Maintain a healthy weight throughout life.

In the United States, overweight and obesity contribute to 14% - 20% of all cancer deaths. Being overweight are clearly associated with increased risk of developing many cancers, including breast (in postmenopausal women), colon, endometrium, kidney, and esophagus, and it is suspected to raise risk of other types of cancer, as well.

The best way to reduce body fat is to restrict caloric instake and increase physical activity. To reduce calories, reduce your portion sizes (ditch the supersizing), avoid high-calorie foods such as fired foods, cookies, cakes, candy, ice cream, and soft drinks. If you have pounds you need to shed, we can help.

Fat tissue increases estrogen levels and high estrogen levels increase breast cancer risk. Obesity also leads to high levels of insulin-like growth factor (IGF-1) in the circulation. This could prevent early-stage cancer cells scattered throughout the body from dying, since insulin-like growth factor inhibits the action of cell suicide genes. Fat cells also release inflammatory chemicals into the circulation that can stimulate the growth of cancer cells. The good news is that regular or moderate exercise lowers the levels of inflammation and IGF-1 -- even if the exercise does not lead to a healthy weight. And, regular exercise also lowers blood-estrogen levels in women, helping protect against breast cancer.

Being overweight in youth tends to continue throughout life, so keeping a healthy (not obsessive) watch on your weight is a good thing.

3. Adopt a physically active lifestyle.
 
Walking - RFL09

Adults:
Engage in at least 30 minutes of moderate to vigorous physical activity, in addition to usual activities, on 5 or more days of the week; 45 to 60 minutes of intentional physical activity are preferable.

Children and adolescents: Engage in at least 60 minutes per day of moderate to vigorous physical activity at least 5 days per week.

Body Mass Index (BMI) Calculator   
 
Calorie Counter   
 
Exercise Counts   

Target Heart Rate Calculator   

Nutrition and Activity Quiz 

4. Eat real food.

Have you ever read the label on packaged foods? It's sometimes hard to figure out what the actual food is inside. The more unprocessed your food is, the better. We recommend you:

- Eat 5 or more servings of vegetables and fruits each day. (This isn't as hard as you think. One serving equals 1 medium apple, banana, orange, etc.; 1/2 cup of chopped, cooked, or canned fruit; 1 cup of raw, leafy vegetables; and 1/2 cup of other cooked or raw vegetables, chopped.)  The brighter the vegetable the more antioxidants it contains. Antioxidants include vitamin C, vitamin E, carotenoids, and many phytochemicals that help prevent damage to cells in the body from chemical reactions with oxygen. Whether they actually reduce cancer risk is open to debate.

- Limit French fries, chips, and other fried vegetable products, and avoid all trans fats.  Major sources of trans fats are margarines and snack foods that contain partially hydrogenated oils, but fortunately trans fats are disappearing from supermarket foods and restaurant fare.

- Choose whole grain rice, bread, pasta, and cereals over processed (refined) products.

- Limit intake of refined carbohydrates (starches), such as pastries, sweetened cereals, and other high-sugar foods.

- Limit intake of processed meats and red meats - both of which have been linked to colon cancer.

- Choose fish, poultry, or beans instead of beef, pork, and lamb.

- When you eat meat, choose lean cuts and eat smaller portions.

- Prepare meat by baking, broiling, or poaching, rather than by frying or charbroiling. Cooking meat and fish at high temperatures causes cancer-causing agents to form. Two ways to alleviate this are to use a marinade that contains lemon or vinegar marinade before you put the meat on the grill, and to avoid having the fire flare up.

5. If you drink alcoholic beverages, limit your intake.
Drink no more than 1 drink per day if you are a woman, and no more than 2 per day if you are a man. Alcohol consumption is an established cause of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast. For each of these cancers, risk increases substantially with intake of more than 2 drinks per day. Regular consumption of even a few drinks per week has been associated with an increased risk of breast cancer in women. How alcohol affects breast cancer is not clear. It may be because alcohol increases estrogen levels in the blood, reduces folic acid, or has a direct effect on breast tissue.

6. Don't catch those rays - outdoors or in the tanning bed.

Skin cancer is the most common of all cancers, and one of the most preventable. It accounts for nearly half of all cancers in the United States. Although repeated exposure to X-rays or contact with certain chemicals can play a role, sun exposure is by far the most common cause of skin cancer.

Most skin cancer occurs on exposed parts of your body, including your face, hands, forearms, and ears. Nearly all skin cancer is treatable if you detect it early, but it's better to prevent it in the first place. Try these tips:

- Avoid peak radiation hours. The sun's ultraviolet (UV) radiation peaks between 10 a.m. and 4 p.m. Minimize or avoid being outside during these hours.
- Stay in the shade. If you go outside, minimize your sun exposure by staying in the shade.
- Cover exposed areas. Wear light-colored, loose-fitting clothing that protects your arms and legs, and wear a broad-brimmed hat that covers your head, ears, and neck.
- Don't skimp on sunscreen. Make sure your sunscreen has a sun protection factor (SPF) of at least 15.
- Don't use indoor tanning beds or sun lamps. These can damage your skin as much as the sun can. There's no such thing as a healthy tan.

A recent study by the Environmental Working Group found that 1 in 8 name-brand sunscreens did not protect against ultraviolet A rays which can cause long-term damage and skin cancer. The sun protection factor (SPF) rating currently placed on all sunscreens only reflects the lotion's effectiveness in blocking ultraviolet B rays. As a result of such research, the U.S. Food and Drug Administration is the process of approving a new regulation that would set standards for testing and labeling sunscreens for UVA protection, as well as for UVB.

Take the sun safety quiz.

7.  Be Proactive - Get screened.

For people age 20 or older having periodic health exams, a cancer-related checkup should include health counseling, and depending on a person's age and gender, might include exams for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some non-malignant (non-cancerous) diseases.

All women should begin cervical cancer screening about 3 years after they begin having intercourse, but no later than age 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test. Women age 40 and older should get a mammogram every year, and men and women age 50, who are at average risk for colon cancer, should begin regular testing.

Read the American Cancer Society Guidelines for the Early Detection of Cancer at www.cancer.org/earlydetection. The earlier cancer is found, the greater chance treatment will be successful. We have a free email mammogram reminder (www.cancer.org/mammogramreminder ) to alert women 40 and older to schedule their yearly mammogram. Share it with a loved one!

Keep up with cancer news
If you are interested in keeping up with cancer issues, read Dr. Len's Blog (www.cancer.org/drlen ). Dr. Lichtenfeld is deputy chief medical officer for the American Cancer Society. He directs the Society’s Cancer Control Science Department, which produces the Society’s widely recognized guidelines for the prevention and early detection of cancer and guidelines for nutrition and physical activity for cancer survivors.

If you ever have questions or concerns about cancer,
call the American Cancer Society, 24/7, 365 days a year at:
1.800.ACS(227).2345. We can help.

 


 

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