Sunshine and holidays equal a tanned skin for many. But we need to adjust our ideas about tanning, according to dermatologists Lieve Brochez and Isabelle Hoorens. Our behavior towards the sun and UV will cause more and more cases of skin cancer in the coming years.
Isabelle: “Indeed, projections by the Global Cancer Observatory (WHO) have shown that the number of new skin cancer diagnoses in Europe will continue to rise until at least 2050. This increase is partly due to the aging of the population. But the most important reason is our UV behavior.”
Lieve: “Skin cancer is already the most commonly diagnosed cancer. But we can still try to slow down the epidemic by focusing on proper protection today. We sometimes hear that we are already good at UV protection today, and that is partly true.
But the development of skin cancer is a long process in which a significant part of the damage occurs in childhood only to result in skin cancer later in adulthood. Generations born before the 1980s were never adequately protected as children.”
Why is the sun so dangerous to our skin?
Lieve: “Sunbathing to tan is a cultural phenomenon that became trendy around 1920 with fashion icon Coco Chanel. But UV is recognised by the WHO as a proven carcinogen, just like tobacco, and it is mainly our UV behaviour that determines the risk."
Isabelle: “The sun's UV rays cause mutations of the genetic material in our skin cells. Those mutations cause the skin to produce pigment that makes us tan. But those same mutations can lead to skin cancer in the long run. So it is not only sunburn that is dangerous. Tanning the skin already causes damage too.”
Lieve: “We need a mind switch to change our sunbathing and tanning habits. It's not about not being allowed to go outside. The way we expose our skin to the sun is important. We must take the UV intensity more into account and protect the skin appropriately on that basis."
Isabelle: "This can be done by avoiding direct sun and seeking shade during the hours of the brightest sun. If you do go out in the sun, protect your skin with appropriate clothing, headgear and sunglasses. Finally, you can use sunscreen for the skin that is not covered by clothing. Sunscreen therefore only comes last in the recommendations."
Lieve: "There are no studies that show a protective effect of sunscreen during sunbathing. On the contrary, studies suggest that the risk of skin cancer may be increased by exposure to more intense sun at more dangerous hours."
How do you know when it's best to avoid the sunshine?
Lieve: “Protection is recommended starting at a UV index 3. You can check the UV index in the weather report, but there are also handy apps that give a real-time estimate of the UV index for the place where you are. Definitely handy even on holiday abroad. Sunsmart is one of the apps supported by the WHO for this purpose.”
Are you completely safe from UV radiation in the shade?
Lieve: “You don't get direct sunshine in the shade, but there is still a chance of getting sunburned. Reflection on water or sand, or too small a shade angle under an umbrella can still surprise you. Providing adequate shade at play and camp sites or sports fields during the summer period would be a valuable initiative."
So sunscreen is the last option as protection against UV radiation. Does it matter which sun cream you choose?
Isabelle: “A sunscreen between factor 30 and 50 usually gives sufficient protection. But on condition that you use it correctly. We see in studies that people usually apply too little. So apply enough and repeat regularly.”
Lieve: “Next to the SPF or protection factor, there should also be a UVA label on the packaging. Which means that the product adequately protects against UVA radiation. This is a European regulation.”
Isabelle: “We do not provide any further advice regarding brand or type of product. We especially recommend a product that you enjoy using, because we know you will use it more quickly.”
Lieve: “t is also not a race for the highest SPF. A higher factor is certainly not an alibi for being in the sun longer than intended.”
4 tips to protect yourself against UV radiation
Lieve and Isabelle were involved in a global recommendation on UV protection. Protect yourself with these 4 tips.
1. Avoid sunbathing and tanning beds
2. Avoid moments with a high UV index. In Belgium this is 2 hours before and 2 hours after the highest position of the sun. At those times, seek shade (from UV index 3) or stay indoors (from UV index 8).Use an app like Sunsmart to see the current UV index.
3. If you do go outside, protect your skin by wearing clothing, headgear and sunglasses. There is also a difference in types of clothing: for example, white or lightly woven fabrics provide less good protection than colored fabrics and fabrics with a greater density.
4. Use sunscreen for the parts of the skin that you cannot otherwise protect. Use a factor of 30 to 50, apply enough and repeat regularly.
Isabelle Hoorens is a dermatologist at Ghent University Hospital and FWO postdoctoral researcher at Ghent University at the SkinCRIG (Skin Cancer Research Institute Ghent). Her research focuses on how we can improve skin cancer care and what the health-economic effects of skin cancer interventions are.
Lieve Brochez is a dermatologist at UZ Gent specialising in skin cancer. In addition, she is part-time full professor at Ghent University and principal investigator of SkinCRIG (Skin Cancer Research Institute Ghent). She is also currently president of the European Society of Skin Cancer Prevention (EuroSKIN).
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