Florida’s number three industry, behind tourism and skin cancer, is voter fraud.
– Dave Barry
People love quick fixes. This seems to be especially true in the US. I guarantee that at least 80% of my patients would choose an expensive pill (within their means) over a free change of habit every time. No criticism implied there. Self-management is hard. But this tendency leaves medical folks in a tough spot.
The interaction of oncology and psychology will always keep us on our toes. Many people are terrified of cancer but still choose not to do the things that definitely help prevent it, like stopping smoking and wearing sunscreen. Sometimes there are economic or social factors that make good self-care impossible, but there are many people with great access and funding who just choose not to save their own lives.
It is some wonder, then, that commercial sunscreen took off early in this country. This came to mind as we were driving through Ormond Beach the other day and passed the huge, expensive beach house that belongs to Ron Rice of Hawaiian Tropic fame.
People have used compounds like zinc oxide on their skin for thousands of years, but it wasn’t until the mid-1900s that Mr Rice and Mr Benjamin Green, another Florida man, created the lotions that built the #1 and #2 selling sunscreen brands in the world.
Now if only we could get everyone to use them.
Skin cancer, the most common malignancy diagnosed every year in the US, costs this country $8.1 billion dollars annually. Most of the 9500 skin cancers diagnosed each day here could have been prevented by reducing sun exposure.
So, what is the difference between people who use careful sun protection and those who don’t? Nobody wants cancer. Anyone in this country who owns a television set or attends public school knows that being in the sun can cause that. It’s not really an avoidable message these days. So where is our public health effort breaking down?
I think it’s down to the quick fix vs prevention issue. In truth, nobody is inclined at baseline to use sun-protective clothing and lotions, and if offered a curative pill instead would switch plans immediately. No such pill exists, of course, and so we need to figure out how to overcome our collective avoidance of annoying self-maintenance. To do so successfully will evidently take a really compelling force.
On the topic of his success with Hawaiian Tropic, Mr Rice has commented, “Vanity is our business.” I think he has hit the nail on the head. Everyone I know who is truly diligent about sunscreen use falls into one of two categories. They have themselves had, or watched a loved one endure, a skin malignancy in the past. Or they are worried about how attractive they will be in 20 years. Many people in the former category continue to ignore the issue, so powerful is the aversion to preventive self-maintenance. Folks in the appearance category, though, seem to be 100% religious in regard to skin care.
Unfortunately, appearance works both ways on this issue. In current US culture, women spend more time and money (lifetime average $225,360) on their appearance than men. Probably often as a result of this, women are about twice as likely to use sunscreen. Sadly they are also three times as likely to use a tanning bed or other intentional, cosmetic exposure to UV radiation. This translates into skin cancer incidence that is higher among women under 50 but higher among men beyond that age.
As with all things human, the curves of behavior of various groups overlap heavily. Men care about their appearance too. I am aware of one individual, 78 years old at the time of his skin cancer diagnosis, who refused treatment to the lesion at his hairline because radiation might make his hair fall out, and surgery would leave him with a visible scar. He literally preferred to die of cancer rather than change his hairstyle. And he did.
Pretty regularly I wish that I could publish pictures of the patients I treat for terrible skin cancers, the ones that grow into people’s eyes and brains. I think that putting these on TV screens every night would get us a lot of traction on this issue, but that’s tough to do without being disrespectful to the folks dealing with these awful situations. This is even more delicate because those who neglect advanced skin cancers of the face quite often, in our experience, have serious psychiatric comorbidities. This is a very vulnerable population
Source: Wikimedia Commons
So in short, please remember to talk to your patients about sunscreen, and maybe find some open-source pictures of folks long dead and beyond insult, like the one here, that you can flash at them to get their attention. Remind them that much of the time those cancers will appear on their faces because of the way that sunlight tends to interact with their bodies (says Neal Stephenson, “topology is destiny.”) Nobody wants their face to be eaten.
If all else fails, follow the advice of Mr Rice and appeal to their vanity.
Please join the discussion below, but if you need to communicate with me offline you can reach me at OncBlogMedscape@gmail.com.
About Dr Kate Hitchcock
Kate Hitchcock, MD, PhD, is a radiation oncologist, biomedical engineer, and retired aircraft carrier driver who grew up as a Wyoming cowgirl. When she is not at the hospital, you can find her with Carolyn, Mary, Tyler, Nick, Marlee, and Colby the barking dog, enjoying the natural splendor of the great state of Florida. She thinks you should visit sometime and try to solve the puzzle of why the natives have so carefully shunted all of the tourists toward the House of Mouse. Connect with her on Twitter: