From The London Telegraph: 7-9-99

Sunbathing is healthy, say experts
By Aisling Irwin, Medical Correspondent

A ray of hope for sun-worshippers

A RESPECTED team of academics has infuriated health campaigners by rejecting their advice to holidaymakers to keep out of the sun.

The epidemiologists say that warnings about the risk of skin cancer are preventing people from indulging in a simple human pleasure which boosts happiness, improves levels of Vitamin D and may even reduce the chance of coronary heart disease. Skin cancer rates are increasing in Britain, with malignant melanoma killing about 1,200 people a year. But the academics argue today that this death rate is low compared with the country’s major killers.

“There is evidence that the potential benefits of exposure to sunlight may outweigh the widely publicised adverse effects on the incidence of skin cancer,” they wrote in the British Medical Journal. “For many people the small absolute increase in risk of melanoma could easily be outweighed by the effect of reduced sunlight on mood.”

But campaigners were dismayed by the article. Christopher New, skin cancer campaign manager for the Health Education Authority, said: “It has taken many years to change people’s attitudes to sunbathing. We are very disappointed with this controversial article. It has scant supporting evidence and it runs the risk of undoing many years of good health education.”

The dispute arose on the hottest day of the year so far, and with a forecast of more sunshine to come. The Bristol team of epidemiologists says that avoiding the sun will do little to decrease an individual’s risk of malignant melanoma, the most deadly of the three types of skin cancer, though it might improve the national statistics for the disease.

Prof. George Davey Smith and Prof. Stephen Frankel wrote: “Even if reducing exposure to sunlight reduces the incidence of melanoma, its effect on overall mortality will be slight, as the number of deaths postponed will be small. In 1995, the deaths of 697 men and 698 women in England and Wales were attributed to malignant melanoma. Even the most forceful campaign could be expected to prevent only a few of these deaths.”

In comparison, they said, coronary heart disease killed 139,000 people in 1995 and there is some evidence that sunlight reduces the chance of a heart attack. Because these figures are so much higher, they argued, “even a modest protective effect of exposure to sunlight could result in a substantial reduction in mortality”.

They added: “People find lying or sitting in the sun enjoyable and relaxing. This subjective sense of well-being may be important in itself in improving the quality of a person’s life.” Sunshine stimulates Vitamin D production, which may be the reason for the effect against heart disease and which also strengthens bones. Depression and suicides have been linked with lack of sun, they said.

But Jean King, director of education for the Cancer Research Campaign, said: “We’re not asking people to live in caves, but skin cancer is a very nasty disease which kills people in their 20s and 30s. This is extremely unhelpful. There’s a very clear and agreed public health message on this issue which we should be careful not to undermine. I don’t think they have produced nearly enough evidence for saying that the health benefits of sun exposure outweigh the harmful effects.”

Prof. Jonathan Rees, a dermatologist at Newcastle University, said: “The facts of this are that ultraviolet is the major known cause of skin cancer. If we all lived underground the rate of cancer would be much lower so in one sense it is a preventable tumour. The question is how should people alter their lives? That is where it gets tricky. Our response should be proportionate to the risk. Death from skin cancer is less than one per cent of all mortality.

“It is not a nice way to die. It is horrific. But there is no equation that allows you to trade that risk against all the happiness so many people get from running around in the sun and having their kids play on the beach in Majorca.” He said the anti-sun message left many people scared. Sunscreens were helpful in protection, he added, but very few people could afford to apply them at the required amounts.

It is not disputed that exposure to sun increases the risk of skin cancer. It is believed that the riskiest types of exposure are sunburn, particularly during childhood, and intermittent exposure – such as office workers taking two-week holidays in the sun. Such intermittent exposure is thought to increase the risk of malignant melanoma by 70 per cent, while sunburn is supposed nearly to double the risk. But studies of sunburn and cancer have been disputed because people with skin cancer are more likely to remember having had sunburn.

The mechanism by which sunshine leads to malignant melanoma is not fully understood. Some people are more at risk, for example if they have red hair and freckles, but the full genetic predisposition is not understood. One paradox which has been difficult to explain is that people who work in the sun appear to have a reduced risk of melanoma.