Canadian Medical Association Journal 1996; 155: 212-213
© 1996 Canadian Medical Association (text and abstract/résumé)
But even though it currently is riding a wave of interest in sun exposure that is shared by the media and a concerned public, the Canadian Dermatology Association (CDA) knows it has to tread carefully in the middle ground between fear-mongering and "so-what?" complacency.
"We have to make people realize that sun exposure is a big enough issue to be concerned about without making them afraid to go outdoors and enjoy themselves," said Dr. Jason Rivers, national director of the CDA's Sun Awareness Program. "Moderation is the answer -- too far in either direction and you lose out. It's difficult to maintain the middle ground, but that's important in order to keep credibility."
Since 1991 the CDA has developed educational information and a sun-awareness campaign to coincide with National Sun Awareness Week, which is observed in May. Themes have included the importance of childhood protection (1992), using hats and clothing for sun protection (1993) and sun and the athlete (1994), a focus which coincided with the Commonwealth Games in Victoria.
In 1996 the CDA concentrated on taking the sun message to elementary schools. About 80 dermatologists -- nearly 20% of the association's membership -- visited elementary schools across Canada armed with multimedia CDs, an educational aid called "Good sun/Bad sun" and the message that it's okay to go out in the sun if you slip, slap and slop. Funding for the program comes from the manufacturers of sunscreen products which bear the endorsement: "The Canadian Dermatology Association recognizes that regular use of this product will help protect against sunburn and may reduce long-term damage to the skin produced by sun exposure."
The campaign was well received, Rivers said. Parents and teachers who hear the message become converts, and realize that children should take simple precautions to prevent skin cancer later in life.
And children who are told how important it is to slip on a shirt, slap on a hat and slop on some sunscreen to prevent sunburn -- "never talk about cancer with children," says Rivers -- see this as another of life's little safety lessons, perhaps akin to wearing a seat belt or not talking to strangers.
Rivers acknowledged that taking the message to children at schools across the country attracted media attention, which led to dozens of interviews and wider exposure for the sun-awareness message. "There's no question we've benefited from generous donations of media time and coverage," he said. However, the media is also responding to global concern about the ozone layer, the public's changing outdoor behaviour and growing popularity of the "untanned" look -- all of which have made skin cancer a "fashionable" topic, he added wryly.
Another popular CDA campaign that attracts media attention is the "beach battle station." Modelled on an Australian screening program, the first one in Canada was held on a public beach in Vancouver in 1991 by the CDA and the Canadian Cancer Society. Volunteers handed out educational material while dermatologists conducted skin-cancer screenings in the privacy of a tent. Between 1991-93 almost 1700 people were screened at the beach battle stations; about 20% were referred to their family physicians for further investigation.
One plus for the sun-awareness campaign is that prevention measures are simple and aren't perceived as infringing on people's personal freedom or choice. "Being advised to wear a hat or not lie in the sun expressly to get a suntan doesn't require a great shift in behaviour," Rivers said.
However, that is no guarantee of long-term success, as Australia is discovering. Its Queensland melanoma project began in the 1960s after a high incidence of advanced skin cancer was identified. The slip-slap-slop campaign got under way in the 1980s and today Australians are more aware of the issue and cover up more, said Rivers, who worked down under for 2 years. However, epidemiologists now are watching to see if there is a trend reversal toward negative behaviour as people grow weary of the message.
Before Canadians tire of the message, the CDA wants to evaluate their knowledge, attitudes and behaviour toward ultraviolet radiation and the threat of sun exposure. This summer more than 3000 Canadians will be part of a national survey, funded by the National Cancer Institute of Canada, to determine what barriers or reasons keep people from adopting healthy sun-related behaviours.
"We're taking a real public-health perspective on this," Rivers said. "The fact is there's no good treatment for advanced melanoma, and it's far more cost effective to prevent skin cancer than it is to fight it. We're just being good corporate citizens."
This year more than 60 000 Canadians will develop skin cancer, and children now have a lifetime 1-in-7 risk of developing the disease. Since more than 60% of lifetime sun exposure has occurred by age 18, childhood sun exposure is now emerging as one of the most significant risk factors for skin cancer later in life. For more information about the sun-awareness program contact the CDA, 604 985-9184; (fax) 604 985-2584.