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Sun exposure puts athletes at higher cancer risk


1SF

07-17-13

July 17--Last summer, when Erik Olson's girlfriend pointed out the weird, pinkish mole on his back, he thought it was a pimple.

He had just come back from a run in the midday sun. A long-distance runner on the Stanford track team, he made lengthy midday runs part of his routine. Olson wasn't particularly concerned, but made an appointment with a dermatologist to get it checked out, just in case. The results of a biopsy stunned him: At 20 years old, Olson had melanoma, the deadliest type of skin cancer.

"I was just so shocked," he said.

Olson and Stanford doctors point to Olson's running habits as the likely culprit of skin cancer at such a young age. Like many athletes, Olson spends hours each day outside training. Before his cancer diagnosis, he usually ran shirtless. Sunscreen, if he remembered to apply it, was only applied to his face and ears.

Research has shown that Olson isn't alone. Increased sun exposure, medical experts say, puts many athletes at a higher risk than most people for skin cancer, yet they fail to slather on sunscreen. So last fall, Stanford launched Sunsport, a partnership that pairs Stanford medical experts with the university's athletics department to increase awareness among student athletes and study their sun habits.

"Athletes are exposed to excessive UV radiation, and there is really substantial evidence to show that they are at increased risk for skin cancer," said Dr. Susan Swetter, director of the Pigmented Lesion & Melanoma Program at Stanford. "What we're looking at in this young athlete population is really something analogous to frequent tanning bed use."

UV radiation

Ultraviolet radiation, emitted by the sun, has a shorter wavelength but higher energy than visible light. UV radiation, both from the sun and tanning beds, are officially classified as a human carcinogen by the U.S. Department of Health and Human Services.

During midday, when many outdoor athletes are practicing or competing, these rays have the shortest distance to travel to Earth and thus are at peak intensity. A study published last fall on the sun habits of NCAA athletes at both Stanford and Duke University found that the average athlete spends four hours a day, 10 months of the year training outdoors.

In an accompanying survey of 290 athletes from 13 sports, 96 percent said they agreed sunscreen helps prevent cancer, yet more than 40 percent never used it and 75 percent used it three or fewer times per week.

For researchers, it was a hard-to-fathom gap: The athletes who spent large amounts of time in the sun understood that sunscreen would protect them from harmful sun exposure, but they didn't put it on.

"It seems like a no brainer," Swetter said. "To me, it's a no brainer."

The athletes, who the researchers followed for more than a year, described simply forgetting to put sunscreen on as the most common reason for not using it. A desire to be tan and the inconvenience of it also were high on the list.

Trophy tan

Olson, a human biology major who will be a senior in the fall, spent much of his youth running around outdoors. He played soccer up until high school, when he began running track and cross-country. In his sophomore year of high school, he became serious about running. He ran nearly every day. Olson's family has a history of "skin issues," but he'd inherited his mom's ability to brown instead of burn.

"I tan easily, so I never worried that much about sunscreen," Olson said.

The tan was sort of a testament to his dedication to his sport, a trophy won from hours of sweating in the sun. At the end of the summer break, runners could tell who spent the most time training in the off-season: They were the tannest. The summer before his freshman year of college, he recalled, he was "so dark it was ridiculous."

"I was just running around in the sun all the time," he said. "My friends and I would try to see how tan we could get."

Certain sports, such as running, soccer, golf and water polo, present a particular risk. A swimmer, who wears hardly anything at all, is doubly challenged by finding sunscreen that will stick to slick, wet skin.

Research has suggested that sweat also puts athletes at an increased risk by intensifying the photosensitivity of the sun and making it easier to burn. Sweaty, wet clothing is also less likely to function well as a protective barrier between the skin and the sun.

Early sun danger

Other studies have shown a strong association between sun exposure during childhood and adolescence and the development of skin cancer later in life. For melanoma in particular, Swetter said, "we think a lot of insults come from earlier in life."

Despite all this, she said, athletic culture is one problematically lacking in concern about the skin.

Sunsport has brought together the Stanford Cancer Institute, the Stanford Department of Dermatology, Stanford Hospital & Clinics and Stanford Athletics to zero in on athletes and coaches, talking to them directly about the risks of the sun, as well as working to make sunscreen more readily available and offering dermatological screenings at games.

The program also promotes "shade structures" for athletes when they're not on the field or in the water. The American Cancer Society guidelines include avoiding direct sun exposure between 10 a.m. and 4 p.m., covering up with clothing, hats and sunglasses and reapplying sunscreen every two hours.

Stanford is also tracking a group of student athletes over time to learn what methods are most effective in getting them to pay attention to their skin. Eventually, Stanford wants to export the program to other universities.

Lesson learned

Erik Olson's cancer was found early -- doctors were able to easily remove the mass from his back, leaving him only with a three-inch scar. As a precaution, two of his lymph nodes also were removed.

The diagnosis, though, was enough to scare Olson into being smarter about the sun. He now runs in the morning or late afternoon, when UV radiation is less intense, and he always wears a shirt. If he does run at the peak of the day, he puts on plenty of sunscreen. Nowadays, he slaps on sunscreen pretty much any time he's in the sun.

"I was just naive," he said. "I really thought that if I didn't burn, my skin wasn't getting damaged."

Kristen V. Brown is a San Francisco Chronicle staff writer. kbrown@sfchronicle.com @kristenvbrown

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Copyright 1SF 2013

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