Sunlight and sunbeds and skin cancer in the UK - statistics

Recent decades have seen huge increases in the numbers of people in the UK being diagnosed with skin cancer. Excessive exposure to ultraviolet (UV) radiation is the most important modifiable risk factor for both malignant melanoma and non-melanoma skin cancer (NMSC). A study published in December 2011 estimated that around 86% of malignant melanomas in the UK (equivalent to around 3.5% of all cancers) are linked to excessive exposure to sunlight and use of sunbeds.23

Exposure to sunlight and cancer

 

What we know about sunlight and sunbeds

Table 6.1 shows a summary of what we know about sunlight and sunbeds and skin cancer.

Table 6.1: Sunlight and skin cancer summary box

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The two types of NMSC, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are both caused by chronic and repeated sun exposure, although the risk of BCC is also increased by sunburn 1, 2, 18. Risk of melanoma has a stronger association with a history of sunburn or sporadic intense exposure to sunlight than with regular and prolonged exposure 3, 4.

Family history of skin cancer, high count of common or atypical nevi (moles), fair skin, red or blond hair, presence of freckles and high body surface area all affect the impact of UV exposure on skin cancer risk 5, 6.

A recent cohort study of women in Norway and Sweden reported a significantly elevated risk of melanoma among participants who used a sunbed at least once a month over the second, third or fourth decade of life compared with women who had rarely or never used a sunbed. 6 Results were adjusted for the number of sunburn episodes during the corresponding period. 7 Since that study, a systematic review showed that sunbed use, especially before the age of 35, increases the risk of malignant melanoma, and use at any age increases the risk of squamous cell non-melanoma skin cancer. 19 In June 2009, the International Agency for Research on Cancer raised the classification of sunbed use to Group 1 "carcinogenic to humans".20

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Holidays abroad and sunbed use

Exposure to UV radiation has increased in recent decades in the UK population as people have increasingly sought a suntan by holidaying in hot countries ( Table 6.28, 17).

Table 6.2: Holidays abroad by UK residents

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Use of sunbeds is also widespread. Surveys commissioned by Cancer Research UK in 2008 and 2009 showed that 6% of 11-17-year-olds in England had used a sunbed, leading to legislation in 2010 banning the use of sunbeds in under-18s in England and Wales (Scotland already had this legislation).21

It is also expected that further depletion of the ozone layer will cause more skin cancer cases in the future 9.

Skin cancer prevention campaigns advise people to avoid exposure to the sun at midday, cover up and use a high sun protection factor (SPF) sunscreen when necessary. There is controversy over whether the way people use sunscreen is effective and whether it increases risk by encouraging people to spend longer in the sun. Evidence from case-control studies is contradictory and prospective studies and clinical trials are necessary 10.

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Incidence and mortality of skin cancers

Around 11,760 cases of malignant melanoma were diagnosed in the UK in 2008. Malignant melanoma incidence rates in Britain have more than quadrupled over the last 30 years. 11  The increase in incidence of melanoma between successive birth cohorts is narrowing but incidence is still expected to increase substantially over the next decades 12. NMSC is the most commonly diagnosed cancer in white populations worldwide, with BCC and SCC occurring at a ratio of about 4:1. Reliable statistics on the incidence of NMSC are difficult to obtain, but it is estimated that around 100,000 people are diagnosed with it each year in the UK 13. Estimates suggest that the incidence of NMSC increased by an average of 3 to 8% per year in Europe, the US, Canada and Australia from the 1960s to the 1990s 14. BCC rarely metastasises, while SCC can spread to other parts of the body. Treatment for NMSC can involve disfiguring surgery and nearly half of patients develop another NMSC within five years 15.

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Vitamin D, sunlight and cancer

There is controversy over whether following sun protection advice could result in vitamin D deficiency, and increased risks of other diseases, including certain internal cancers. Some studies have suggested that high levels of vitamin D are associated with a reduced risk of bowel cancer, although the mechanism remains unclear.16,22 For other cancers, the evidence is inconsistent or limited. The time required to make sufficient vitamin D varies, but is typically short and less than the time needed for skin to redden or burn. Photosynthesised vitamin D will not be stored by the body once the optimum level has been reached so there is no benefit from deliberate prolonged sun exposure. There is more information in the Consensus Vitamin D Position Statement.

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References for sunlight and cancer risk

  1.  van Dam, R.M., et al., Risk factors for basal cell carcinoma of the skin in men: results from the health professionals follow-up study. Am J Epidemiol, 1999. 150(5): p. 459-68.
  2.  Zanetti, R., et al., The multicentre south European study 'Helios'. I: Skin characteristics and sunburns in basal cell and squamous cell carcinomas of the skin. Br J Cancer, 1996. 73(11): p. 1440-6.
  3.  Veierod, M.B., et al., A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women. J Natl Cancer Inst, 2003. 95(20): p. 1530-8.
  4.  Elwood, J.M. and J. Jopson, Melanoma and sun exposure: an overview of published studies. Int J Cancer, 1997. 73(2): p. 198-203.
  5.  Tucker, M.A. and A.M. Goldstein, Melanoma etiology: where are we? Oncogene, 2003. 22(20): p. 3042-52.
  6.  Veierod, M.B., et al., A Prospective Study of Pigmentation, Sun Exposure, and Risk of Cutaneous Malignant Melanoma in Women. JNCI Cancer Spectrum, 2003. 95(20): p. 1530-1538.
  7.  Rivers, J.K., Is there more than one road to melanoma? Lancet, 2004. 363(9410): p. 728-30.
  8.  Roger Smith Travel Trends, 2009 Office for National Statistics: London. 2010
  9.  Health Development Agency, Cancer Prevention: A resource to support local action in delivering the NHS cancer plan. 2002, Health Development Agency. p. Chapter 6, pages 127-146.
  10.  de Vries, E. and J.W. Coebergh, Cutaneous malignant melanoma in Europe. Eur J Cancer, 2004. 40(16): p. 2355-66.
  11.  Cancer Research UK. Cancer statistics, malignant melanoma. 2005
  12.  Diffey, B.L., The future incidence of cutaneous melanoma within the UK. Br J Dermatol, 2004. 151(4): p. 868-72.
  13.  Holme, S.A., K. Malinovszky, and D.L. Roberts, Changing trends in non-melanoma skin cancer in South Wales, 1988-98. Br J Dermatol, 2000. 143(6): p. 1224-9.
  14.  Diepgen TL, Mahler V, The epidemiology of skin cancer. Br.J Dermatology, 2002.146(61) p.1-6
  15.  Nguyen, T.H. and D.Q. Ho, Non-melanoma skin cancer. Curr Treat Options Oncol, 2002. 3(3): p. 193-203.
  16.  Giovannucci, E., The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes and Control, 2005. 16(2): p. 83-95.
  17.  Iain Macleay, Ed Travel trends. A report on the 1999 International Passenger Survey Office for National Statistics: London. 2000
  18.  Madan, V. et al., Non-melanoma skin cancer. Lancet, 2010. 375(9715): p. 673-85.
  19.  The International Agency for Research on Cancer Working Group on Artificial Ultraviolet (UV) light and skin cancer, The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. Int J Cancer, 2007. 120(5): p. 1116-22.
  20.  El Ghissassi, F. et al., A review of human carcinogens--part D: radiation. Lancet Oncol, 2009. 10(8): p. 751-2.
  21.  Thomson, C.S., Woolnough, S., Wickenden, M., Hiom, S., Twelves, C.J. Sunbed use in children aged 11-17 in England: face to face quota sampling surveys in the National Prevalence Study and Six Cities Study. BMJ, 2010.340:c877. doi: 10.1136/bmj.c877.
  22.  Lee, J.E., Li, H., Chan, A.T., et al., Circulating levels of vitamin D and colon and rectal cancer: the Physicians' Health Study and a meta-analysis of prospective studies. Cancer Prev Res (Phila), 2011
  23.  Parkin, D.M., Mesher, D., Sasieni, P. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer, 6 Dec 2011; 105 (S2):S66-S69; doi: 10.1038/bjc.2011.486