Conversation with United States Surgeon General, Dr. Jerome Adams: Recent Successes and Next Steps in Combating Skin Cancer Nationwide

In 2014 the Surgeon General’s Call-to-Action to Prevent Skin Cancer¹ (written by then Acting Surgeon General, Boris D. Lushniak, M.D., M.P.H.) was published, and with it, public awareness initiatives were set on course amongst organizations like IMPACT Melanoma around the United States – helping communities and the citizens residing therein with the educational and preventative measures necessary to practice more forward thinking sun safe behavior as it pertains to their skin’s health.

As a follow-up, the CDC released their Skin Cancer Prevention Progress Report² on the heels of the five-year anniversary of the initial Call-to-Action. As you might suspect, positive traction has been achieved, but, in the same breath, questions still exist and further progress needs to be made to improve the country’s overall exposure to the harmful effects that the sun causes our skin each and every year. The aim is to lessen the overall impact of UV exposure and increase general populace thinking with regard to skin health and preventative measures that, on the surface, seem quite simple. That said, creating a greater general awareness and being able to provide community driven access to more preventative solutions are big items we collectively need to address and will look to improve upon over the next five years and beyond.

Since its inception, IMPACT Melanoma has served its mission in servicing many of the goals outlined in the Surgeon General’s Call-to-Action to Prevent Skin Cancer and have thus contributed to the successes that have been reported on in the subsequent Skin Cancer Progress Report. Over the years IMPACT has worked to help pass legislature protecting minors from the harm of tanning beds, which is now present in 21 states as well as the District of Columbia, and has utilized its various programs to aide in forwarding the underlying initiative(s) while helping spearhead the ongoing discussion.

For example:

Practice Safe Skin: Has initiated the installation of 3,500 automatic sunscreen dispensers in communities around the country.

Skinny On Skin: Has successfully brought training awareness initiatives to 300,000 salon professionals across the country.

Your Skin Is In: Has educated over 1,000,000 students nationwide through its eLearning portal, as well as awarded various scholarships to student ambassadors and educators nationwide.

Billy’s Buddies and Support Groups: Has helped support over 500 melanoma patients and their caregivers who are faced with uphill challenges and a general sense of unease following a skin cancer diagnoses.

Safe Skin at Work: The latest program launch which aides in installing sunscreen dispensers, shade structures, and educating outdoor workers on proper skincare initiatives due to their increased exposure to UV radiation on jobsites.

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The topic carried through the narrative thus far will be the basis of conversation at Harvard Medical School’s Pechet Room on November 14th (which IMPACT will be hosting). IMPACT has invited the current United States Surgeon General, Dr. Jerome Adams, as the guest of honor who will be leading a conversation moderated by Alan C. Geller, of Harvard T.H. Chan School of Public Health. Dr. Adams will also make an appearance along with his wife, Lacey Adams, a melanoma survivor, at IMPACT’s Shades of Hope Gala the following night, November 15th.

In anticipation, IMPACT had the opportunity to discuss the Call-to-Action and ensuing Progress Report with the Surgeon General. The transcript of that conversation is as follows:

IMPACT Melanoma: We really appreciate you coming to visit us here in Boston and are very much looking forward to your participation at IMPACT Melanoma’s annual Shades of Hope Gala event. What was the impetus that drove you to get involved here?

Dr. Jerome Adams: We know that skin cancer is a serious public health concern for our country. Each year nearly 5-million people are treated for skin cancer and that costs us over 8-billion dollars. Also, we know skin cancer is preventable. But despite that, incidence rates have continued to increase over time with more than 80,000 cases of melanoma and 8,000 melanoma deaths each and every year. About one-third of adults and more than one-half of high school students actually get sunburned each year, which we know is a risk factor in developing melanoma. Although use of indoor tanning has declined, an estimated 900,000 high school students and 8-million adults continue to put themselves at risk by using indoor tanning devices. That’s from a sort of 30,000 foot point-of-view…

I’ve also seen how skin cancer effects the lives of individuals and their families, including my own family through my wife’s experiences with melanoma.

IM: Let’s keep going with that last thought… How has skin cancer impacted you personally? What’s your advice to every American on this topic?

JA: It’s certainly impacted me and my family in a way that is very significant and very personal. My wife was diagnosed with stage-3 metastatic melanoma soon after she moved to Washington D.C. So, she had to undergo surgery and then a year of immunotherapy. One of the things that is very important to me is helping other families understand what we went through, and also the fact that my wife tanned – including the use of indoor tanning beds – when she was younger and her skin cancer, like a lot of skin cancers, was caused by, or accelerated by her tanning habits.

That, I think, leads into your next question of what advice would you give Americans on this topic…

To me there’s really three simple steps:

1. Make sun protection a habit. That includes seeking shade during the daytime, wearing clothing that covers sun exposed skin, and using broad spectrum sunscreen with SPF values of SPF 15 or higher on exposed skin.

2. Try to avoid tanning – whether it’s outside in the sun, or inside in a tanning bed – tanning is, quite frankly, damaging your skin. We’ve learned that lesson the hard way as a family.

3. Talk to a doctor if you notice changes in your skin. One of the most interesting things about my wife’s situation is that even having a physician as a husband, we didn’t initially think about the changes in her skin potentially being skin cancer. So it’s important for folks to know that a new growth or a sore that doesn’t heal, or a change in an old growth, or any of the ABCDE’s of melanoma are important to watch out for. That’s especially the case in having damaged your skin either through intentional tanning or even just having been outside and sun exposed throughout your life.

IM: Just recently the five-year Skin Cancer Prevention Progress Report of the Surgeon General’s Call-to-Action to Prevent Skin Cancer was released by the CDC. As you prepared to write the foreword for this progress report what struck you when looking through the information with regard to the progress that’s been made in the last five years? What successes stood out? How did we achieve them?

JA: Well, one of the highlights of that report was that we’ve made significant progress over the years. A couple of things:

1. We’ve seen substantial decline in the use of indoor tanning devices and we know that this decline is likely due in part to legislation at the state level that restricts minors’ access to indoor tanning. Research from the CDC indicates that high school aged females are half as likely to use an indoor tanning device if there’s a law in place that prohibits their use. So, that’s real progress over the last five years.

2. Across the country, many communities have taken steps to make it easier for people of all ages to stay sun safe while spending time outdoors from ensuring students can carry and self-apply sunscreen at school – that’s a big deal, to make shade and sunscreen more available in outdoor public spaces. So really helping communities and institutions understand that they have a role in creating sun safe environments…

The fact is, these successes were the results of many people across various community sectors. Working together on a public health problem can serve as an example of how we can live my motto of “better health through better partnerships.”

IM: What do we need to focus on next to improve upon these findings over the course of the next five years? Who needs to be involved in this next phase of work?

JA: Well, that’s a great question because one part of the five year progress report was about emphasizing the successes that have occurred, but another part of it was about identifying gaps. In thinking through gaps, we know that continued efforts are needed to further reduce indoor tanning. An estimated 900,000 high school students, and again, 7.8 million adults continue to put themselves at risk by using indoor tanning devices which still remain available and often unsupervised in gyms, fitness centers, apartment complexes, and salons. So that’s a gap that still exists.

We know more work is needed to raise awareness about, and address the prevalence of high rates of sunburn. Sunburned skin is damaged skin and about one-third of adults and more than half of high school students get sunburned each and every year. If we don’t work to decrease sunburns, skin cancer rates will likely continue to increase in future decades. We need evidence based on interventions to increase sun protection, and more opportunity to help communities to adapt and adopt strategies to meet their unique needs and maximize the likelihood of sustainability over time. So, you know, we’re really concerned that we continue to see a rise in skin cancer diagnoses despite our knowledge of these best policies; so there’s work to be done there…

You asked who could be involved, and I’ll highlight again that many community sectors can and must play a role by providing options for people to limit their UV exposure.

1. Increasing shade in places like parks and pools.

2. Promoting sun protection in recreation areas including hats, sunscreen and sunglasses.

3. Educating: Many different sectors play a role in educating the public about skin protection and sun safety.

4. Policies: Restricting the availability of indoor tanning by minors. We need folks who are policy makers to lean into these practices. And finally, promoting other policies that advance the goal of preventing national occurrences of skin cancer.

So, again, gaps exist, but I think a lot of progress has been made and if we continue to reinforce these partnerships in communities we’ll fill in those gaps and make progress in decreasing new incidences of skin cancer.

IM: What’s the importance of an organization like IMPACT Melanoma existing as an aide in your own fight to accomplish the goals of nationwide prevention measures?

JA: First of all, I couldn’t be more proud of the work IMPACT Melanoma has done over the years. They really highlight the fact that, to be really successful in our prevention efforts, the science of skin cancer prevention needs to be put into action at the local level. The CDC can put out guidelines, the Surgeon General can talk about them, but it’s organizations like IMPACT Melanoma that actually bring the science into action in communities. The work of IMPACT Melanoma helps us reach people where they are in communities all around the country and helps us raise awareness and educate the public about skin cancer, while providing support services for skin cancer patients like my wife and their caregivers. So, again, I’m so appreciative of the work IMPACT Melanoma is doing. We need to lift up more organizations like IMPACT Melanoma if we’re going to have continued success in this fight.

I’m looking forward to the opportunity here. I’m really excited to meet other skin cancer survivors, and I’m also excited to meet the folks that are doing the work on the ground and finding out where they’ve been successful in communicating these sun safety messages to people in the surrounding communities.

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If you’d like to attend the November 14th discussion with Dr. Adams, please contact us and we’ll let you know if space allows. Visit www.impactmelanoma.org/event/shades-of-hope for more information on the Shades of Hope event.

References:

1. View the 2014 Surgeon General’s Call-to-Action to Prevent Skin Cancer here.

2. View the CDC’s Skin Cancer Prevention progress report here.