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HOUSE CALL WITH DR. SANJAY GUPTA
Melanoma on the Rise; Smoking Puts Women at Higher Risk for Lung Cancer Than Men; Diet Alone Does Not Prevent Cancer
Aired July 15, 2006 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.
And this morning, we're talking about skin cancer. Now there are a million new cases every year. And about 10,000 of those people will die. As with most cancers, prevention and early detection are key to keeping the largest organ, that's your skin, healthy.
As Christy Feig reports, the deadliest of skin cancers, melanoma, is on the rise including in a population you might not expect.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): One year ago, 44- year-old Elmer McNeal sought treatment for a rash on his foot, but he soon found out he had a much bigger problem -- a mole there that turned out to be skin cancer.
ELMER MCNEAL, MELANOMA PATIENT: She didn't sugar coat it. Right away, she told me that it was a deadly form of melanoma and it needed to be addressed right away. It was something that life threatening. Within a year, it could be potentially fatal.
FEIG: Melanoma is on the rise in this country. According to the American Cancer Society, there are more than 60,000 new cases a year. Nearly 8,000 Americans die annually of the disease. Almost one every hour. The disease is more prevalent in whites, but it is increasing in people of color. And for them, it's often more deadly.
DR. PAULA BOURELLY., GEORGETOWN UNIVERSITY HOSPITAL: You need to be looking in areas that don't necessarily get the sun. For example, the palms, the soles, in between your fingers, in between your toes, and in your nails because those are the types of melanomas that can be the most deadly. And they're the ones that most commonly affect people of color.
MCNEAL: Experts say genetics and family history most likely play a large role for people of color, but they still need to be concerned about the amount of sun they're getting.
BOURELLY: I don't want to lull people into a false sense of security and say, well, since the sun's not going to be my issue because I'm brown skin, I don't have to worry about protecting myself. I don't have to worry about wearing sunscreen.
MCNEAL: But whether it's exposure to the sun's ultraviolet rays or genetics that's pulling the trigger, melanoma is the deadliest form of skin cancer. And doctors say early detection is key regardless of skin color.
So if you have a mole that changes color, shape, or texture, see your doctor because melanoma is almost always curable in the early stages. But once it spreads, the prognosis is poor.
Christy Feig, CNN, Washington.
GUPTA: All right, thanks, Christy.
And just four percent of skin cancers are melanoma, but they make up the majority of skin cancer deaths. So beware if you have fair skin, have had excessive sun exposure. Also, if you've had severe sunburns as a child or have multiple or atypical moles.
Now as Christy also reported, a family history can also play a role, along with environmental hazards, like working around coal or tar.
And joining us to talk about the latest news on skin cancer is Dr. Darrell Rigel. He's a dermatologist. He's also professor at New York University Medical Center.
Welcome back to the show, doctor.
DR. DARRELL RIGEL, DERMATOLOGIST: It's a pleasure to be back. Thank you for having me.
GUPTA: Thank you. And you just saw the piece as well. An African-American gentleman in this case got melanoma. They talked about the palms, the soles of the feet. What do we really know about the cause of melanoma and where it can appear?
RIGEL: Well, the vast majority of melanomas have been really traced to sun exposure. So you typically see melanoma most commonly where the sun does shine on the face, the head and neck, and where people get sunburned.
So on the trunk in men, on the legs in women. But you can get melanoma where the sun doesn't shine. And again, the theory is that you're getting hit with ultraviolet radiation. It's lowering your immune system. So you're at risk all over your body, too.
GUPTA: OK. Well, let's stay on the topic of melanoma. We have an e-mail question from a worried sister, frankly. Barbara writes this. "My brother was diagnosed and treated for early stage melanoma. Is this genetic and how does this affect his other family members?"
She's obviously concerned about her brother and herself, as well. What do you tell someone like that?
RIGEL: Well, this is a question that we as dermatologists get a lot because the rates of melanoma are rising. So more people have relatives who have had melanoma.
If you have a first degree family member who's had melanoma, mother father, brother, sister, son, daughter, your chance of getting melanoma yourself is about five times increased over the general population. So it's not automatic, but it's certainly elevated.
GUPTA: OK. We sent our roving camera out and got some questions for you on this particular topic. Let's hear one now.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: When I lay out in the sun and I burn. What is my risk of getting skin cancer?
(END VIDEO CLIP)
GUPTA: OK, again, doctor, I'm sure this is a question you get a lot of. She gets burns easily, it sounds like. What is her risk?
RIGEL: Well, the more sunburns you get, the greater risk of getting skin cancer. We do know that you have five or more sunburns in your life, your chance of skin cancer doubles over time.
So again, the fairer skinned you are, the more likely you are to get sun burned, the more susceptible you are to skin cancer. So you need to protect yourself. I think that's the bottom line.
GUPTA: That's pretty remarkable. You know, five or more sunburns. It seems like, gosh, you know, when we were kids, I mean, a lot of people just out in the sun a lot. Five sunburns doesn't seem like a lot.
RIGEL: No, it's not. And it doesn't take that much to give you skin cancer that way. That's right.
GUPTA: OK, let's keep on topic. Another e-mail now. This one from Maryann in Connecticut.
"I've had surgery," she writes, "for several basal cell carcinomas. Am I more likely to develop melanoma than someone with no history of cancer?"
First of all, let me just say -- explain that there are three major types of skin cancer. Dr. Rigel, as you know, basal cell is the most common and least likely to spread. Then there's squamous cell, which is also slow growing and very treatable. And then of course, melanoma, which we've been talking about.
I guess, Dr. Rigel, is someone more likely to get melanoma if they've had basal or squamous cell cancer?
RIGEL: Well, they are. And it's not because the basal or the squamous cell cancers turn into melanoma. But if you have those other skin cancers, it's a sign you've a lot of sun and you're susceptible to it, which are the same risk factors for melanoma. If you've had even one basal cell, your chance of getting melanoma is about three to five times increased over the general population.
GUPTA: Are there certain populations that are more likely to get basal or squamous versus melanoma? Or is it the same? Just fair- skinned to high sun population?
RIGEL: I mean, basically, it's the same. The more susceptible you are to the sun, the easier you burn, the more poorly you tan, the greater your risk. But as you saw from the piece earlier, even the darkest skin individuals can still get melanoma.
GUPTA: Now we're going to talk specifically, because I know a lot of people are probably looking at their skin right now saying, well jeez, I wonder if this is something. We'll talk specifically about what to look for, but time for a quick break right now.
When we come back, is your sunscreen doing what the label says? Some lawyers say no. And they're suing some big names. Stay tuned.
UNIDENTIFIED FEMALE: The ABCs of SPF, 15, 30, 45. Which is best? And does waterproof really protect you better?
And later, how your weight affects your cancer risk.
First, take today's quiz. What does SPF stand for? That answer coming up.
UNIDENTIFIED FEMALE: Before the break, we asked, what does SPF stand for? The answer? Sun Protection Factor.
GUPTA: The American Cancer Society recommends you choose a sunscreen of SPF 15 or higher, and one that blocks both UVA and UVB rays. You got to look for this. They're known as broad spectrum sunscreens.
Also, apply sunscreen 30 minutes before going outside. That gives your body some time to protect itself. About one ounce of a lotion should be enough to cover most of your body. That's quite a bit, actually. And that amount should fill a shot glass to give you a scale of reference.
And don't forget to reapply it every two hours, more often if you're in the water, or if you're sweating a lot.
We're talking with Dr. Darrell Rigel. He's a dermatologist. He's a professor at New York University Medical Center.
Doctor, you get did these questions all the time. We had a lot of viewers write in with questions on this topic.
So let's get to Andrew from California, who writes this. "How effective are 'waterproof' sunscreens while swimming?" And Dr. Rigel, let me just start off by saying CNN reported a major lawsuit involving the sun protection industry just a few weeks ago. One of the points in that lawsuit is that the language on some sunscreens can be misleading. Attorneys, of course, are using even stronger language. But the bottom line is that words such as 'waterproof' are being called in to question.
So answering Andrew's question, how effective are these 'waterproof' sunscreens?
RIGEL: Well, there really isn't truly a totally waterproof sunscreen. Even ones labeled as waterproof probably last about an hour and a half or so before you have to reapply. So I think it's important to realize you need to reapply sunscreen probably every 90 minutes or so if you're in the water.
Even if you're not in the water, sunscreens begin to lower in their effectiveness in about two hours or so. So you probably should reapply within two hours, unless you have some of the sunscreens with some of the newer technologies that last a little longer.
GUPTA: OK. Let's stay on topic of the sunscreens here. We have a question from Kayla in Georgia. This is our roving camera. Just take a listen.
(BEGIN VIDEO CLIP)
KAYLA: Is there a difference between SPF 30 opposed to 45? And if there is, what is it?
(END VIDEO CLIP)
GUPTA: I have to say, doctor, this is a question we get all the time. I mean, you know, is higher always better? Is there some point where you're just not getting any additional benefit?
RIGEL: Well, you know, there is some benefit to having a higher number. This is a question, as a dermatologist, I probably get five times a day this time of year easily.
What happens is if you use an SPF 30, and you use it correctly, that's plenty. But correctly means using it in the way that the FDA tests the sunscreen.
And when you look at studies, sunscreen costs money. And people have to apply it. And they apply usually less than it's rated. And probably people apply maybe 20 to 50 percent of the rated amount. So therefore, if you're putting on a 30, you're only getting the protection of anywhere from a 6 to a 15 on average.
If you use a 45 or higher, even if you skip a little bit, you can still get that protection of a 30. So that's the real answer why the higher numbers can be better in some cases.
GUPTA: Are you talking about skimping on it, you know, just a frame of reference again. A one week long beach vacation, how much sunscreen should you be using during that time?
RIGEL: Well, typically, it's one ounce for every application. And the typical bottle is four ounces. That's only four applications. If you're out more than two hours, that's two applications in a day. So use them up pretty quickly.
I always laugh when people come in and say I've had this bottle of sunscreen for two years. Is it still good because it means they haven't been using very much of it.
GUPTA: Yes, that's a really good point. I think that's probably one of the most important points. A full ounce, I mean, a lot of these bottles, four ounces, that can be just a couple of day's worth of protection.
Let's get to another question now, this one coming from Rick in sunny San Diego. "I've heard that over the long run, the chemicals in sunscreen are actually worse for you than moderate sun exposure. Is there any truth to this?"
Interesting question, Dr. Rigel. Any truth to that?
RIGEL: Well, not really. There's to kinds of sunscreens. There's the screens that are absorbed a little bit into the skin that filter the sun's rays. And they're the blocks, like zinc oxide or titanium dioxide, that just reflect the rays.
But there's really been no studies that show that it's dangerous in terms of the chemicals themselves.
On the other hand, we do know that exposure to ultraviolet light, even moderate amounts, increase your risk over the long run of skin cancer. So I'd say I'd still go with the sunscreen.
GUPTA: You know, you must have people come to you all the time, doctor, and say, well, I mean, how much sun is OK? And I hear differing things on this. Some people say there's no such thing as a safe tan. People in New York or places, you know, that were not necessarily beaches close by, they say I want to go out there and get some sun. What do you tell them?
RIGEL: Well, you know, you got to be realistic. There is no such thing as a safe tan. You have to think about why you're getting tan.
Well, the ultraviolet rays hit your skin. The first thing they do is they damage the cells in the skin. And your body produces the pigment in the tan, the melanin, to try to protect it from further damage. So you have to get damage to get tan.
If people really want to get tan, the best way to do it is with a self tanner, an artificial tanner, because all that really does is put a stain on your skin. It's safe, it's a protein, it comes off in about five to seven days. And if you really want that tan look, that's the safe way to do it. GUPTA: OK, well, that might be good advice. A lot of people paying attention to that. We've got time for another quick question. This comes from Brenda in Virginia.
"What is the youngest age I can start applying sunscreen to my baby? She is now 3 months old. What sunscreens are safest in protecting baby's skin?"
Doctor, what do you say?
RIGEL: That's a great question because that's a common one, too. You know, we always say that you could theoretically use sunscreen even when someone is first born, in a child, but the problem is, is that newborns might lick it off. It might get in the mouth. Nobody really knows what the ramifications of that are.
So typically, what we recommend is up until six months, protect with natural protection. Shade, big hats, cover the baby, whatever.
Above six months, it's pretty safe to use sunscreen. And beyond that, you really can use any sunscreen. The ones that are formulated for kids, the only difference primarily is a fragrance. They smell more like baby powder, but they have the same protection and the same ingredients as adult sunscreen typically.
GUPTA: That's good advice. And as the father of a one-year-old, we have a lot of big straw hats and light colored clothing. That seemed to do the trick, as well.
We're talking with Dr. Darrell Rigel about skin cancer. Coming up, can you be addicted to the sun? Find out.
UNIDENTIFIED FEMALE: Food and cancer, is it the blueberries, the green leafy veggies? Tune in for a surprising look at what impact your diet has on cancer.
First, this week's medical headlines in "the pulse."
JUDY FORTIN, CNN CORRESPONDENT (voice-over): Smoking puts women at higher risk for lung cancer than men. Cornell researchers say women may be more susceptible to tobacco carcinogens, but for unknown reasons, they have a lower death rate.
Progress in hospital nurseries. The March of Dimes says nearly two-thirds of newborns are being screened for important life threatening disorders, nearly twice last year's rate.
Doctors may want to rely on the basics when it comes to assessing risk for coronary heart disease, an advanced method of screening for C reactive proteins, a blood marker that signifies inflammation, did not improve the accuracy of heart disease diagnosis.
University of Minnesota researchers say knowing risk factors like age, race, blood pressure, and cholesterol levels is still the best way to predict heart problems.
Judy Fortin, CNN.
GUPTA: We're back with HOUSE CALL. We've been talking a lot about skin cancer.
But for the moment, let's expand that to all types of cancer. Are the foods out there that you could be eating that help prevent cancer in the first place? Or is it activity in the food you don't eat that matter the most?
We investigate in today's "Fit Nation" report.
GUPTA (voice-over): We've all seen the headlines. Green leafy vegetables keep cancer at bay. Blueberries, a cancer cure. Or how about this one? Eating and drinking your cancer away. A beer and pizza prevention plan. Despite the headlines, new research shows your diet doesn't really impact most cancers that way.
DR. WALTER WILLETT, HARVARD SCHOOL OF PUBLIC HEALTH: There's not really one type of diet, or one magic pill, or one magic food that's going to prevent cancer.
GUPTA: Dr. Walter Willett is a Harvard nutrition specialist, who co-authored the book, "Eat, Drink, & Weigh Less." He's suggests about 35 percent of cancers in the U.S. are due to nutritional factors. Most, he says, because so many Americans are obese. And so many don't exercise.
Obesity is a proven risk factor for colon, breast, endometrial, esophageal and kidney cancers. But it's our approach to eating that's our real downfall.
WILLETT: We don't pay enough attention to the quality of our food. We seem to be enamored of super sizing large amounts in place of really high quality foods. And that, of course, leads to excess calories, and overweight, and obesity.
SCOTT PEACOCK, CHEF: I do think that like food is like a shark. And it can smell fear. You know, it has a sense about it. And you have to be fearless when you're cooking.
GUPTA: Executive chef Scott Peacock demonstrates how to make some of those high quality food alternatives at an Atlanta area cooking class. Chef Peacock has earned an international reputation for the southern food he makes at his restaurant watershed.
PEACOCK: And it looks very unpromising so far. Not like something you'd want to eat, I know, but cooking is magic. It is a lot of fun. It's a diet high in roughage and freshness. I mean, that emphasizes the shortness or the distance from field to table.
GUPTA: The shorter the distance, Peacock says, the fresher the taste of these fruits and vegetables.
PEACOCK: It's much more satisfying. So I don't you need to eat as much.
GUPTA: And that's the other key to keeping obesity away. Portion control helps, even if you pick food that isn't low fat.
PEACOCK: We're very generous. But you don't have to eat everything. People come and share. And that's a big part of the southern table.
GUPTA: So go beyond the headlines. Eat well and eat less. You may just keep cancer away.
GUPTA: So the message is clear. Watch those portion sizes and get moving.
We're talking about tanning again when we return. Could it be addictive? Find out after the break.
UNIDENTIFIED FEMALE: From sunburn to skin cancer, how close is the link? More tips on keeping your skin healthy when HOUSE CALL returns.
GUPTA: Before heading outside today, try checking out your UV levels at www.epa.gov/sunwise/uvindex. Just put in your zip code for a local forecast.
And for more information on skin cancer, click on cancer.gov. That's a National Cancer Institute's Web site. It has links to clinical trials and much, much more.
We've been talking about skin cancer on today's show. It's the most common cancer to be diagnosed -- with one million new cases every year.
Remember, though, this is very treatable and very preventable, as well. Telling us how to do that is Dr. Darrell Rigel. He's a dermatologist who specializes in skin cancer.
Welcome back, doctor. Let's get right back to our inbox now with a question from Reem in New York, who asks this. "What is the best way to get a tan in the summer?"
And doctor, we talked about this a little bit earlier. There is no such thing as a safe tan, but something we found could account for the people that -- people wanted to get that tan. It was a small study done, finding that frequent users of tanning beds can have an endorphin like rush, almost like a runner's high, after being exposed to UV rays.
Now could this be part of the reason for sun worshipping or sun addiction even?
RIGEL: I think it probably is. It's very clear that there are some people who are addicted to tanning. This study just showed that it's out there. And it's more than just the warmth you feel when you go out in the sun and lie out there. There's more to it than that, because even on cooler days, where they -- the warmth is not there, people who are really addicted to this want to be tan, and will do almost anything to get tan, almost similar to cigarette smoking, where you know it's bad for you, yet you still do it.
GUPTA: And you say what to them when they say, but I get this endorphin like rush?
RIGEL: Well, I tell them to do it in other ways. You know, go out and run, exercise. There are other ways to feel good about yourself. And they're not negative to your health.
And you only can get so far. Unfortunately, it is an addiction. You have to treat it with behavior modification. The people to do other things besides going and baking, avoiding the midday sun, using sunscreen, protecting themselves, lowering their risk.
GUPTA: OK. Good points, doc. I just want to make sure we're making that point very clearly.
Another question now from a roving camera. Listen to this.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: The question I really have is with the removal of pre-cancerous lesions actually lower the risk of cancer itself?
(END VIDEO CLIP)
GUPTA: Fair enough question. So someone sees something atypical, they go to their doctor, they have it removed. Does it reduce their chance of developing cancer later?
RIGEL: It actually does. Skin cancer's the most clear cut case of a cancer. If it's treated early, it's not a big deal. But once it spread, basically, nothing works.
So if you have something growing, bleeding, crusting or changing, see your dermatologist because again, catching it earlier is the most critical thing you can do.
GUPTA: I hope we've made that message loud and clear today. Dr. Darrell Rigel, thank you so much for being with us this morning.
RIGEL: My pleasure, Sanjay.
GUPTA: Unfortunately, we're out of time for today. Make sure to watch next weekend. We're going to go inside the mysteries of autism. E-mail us your questions about everything from the causes, to the treatments of autism at HouseCall@CNN.com. Remember, this is a place for the answers to all of your medical questions. Thanks for watching.
I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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