What is Breast Cancer?

In a healthy body, natural systems control the creation, growth and death of cells. But when these systems malfunction, more cell growth than death can occur. The result is a mass of tissue we call a malignant tumor—or cancer. And when this process takes place in the breast, it’s breast cancer. Tumors in the breast tend to grow slowly; by the time a lump is large enough to feel, it may have been growing for as long as 10 years. Some tumors, however, are aggressive and grow much faster. 

Did you know? 

50 to 75% of breast cancers begin in the milk ducts. 10 to 15% begin in the lobules. A few begin in other breast tissues.

Non-invasive Breast Cancer 

Non-invasive breast cancer (also known as ductal carcinoma in situ or DCIS) occurs when abnormal cells grow inside the milk ducts but have not spread to nearby tissue or beyond. This may also be referred to as “pre-invasive breast carcinoma.” Although the abnormal cells have not spread to tissues outside the ducts, they can develop into invasive breast cancer. Learn more

Invasive Breast Cancer

Invasive breast cancer is when abnormal cells break out of the milk ducts or lobules and move into nearby breast tissue. Cancer cells can travel from the breast to other parts of the body through the blood stream or the lymphatic system. And they may travel early in the process when the tumor is small or later when the tumor is large. 

The lymph nodes in the underarm area (the axillary lymph nodes) are the first place that breast cancer is likely to spread. In advanced stages, breast cancer cells may spread to other parts of the body like the liver, lungs, bones and brain (in a process called metastasis). There, the breast cancer cells may again begin to divide too quickly and form new tumors. Learn more

Stage IV Breast Cancer 

Stage IV breast cancer (also known as metastatic or advanced breast cancer) has spread beyond the breast to other parts of the body, most often the bones, lungs, liver or brain. Some women have stage IV when they are first diagnosed but this is not common in the United States. More commonly, metastatic breast cancer arises months or years after a person has completed treatment for early or locally advanced breast cancer (stage I, II, or III.) Learn more

Other Forms of Breast Cancer 

Though they are not specific types of tumors, there are some special forms of breast cancer. These include inflammatory breast cancer (IBC), Paget disease of the breast or nipple, and metaplastic breast cancer. Learn more

Diagnosing and Treating Breast Cancer

 Differences in breast cancer type, tumor, stage, and other factors affect treatment and prognosis. Because of this, it’s important to understand the details of your diagnosis before choosing a treatment path. 

If you’re ready to learn how breast cancer is diagnosed and what you can expect to learn from diagnostic reports, get started here.

Updated 03/20/14

Physical Activity and the Risk of Breast Cancer (from New England School of Medicine)

Vigorous physical training1-5 and even moderate exercise6-9 can interrupt the menstrual cycle, perhaps by suppressing the pulsatile release of gonadotropin-releasing hormone.10,11 This effect of physical activity may lower a woman's cumulative exposure to estrogen and progesterone, thereby inhibiting carcinogenesis in the breast.12-22 Energy balance might also influence the risk of breast cancer. Caloric restriction in rodents reduces the proliferative activity of the mammary glands23 and inhibits carcinogenesis.24,25 However, the effect of energy balance, as indicated by energy intake, body-mass index (the weight in kilograms divided by the square of the height in meters), and energy expenditure, on the risk of breast cancer has not been examined thoroughly in humans.
In this study we evaluated the influence of physical activity, both at work and during leisure time, on the risk of breast cancer in a cohort of 25,624 premenopausal and postmenopausal women. Data on parity, dietary factors, and body-mass index allowed adjustment for potentially confounding factors, and reassessment of physical activity after three to five years gave an indication of the effect of sustained physical activity on the risk of breast cancer.

Methods

Study Population

From 1974 to 1978, the National Health Screening Service invited people in three counties in Norway (Oppland, Sogn og Fjordane, and Finnmark) to participate in a survey of risk factors for cardiovascular disease. All women who were 35 to 49 years of age and a random sample of 10 percent of those who were 20 to 34 years of age were invited. In four municipalities in Finnmark all women who were 20 to 34 years of age were invited. A comprehensive description of these populations has been published previously.26 A total of 31,556 women were invited to participate, and 28,621 (91 percent) actually did.
All women in this survey as well as a random sample of women who were 20 to 39 years of age were invited to participate in a second survey three to five years later (1977 to 1983). Of these 34,378 women, 31,209 (91 percent) participated.27 This second survey was used as the base line, because no information on parity and dietary factors was collected during the first survey.
Each woman received a written invitation to participate, together with a one-page questionnaire. The participants were asked to answer the questionnaire and bring it to the clinical examination. At screening, trained nurses checked the questionnaire for inconsistencies regarding physical activity and menopausal status, measured weight and height, and collected blood samples.
During screening in the second survey, the participants were asked to fill out a food-frequency questionnaire, to be returned by mail. After one reminder, 25,892 (83 percent) returned the questionnaire. The energy and fat intakes for each woman were derived from the sum of all food consumed. The semiquantitative food-frequency questionnaire that we used has been described in detail and validated.28,29

Assessment of Physical Activity

Self-reported categories of physical activity during leisure hours in the year preceding each survey were assessed when the women entered the study and graded from 1 to 4 according to the participant's usual level of physical activity. A grade of 1 was assigned to those whose leisure time was spent reading, watching television, or engaging in other sedentary activities; a grade of 2 to those who spent at least four hours a week walking, bicycling, or engaging in other types of physical activity; a grade of 3 to those who spent at least four hours a week exercising to keep fit and participating in recreational athletics; and a grade of 4 to those who engaged in regular, vigorous training or participating in competitive sports several times a week. The self-reported level of physical activity during work hours in the preceding year was also graded on a four-point scale. A grade of 1 was assigned to those whose work was mostly sedentary; a grade of 2 to those whose job involved a lot of walking; a grade of 3 to those whose job required a lot of lifting and walking; and a grade of 4 to those engaged in heavy manual labor.
Two identical assessments of leisure-time activity were made at an interval of three to five years, and the results were combined for all groups. Women who reported moderate (grade 2) or regular (grade 3 or 4) exercise during leisure time in the first survey and regular exercise (grade 3 or 4) in the second survey were characterized as being consistently physically active. Women who were sedentary (grade 1) during leisure time in both surveys were characterized as being consistently sedentary. The women who were neither consistently sedentary nor consistently active during leisure time were characterized as being moderately active.

Follow-up and Identification of Cases of Breast Cancer

We followed a total of 25,707 women who had not been given a diagnosis of cancer before our base-line survey (1977 to 1983). We used the participants' national 11-digit personal identification numbers to identify every incident case of breast cancer reported to the Cancer Registry of Norway and Statistics Norway through the end of follow-up (December 31, 1994). A total of 98 percent of the cases were verified histologically. Women in whom cancer developed (n = 72) or who died (n = 11) within the first year of the study were excluded from the analyses to account for the possibility that undiagnosed cancer or severe illness might influence the level of physical activity. Through a linkage to the Central Population Register at Statistics Norway, we obtained information concerning the reproductive history of each woman, including the date of birth of each liveborn child through December 31, 1992, and deaths in the cohort through December 31, 1994.
The ultimate study cohort consisted of 25,624 women who participated in both surveys (age range, 20 to 69 years) during 359,930 person-years of follow-up.

Statistical Analysis

Base-line variables were adjusted for age and compared by analysis of covariance. Cox proportional-hazards regression analysis was carried out to investigate the simultaneous effect of physical activity and covariates on the incidence of breast cancer. To calculate the risk of breast cancer, women were observed for the development of breast cancer from entry into the study to the date of diagnosis of any cancer, the time of death, or the end of follow-up, whichever event came first. In the analysis, grades 3 and 4 of leisure-time activity were merged because of the small numbers of women with a grade of 4 in both surveys (48 women in the first survey and 57 in the second survey). As a reference group we used women who were sedentary at work or during leisure time.
In the analyses, we adjusted for age at entry (a continuous variable), county of residence, number of children, age at birth of first child, intake of total fat and energy, and body-mass index. Women who reported that they were premenopausal at base line were treated as premenopausal until they reached the age of 50 during follow-up, at which time they were considered postmenopausal. Women who reported that they were postmenopausal at base line were treated as postmenopausal.
Because there were few women with breast cancer who were sedentary both at work and during leisure time, the effect of this combination on the risk of breast cancer could not be analyzed. All significance tests were two-tailed, and the level of significance was set at 5 percent. The analyses were performed with the SAS statistical package version 6.11.

Results

There were 351 incident cases of breast cancer (100 among premenopausal women and 251 among postmenopausal women) among 25,624 women. The mean length of follow-up was 14.0 years (median, 13.7), and the median age at diagnosis was 54.7 years (range, 36.3 to 68.0).
Table 1Table 1Base-Line Characteristics of the Women According to the Level of Physical Activity in the 1977–1983 Survey. gives the base-line characteristics of the participants. Two thirds of the women reported moderate activity during leisure time, whereas 15 percent exercised regularly. Only 14 percent reported being sedentary at work, whereas 20 percent reported lifting and 5 percent reported doing heavy manual labor. Women who reported regularly exercising during leisure time did not differ from women who were inactive during their leisure time with respect to age at entry or number of children, but they tended to be taller and to have a lower body-mass index, a relatively low ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol in serum, lower serum triglyceride levels, and higher HDL cholesterol levels. Women whose work involved lifting or heavy manual labor had a higher body-mass index and more children than those engaged in sedentary work. Energy intake was positively related to physical activity, but the association was more pronounced with work activity than with leisure-time activity.
We analyzed other possible age-adjusted risk factors for breast cancer at base line and found a 28 percent increase in risk for each additional 6 cm of height and a 13 percent reduction in risk for each child. An older maternal age at the birth of a first child was associated with a borderline increase in risk, whereas body-mass index (in the group as a whole or in the subgroups of premenopausal and postmenopausal women), energy intake, and total fat intake did not influence the overall risk of breast cancer (data not shown).
Table 2Table 2Adjusted Relative Risk of Breast Cancer According to the Level of Physical Activity during Leisure Time and at Work in the 1977–1983 Survey. shows the relation between the level of leisure-time or work activity and the overall risk of breast cancer. After adjustment for age and with the sedentary group as the reference group, the relative risk of breast cancer was reduced among women whose jobs involved walking, lifting, or heavy manual labor. Adjustments for other factors (body-mass index, county of residence, number of children, and height) in addition to age changed the risk estimates only slightly. Further adjustments for age at first birth or dietary factors (energy intake, total fat intake, and fiber intake) did not influence our estimates of relative risk and were omitted from the final model. A 52 percent reduction in risk was observed among the women who reported doing heavy manual labor (relative risk, 0.48; 95 percent confidence interval, 0.25 to 0.92). The overall adjusted risk of breast cancer decreased in a dose–response manner with increasing activity level during leisure time (P for trend = 0.04). Women who exercised at least four hours a week during leisure time had a 37 percent reduction in the risk of breast cancer (relative risk, 0.63; 95 percent confidence interval, 0.42 to 0.95).
When the group was divided according to menopausal status (Table 3Table 3Adjusted Relative Risk of Breast Cancer According to Menopausal Status and the Level of Physical Activity in the 1977–1983 Survey.), a consistently inverse association was observed between the level of leisure-time activity and the premenopausal risk of breast cancer; the adjusted relative risk declined to 0.77 (95 percent confidence interval, 0.46 to 1.27) and further to 0.53 (95 percent confidence interval, 0.25 to 1.14) as the level of activity increased (P for trend = 0.10). A weaker association was observed between the level of leisure-time activity and the postmenopausal risk of breast cancer. The inverse association between the level of activity at work and the risk of breast cancer was also pronounced among premenopausal women; among premenopausal women whose jobs involved lifting or heavy manual labor, the relative risk was 0.48 (95 percent confidence interval, 0.24 to 0.95).
We also divided the cohort into women who were younger than 45 years of age at entry and those who were 45 or older. Among those younger than 45 years at entry for whom data were complete (of whom breast cancer developed in 138; mean age at diagnosis, 48.3 years), the adjusted relative risk declined to 0.80 (95 percent confidence interval, 0.52 to 1.22) and further to 0.38 (95 percent confidence interval, 0.19 to 0.79) as the level of activity during leisure time increased (P for trend = 0.01). The respective adjusted relative risks were 1.03 (95 percent confidence interval, 0.72 to 1.48) and 0.84 (95 percent confidence interval, 0.51 to 1.39) (P for trend = 0.54) among those for whom data were complete who were 45 years of age or older at entry (of whom breast cancer developed in 208; mean age at diagnosis, 58.2 years). These values indicate that physical activity had a protective effect, particularly with respect to the risk of breast cancer before and soon after menopause.
We examined models stratified according to body-mass index (Table 4Table 4Adjusted Relative Risk of Breast Cancer According to Body-Mass Index and the Level of Physical Activity during Leisure Time in the 1977–1983 Survey.). Among lean (body-mass index, <22.8), regularly exercising women, the risk of breast cancer was reduced by 72 percent (relative risk, 0.28; 95 percent confidence interval, 0.11 to 0.70). No such association was observed in the middle or upper thirds of body-mass index among regularly exercising women. In models stratified according to both body-mass index and menopausal status, this association was seen among both premenopausal and postmenopausal lean women (data not shown).
In the second survey 61.2 percent of the participants reported the same level of leisure-time activity as in the first survey, 23.5 percent reported an increased level, and 15.3 percent reported a reduced level. By combining these two assessments of leisure-time activity, we observed that the relative risk declined to 0.23 (95 percent confidence interval, 0.09 to 0.60) as the level of sustained activity increased in lean (body-mass index, <22.8) women (P for trend = 0.002) (Table 5Table 5Adjusted Relative Risk of Breast Cancer According to Body-Mass Index and Overall Level of Physical Activity during Leisure Time in the 1974–1978 and 1977–1983 Surveys.). This protective effect across increasing levels of sustained leisure-time activity was observed in both lean premenopausal women (relative risk, 0.23; 95 percent confidence interval, 0.06 to 0.88; P for linear trend = 0.02) and lean postmenopausal women (relative risk, 0.24; 95 percent confidence interval, 0.06 to 0.96; P for linear trend = 0.03).

Discussion

Our results support the idea that physical activity protects against breast cancer, particularly among premenopausal and younger postmenopausal women. Activity during both leisure time and work reduced the overall risk. There was a significant inverse dose–response relation between leisure-time activity and the risk of breast cancer. The protective effect was evident among lean premenopausal and postmenopausal women, and repeated assessment emphasized the preventive effect of physical activity.
The overall reduction in the risk of breast cancer among active women is consistent with findings in other cohort15,17 and case–control19-22 studies, but at variance with the findings of a few others.30,31 In one of these discrepant studies,31 most of the women were older than in the present study and breast cancer was diagnosed mainly among postmenopausal women. In the other,30 physical activity at college was assessed 35 to 70 years before the diagnosis of breast cancer, and no adjustments were made for potential confounding factors. Our finding of a protective effect of work-related activity on the risk of breast cancer is also in agreement with other studies.18,32,33
Precise assessment of physical activity is difficult in a population-based cohort. The accuracy of the levels of leisure-time activity reported on the questionnaire that we used has been validated previously.34-36 Since the level of leisure-time activity correlates with the degree of physical fitness,34,36 our observation that recreationally active women tended to be leaner than inactive women and had serum lipid profiles associated with regular exercise strengthens the validity of our assessments. Energy intake was also positively related to both leisure-time and work activities, particularly work activities.
Repeated assessment of leisure-time activity is important in any analysis of the effect of sustained activity on the risk of breast cancer. The protective effect was notable among lean women who were consistently active during their leisure time. In combining the two assessments for each woman, we may also have increased the precision of our assessment of physical-activity levels, but we cannot differentiate the effect of sustained activity from any misclassification.
The population-based approach and the high participation rate in our study reduced selection bias. The almost complete reporting of incident cases of breast cancer also strengthens our results. Age at menarche was not available and could have confounded our results, but this is not likely, since an increased risk of only 4 percent was observed for each year of earlier age at menarche in a similar study population in Norway.37
Information about the use of hormonal contraceptives was not available, although recent meta-analyses suggest that there is only a small increase in the risk of breast cancer among the youngest women who commonly use hormonal contraceptives.38 It is probable that this information would not have confounded our results to any large extent.
How does physical activity influence the development of breast cancer? The propensity to be physically active may be inherited,39 so the genotype may influence both physical activity and the predisposition to breast cancer. Social and cultural influences on exercise and energy balance seem to be more important than genetic factors,39,40 which points to leisure-time activity as an independent and modifiable variable with regard to its effect on the risk of breast cancer.
A reduction in the cumulative exposure to cyclic estrogens and progesterone may in part explain the preventive effect of both leisure-time and work activity. Over the long term, vigorous training and moderate leisure-time activity may decrease estradiol and progesterone secretion,3,6,41 reduce the length of the luteal phase,10,42 induce anovulation,7,8,41,43 delay menarche,4,5 and cause secondary amenorrhea.2,12
Physical activity influences energy balance, and experimental studies have shown that calorie restrictions inhibit mammary carcinogenesis.24,25,44 Anthropometric measures such as height, body-mass index, and weight gain have been used as biomarkers of calorie intake, and increased values have been reported to be risk factors for breast cancer in humans.45-48 A diet involving a high energy intake has also been associated with early age at menarche,5,49 and this finding supports the hypothesis that increased net energy may increase the cumulative hormonal levels that are of importance for carcinogenesis of the breast. Women who were active during leisure time reported only a slightly higher total energy intake than sedentary women, and they tended to be leaner, indicating that their net available energy was lower. The greater protective effect of leisure-time activity against breast cancer in lean women indicates that there may be an optimal energy balance that inhibits mammary carcinogenesis.
Triglycerides are known to displace estradiol from its tight binding to the sex hormone–binding globulin, which is found in low levels in obese women,50 and thus triglycerides increase levels of free estradiol. Serum levels of triglycerides were higher in sedentary women than in women who were more active during their leisure time; thus, exposure to estrogen may be greater in inactive women. This underscores the importance of avoiding obesity if physical activity is to have an optimal inhibitory effect on the risk of breast cancer.

Original article at: http://www.nejm.org/doi/full/10.1056/NEJM199705013361801#t=articleTop

Yard Work and Gardening is Physical Activity

by Normand Richard, Certified Exercise Physiologist

Spring has finally sprung, which for most of us means it’s time to get outside and get those gardens in tip top shape! If you find it hard to get motivated you’ll be happy to know that things like digging, raking, hauling and pruning all support you leading a healthy active lifestyle.
There is sometimes a misconception that you must be in a fitness centre, wearing athletic clothing and dripping with sweat to be physically active. Truth is, getting outside in the fresh air and doing some yard work or doing chores around the house provides a variety of health benefits and you don’t need special clothes.
Here are some pointers to help get the most out of your physical activity while tending to your yard.

• Yard work:
• Consider more frequent, but less heavy wheelbarrow trips
• If you have difficulty raking the entire lawn at once, do half earlier in the day and the other later in the day
• Use a broom to clean your driveway instead of the garden hose. You will a) work the muscles in your upper body, and b) minimize water wasting

• Gardening:
• Avoid staying in one position (e.g. kneeling) for an extended period of time
• When weeding your garden, alternate between your right and left hands to work both sides of your body
• When lifting heavy soil bags, get your body as close as possible to the bag and ensure good lifting posture

Yard work and gardening can provide you with a strong sense of accomplishment. If you don’t have a garden, offer to help a neighbour or join a community garden. Don’t forget to put on your sunhat, kick back, relax, and admire the fruits (and vegetable!) of your labour. Visit us on Facebook and tell us your gardening stories. Let’s get outside and get active.

Noise-Induced Hearing Loss

Hearing plays an essential role in communication, speech and language development, and learning. Even a small amount of hearing loss can have profound, negative effects on speech, language comprehension, communication, classroom learning, and social development. Studies indicate that without proper intervention, children with mild to moderate hearing loss, on average, do not perform as well in school as children with no hearing loss. This gap in academic achievement widens as students progress through school.^1,2
An estimated 12.5% of children and adolescents aged 6–19 years (approximately 5.2 million) and 17% of adults aged 20–69 years (approximately 26 million) have suffered permanent damage to their hearing from excessive exposure to noise.^3,4

Hearing loss can result from damage to structures and/or nerve fibers in the inner ear that respond to sound. This type of hearing loss, termed “noise-induced hearing loss,” is usually caused by exposure to excessively loud sounds and cannot be medically or surgically corrected. Noise-induced hearing loss can result from a one-time exposure to a very loud sound, blast, or impulse, or from listening to loud sounds over an extended period.

Preventing Noise-Induced Hearing Loss

Hearing loss caused by exposure to loud sound is preventable.⁵ To reduce their risk of noise-induced hearing loss, adults and children can do the following:

• Understand that noise-induced hearing loss can lead to communication difficulties, learning difficulties, pain or ringing in the ears (tinnitus), distorted or muffled hearing, and an inability to hear some environmental sounds and warning signals
• Identify sources of loud sounds (such as gas-powered lawnmowers, snowmobiles, power tools, gunfire, or music) that can contribute to hearing loss and try to reduce exposure
• Adopt behaviors to protect their hearing:
  • Avoid or limit exposure to excessively loud sounds
  • Turn down the volume of music systems
  • Move away from the source of loud sounds when possible
  • Use hearing protection devices when it is not feasible to avoid exposure to loud sounds or reduce them to a safe level⁵
• Seek hearing evaluation by a licensed audiologist or other qualified professional, especially if there is concern about potential hearing loss

References

1. American Speech-Language-Hearing Association. Effects of Hearing Loss on Development. Rockville, MD: American Speech-Language-Hearing Association.
    
2. Bess FH, Dodd-Murphy J, Parker RA. Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear and Hearing 1998;9:339–354.
    
3. Niskar AS, Kieszak SM, Holmes AE, Esteban E, Rubin C, Brody DJ. Estimated prevalence of noise induced hearing threshold shifts among children 6 to 19 years of age: The third national health and nutritional examination survey. 1988-1994, United States. Pediatrics 2001;108:40–43.
    
4. National Institute on Deafness and Other Communication Disorders. Quick Statistics. Bethesda, MD: U.S. Department of Health and Human Services; August 2008.
    
5. National Institute on Deafness and Other Communication Disorders. Noise Induced Hearing Loss. Bethesda, MD: April 2007. NIH Pub No. 97-4233.

5 Steps to Loving Exercise ... Or At Least Not Hating It

We all know the benefits of regular physical activity – increased energy, better cardiovascular health, reducing the risk of heart disease and stroke and looking more svelte.

But about 80 percent of Americans don’t make exercise a regular habit, and, according to a recent American Heart Association website survey, 14 percent say they don’t like exercise.

So how do you overcome an exercise aversion? Mercedes Carnethon, Ph.D., assistant professor of preventive medicine at Northwestern University’s Feinberg School of Medicine, has some tips to help you incorporate exercise into your life – and maybe even learn to like it.

1. Exercise That Suits YouFind an exercise that best fits your personality, Dr. Carnethon said. If you are social person, do something that engages you socially – take a group exercise class, join a kickball team or walk with a group of friends. Or, if you prefer having time alone, walking or jogging solo might be a better fit for you. MyWalkingClub.org is the perfect way to connect with others who share your goals, lifestyles, schedules and hobbies.
   
   Try some of these ideas to help you get moving – at home, at work or at play.
    
2. Make it a Habit
   It takes about three weeks for something to become a habit, so give yourself the time to create a regular routine. One way is to try to exercise around the same time each day.
   “Exercise can become addictive in a positive way,” said Dr. Carnethon, who is also an American Heart Association volunteer. “Once it becomes a habit, you’ll notice when you aren’t doing something.”
    
3. Build Exercise Into Your LifestyleBe honest with yourself. If you don’t live close to a gym, it’s not going to become a habit for you. Likewise, if you are not a morning person, don’t plan on somehow getting up at the crack of dawn to make a boot camp class.
   
   “The key is building activity into your lifestyle so it is not disruptive,” Dr. Carnethon said.
   
   There are many ways to fit exercise into your life, and it doesn’t mean you have to make a big financial investment.
   
   You can borrow exercise videos from the library or DVR an exercise program. Do weight or resistance training with items around your home (for example, use canned goods as light weights).  Walking is great option, as well. The only investment is a good pair of shoes.
    
4. Do Bouts of Exercise It’s OK to break up your physical activity into smaller segments, Dr. Carnethon said. The American Heart Association recommends 30 minutes a day of exercise most days, but if that sounds overwhelming, try three 10-minute workout sessions.
   
   You could do a quick calisthenics routine when you wake up, take a brief walk after lunch at work and, if you commute with public transportation, get off a stop earlier and walk the rest of the way.
    
5. Keep GoingIf you miss a day or a workout, don’t worry about it. Everybody struggles once in a while. Just make sure you get back at it the next day.
   
   “It doesn’t take too long to get back on track,” Dr. Carnethon said. “It’s easy to make something a habit again. You will see same benefits before. Any little bit you can fit in will show benefits.”

Source: American Heart Association

Eye Safety at Work: Is Everyone's Business

Each day, about 2,000 U.S. workers receive medical treatment because of eye injuries sustained at work.

Workplace injury is a leading cause of eye trauma, vision loss, disability, and blindness, and can interfere with your ability to perform your job and carry out normal activities.

Employers and workers need to be aware of the risks to sight, especially if they work in high-risk occupations.

High-risk occupations include construction, manufacturing, mining, carpentry, auto repair, electrical work, plumbing, welding, and maintenance. The combination of removing or minimizing eye safety hazards and wearing proper eye safety protection can prevent many eye injuries. 

Personal protective eyewear such as safety glasses with side shields, goggles, face shields, and/or welding helmets can protect you from common hazards, including flying fragments, large chips, hot sparks, optical radiation, splashes from molten metals, objects, particles, and glare. The risk of eye injury and the need for preventive measures depend on your job and the conditions in your workplace. 

Employers can take several precautions to make the work environment as safe as possible and help reduce the risk of visual impairment and blindness caused by injury:

• Conduct an eye-hazard assessment
• Remove or reduce all eye hazards where possible
• Provide appropriate safety eye protection for the types of hazards at the worksite
• Require all employees in hazardous situations to wear the appropriate eye protection
• Keep eye protection in good condition and assist workers with attaining the proper fit
• Keep bystanders out of work areas and/or behind protective barriers
• Use caution flags to identify potential hazards such as hanging or protruding objects
• Provide emergency sterile eyewash solutions/stations near hazardous areas
• Post first-aid instructions and information on how to get emergency aid.

Eye safety should receive continuing attention in workplace educational programs. Procedures for handling eye injuries should also be established and reinforced. 

Workers should have a comprehensive dilated eye examination on a regular basis (typically every 2 years) to help ensure good eye health. Maintaining healthy vision is important to avoiding injuries on the job.

Make vision a health priority, because eye safety at work is everyone’s business

From National Eye Institute

More People Walk to Better Health

More than 145 million adults now include walking as part of a physically active

lifestyle. More than 6 in 10 people walk for transportation or for fun, relaxation, or

exercise, or for activities such as walking the dog. The percentage of people who report

walking at least once for 10 minutes or more in the previous week rose from 56% (2005) to

62% (2010).

 

Physical activity helps control weight, but it has other benefits. Physical activity such as walking can help improve health even without weight loss. People who are physically active live longer and have a lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers. Improving spaces and having safe places to walk can help more people become physically active.

 

What Can Be Done?

US government is...

• Working with partners to carry out the National Prevention Strategy to make physical activity easier where people live, work, and play 
• www.healthcare.gov/prevention/ 
• nphpphc/strategy/index.html

• Helping people get active through programs like Community Transformation Grants and Nutrition, Physical Activity, and Obesity state programs, and by working with partners like Safe Routes to Schools
• www.cdc.gov/obesity/
• stateprograms/cdc.html
• www.saferoutespartnership.org/

• Studying ways that communities can make it easy and convenient for people to be
• more active. State and local government can
• Considering walking when creating long-range community plans.
• Consider designing local streets and roadways that are safe for people who walk and other
• road users.
• Consider opportunities to let community residents use local school tracks or gyms after
• classes have finished.
• Make sure existing sidewalks and walking paths are kept in good condition, well lit and
• free of problems such as snow, rocks, trash, and fallen tree limbs.
• Promote walking paths with signs that are easy to read, and route maps that the public can
• easily find and use.

Employers can...

• Create and support walking programs for employees.
• Identify walking paths around or near the work place and promote them with signs
• and route maps.
• Provide places at work to shower or change clothes, when possible.

Individuals can...

• Start a walking group with friends and neighbors.
• Help others walk more safely by driving the speed limit and yielding to people who walk.
• Use crosswalks and crossing signals when crossing streets and not jaywalk.
• Participate in local planning efforts that identify best sites for walking paths and sidewalks.
• Work with parents and schools to encourage children to walk to school where safe

Facts About Skin Cancer

GENERAL

• Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.¹
   
• Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.²
   
• Treatment of nonmelanoma skin cancers increased by nearly 77 percent between 1992 and 2006.¹
   
• Over the past three decades, more people have had skin cancer than all other cancers combined.³
   
• One in five Americans will develop skin cancer in the course of a lifetime.⁵
   
• 13 million white non-Hispanics living in the US at the beginning of 2007 had at least one nonmelanoma skin cancer, typically diagnosed as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).³
   
• Basal cell carcinoma is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the US. BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.⁶
   
• Squamous cell carcinoma is the second most common form of skin cancer. An estimated 700,000 cases of SCC are diagnosed each year in the US.^6,7
   
• The incidence of squamous cell carcinoma has been rising, with increases up to 200 percent over the past three decades in the US.⁵⁴
   
• About 2 percent of squamous cell carcinoma patients – between 3,900 and 8,800 people – died from the disease in the US in 2012.⁵⁴
   
• Between 40 and 50 percent of Americans who live to age 65 will have either BCC or SCC at least once.⁴
   
• Actinic keratosis is the most common precancer; it affects more than 58 million Americans.⁸
   
• Approximately 65 percent of all squamous cell carcinomas and 36 percent of all basal cell carcinomas arise in lesions that previously were diagnosed as actinic keratoses.⁹
   
• About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.¹⁰
   
• Half of all adults report at least one sunburn in the past 12 months.⁴⁷ 

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MELANOMA

• One person dies of melanoma every hour (every 57 minutes).²
   
• An estimated 76,690 new cases of invasive melanoma will be diagnosed in the US in 2013.²
   
• An estimated 9,480 people will die of melanoma in 2013.²
   
• Melanoma accounts for less than five percent of skin cancer cases, but the vast majority of skin cancer deaths.²
   
• Of the seven most common cancers in the US, melanoma is the only one whose incidence is increasing. Between 2000 and 2009, incidence climbed 1.9 percent annually.¹¹
   
• 1 in 50 men and women will be diagnosed with melanoma of the skin during their lifetime.¹¹
   
• In 2009, there were approximately 876,344 men and women alive in the U.S. with a history of melanoma.¹¹
   
• Survival with melanoma increased from 49 percent (1950 – 1954) to 92 percent (1996 – 2003).¹²
   
• About 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.¹³
   
• Melanoma is one of only three cancers with an increasing mortality rate for men, along with liver cancer and esophageal cancer.¹⁴
   
• Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.¹⁵
   
• The vast majority of mutations found in melanoma are caused by ultraviolet radiation.¹⁶
   
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.¹⁷
   
• The overall 5-year survival rate for patients whose melanoma is detected early, before the tumor has spread to regional lymph nodes or other organs, is about 98 percent in the US. The survival rate falls to 62 percent when the disease reaches the lymph nodes, and 15 percent when the disease metastasizes to distant organs.²
   
• A person’s risk for melanoma doubles if he or she has had more than five sunburns.¹⁹
   
• One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.²⁰
   
• Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by 40 percent and the risk of developing melanoma by 50 percent.^{56, 57}

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MEN/WOMEN

• Young men account for 40 percent of melanoma cases, but more than 60 percent of melanoma deaths.⁵³
   
• From ages 15-39, men are 55 percent more likely to die of melanoma than women in the same age group.⁵³
   
• An estimated 45,060 new cases of invasive melanoma in men and 31,630 in women will be diagnosed in the US in 2013.²
   
• An estimated 6,280 men and 3,200 women in the US will die from melanoma in 2013.²
   
• Melanoma is the fifth most common cancer for males and seventh most common for females.²
   
• Five percent of all cancers in men are melanomas; four percent of all cancers in women are melanomas.²
   
• Up until age 40, significantly more women develop melanoma than men (1 in 391 women vs. 1 in 691 men). After age 40, significantly more men develop melanoma than women. Overall, one in 35 men and one in 54 women will develop melanoma in their lifetimes.²
   
• Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.²
   
• The majority of people diagnosed with melanoma are white men over age 50.¹¹
   
• Caucasian men over age 65 have had an 5.1 percent annual increase in melanoma incidence since 1975, the highest annual increase of any gender or age group.²¹
   
• The number of women under age 40 diagnosed with basal cell carcinoma has more than doubled in the last 30 years; the incidence of squamous cell carcinoma among women under age 40 has increased almost 700 percent.²²
   
• Adults over age 40, especially men, have the highest annual exposure to UV.²³

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TANNING

• Ultraviolet radiation (UVR) is a proven human carcinogen.²⁴
   
• The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances. Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.²⁵
   
• Currently tanning beds are regulated by the FDA as Class I medical devices¹⁸, the same designation given elastic bandages and tongue depressors.²⁶
   
• More than 170,000 cases of non-melanoma skin cancer in the US each year are associated with indoor tanning. ⁵⁵
   
• One indoor UV tanning session increases users’ risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent.⁵⁵
   
• The risk of basal cell carcinoma is increased by 73 percent if one tans six times per year.²⁷ 
• Indoor tanners have a 69 percent increased risk of early-onset basal cell carcinoma.²⁸ 
• Approximately 25 percent of early-onset basal cell carcinomas could be avoided if individuals have never tanned indoors.²⁸ 
• Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.²⁴
   
• One minute in the average indoor tanning machine in England is twice as cancer-causing (carcinogenic) as one minute in the midday Mediterranean sun.⁵⁰
   
• Just one indoor tanning session increases users’ chances of developing melanoma by 20 percent, and each additional session during the same year boosts the risk almost another two percent.⁴⁶
   
• Of melanoma cases among 18-to-29-year-olds who had tanned indoors, 76 percent were attributable to tanning bed use.⁴⁸
   
• Indoor tanners have a 69 percent increased risk of early-onset basal cell carcinoma.²⁸
   
• People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent.²⁹
 
• Nearly 30 million people tan indoors in the U.S. every year.³¹ Two to three million of them are teens.³²
   
• The indoor tanning industry has annual estimated revenue of $5 billion.³²
   
• People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.³³
   
• Seventy-one percent of tanning salon patrons are females.³⁴
   
• On an average day, more than one million Americans use tanning salons.³⁵

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ETHNICITY

• The overall 5-year melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.¹⁴
   
• Skin cancer represents approximately two to four percent of all cancers in Asians.³⁶
   
• Skin cancer comprises one to two percent of all cancers in African Americans and Asian Indians. ³⁶
   
• Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.³⁶
   
• Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese Asian and the Japanese.³⁶
   
• Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians.³⁶
   
• Squamous cell carcinomas in African Americans tend to be more aggressive and are associated with a 20-40 percent risk of metastasis (spreading).³⁶
   
• Late-stage melanoma diagnoses are more prevalent among minority patients than Caucasian patients; 52 percent of non-Hispanic black patients and 26 percent of Hispanic patients receive an initial diagnosis of advanced stage melanoma, versus 16 percent of non-Hispanic white patients.³⁷
   
• Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.³⁸
   
• While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.³⁸

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PEDIATRICS

• Pediatric melanoma increased by an average of two percent per year from 1973 to 2009.⁵¹
  
• Melanoma is nine times more common between the ages of 10 and 20 than it is between birth and 10 years.³⁹
   
• Ninety percent of pediatric melanoma cases occur in patients aged 10-19.³⁹
   
• 6.5 percent of pediatric melanomas occur in non-Caucasians, which is a higher percentage than that seen in adults.⁴⁴
   
• Melanoma accounts for up to three percent of all pediatric cancers.⁴⁰
   
• Between 1973 and 2001, melanoma incidence in those under age 20 rose 2.9 percent.⁴¹
   
• Diagnosis and treatment is delayed in up to 40 percent of childhood melanoma cases.⁴⁰

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SKIN AGING

• More than 90 percent of the visible changes commonly attributed to skin aging are caused by the sun.⁴²
   
• Daily sunscreen use by adults under age 55 can reduce skin aging. ⁵²
  
• People who use sunscreen daily show 24 percent less skin aging than those who do not use sunscreen daily.⁵²
  
• Contrary to popular belief, 80 percent of a person’s lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.²³

Lifetime UV Exposure in the United States

Ages	Average Accumulated Exposure*
1-18	22.73 percent
19-40	46.53 percent
41-59	73.7 percent
60-78	100 percent

*Based on a 78 year lifespan
 

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TREATMENT

• In adults 65 or older, melanoma treatment costs total about $249 million annually. About 40 percent of the annual cost for melanoma goes to treating stage IV (advanced) cancers, though they account for only three percent of melanomas.⁴³
   
• The estimated cost of treating melanoma in 2010 was $2.36 billion.⁴⁹
   
• The number of nonmelanoma skin cancers in the Medicare population went up an average of 4.2 percent every year between 1992 and 2006.¹
   
• In 2004, the total direct cost associated with the treatment for nonmelanoma skin cancer was $1.4 billion.⁸

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REFERENCES

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2. American Cancer Society. Cancer Facts & Figures 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed January 31, 2013.
3. Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282.
4. Sun Protection. Cancer Trends Progress Report – 2009/2010 Update. National Cancer Institute. http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2007&chid=71&coid=711&mid.  Accessed November 1, 2010.
5. Robinson, JK. Sun exposure, sun protection, and vitamin D. JAMA 2005; 294:1541-43.
6. Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to The Skin Cancer Foundation. March 31, 2010.
7. Squamous Cell Carcinoma.  American Academy of Dermatology. http://www.aad.org/skin-conditions/dermatology-a-to-z/squamous-cell-carcinoma.  Accessed August 27, 2012
8. The Lewen Group, Inc. The burden of skin diseases 2005. The Society for Investigative Dermatology and The American Academy of Dermatology Association. 2005.
9. Criscione, VD, Weinstock, MA, Naylor, MF, Luque, C, Eide, MJ and Bingham, SF. Actinic keratoses natural history and risk of malignant transformation in the Veterans Affairs Tropical Tretinoin Chemoprevention Trial. Cancer 2009; 115: 2523-2530.
10. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer: Current status. Archives of Dermatology. 1996; 132: 436-442
11. Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesa, MD: National Cancer Institute; http://seer.cancer.gov/csr/1975_2009_pops09/; Accessed August 22, 2012.
12. Ries LAG, Melbert D, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2004. Bethesda, MD: National Cancer Institute; http://seer.cancer.gov/csr/1975_2004/. Accessed January 24, 2011.
13. Parkin DM, Mesher D, P Sasieni. Cancers attributable to solar (ultraviolet) radiation exposure in the UK in 2010. Br J Cancer. 2011; 105:S66-S69.
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15. Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of secondary primary cancers after a diagnosis of melanoma. Arch Dermatol 2010; 146(3):265-272.
16. Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature 2009; 463:191-196.
17. Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. Bethesda, MD: National Cancer Institute; 2006.
18. Felton R. Introduction to FDA’s regulation and classification of tanning lamps. U.S. Food and Drug Administration. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/GeneralandPlasticSurgeryDevicesPanel/UCM211206.pdf. Accessed Sept 3, 2012.
19. Pfahlberg A, Kolmel KF, Gefeller O.  Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. Brit J Dermatol March 2001; 144:3:471.
20. Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Onc 1983; 12:981-6.
21. National Cancer Institute. A snapshot of melanoma. National Cancer Institute. http://www.cancer.gov/aboutnci/servingpeople/snapshots/melanoma.pdf. updated Oct 2011; accessed Aug 27, 2012.
22. Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005; 294(6):681-690.
23. Godar DE, Urbach F, Gasparro FP, Van der Leun JC. UV doses of young adults. Photochem Photobiol 2003; 77(4):453-457.
24. National Toxicology Program. Report on Carcinogens, Twelfth Edition. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. 2011: 429-430. http://ntp.niehs.nih.gov/ntp/roc/twelfth/profiles/UltravioletRadiationRelatedExposures.pdf. Accessed February 12, 2012.
25. El Ghissassi, F. et al., Special report: policy. A review of human carcinogens—part D: radiation. The Lancet 2009; 10(8):751-752.
26. US Food and Drug Administration. Learn if a medical device has been cleared by FDA for marketing. FDA. http://www.fda.gov/MedicalDevices/ResourcesforYou/Consumers/ucm142523.htm.   Accessed October 25, 2010.
27. Zhang M, Qureshi AA, Geller AC, Frazier L, Hunter DJ, Han J. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30(14):1588-93.
28. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. Journal of American Academy of Dermatology. 2011.
29. Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly-exposed population. Cancer Epidem Biomar Prev 2010 June; 19(6):1557-1568.
30. World Health Organization. Sunbeds. World Health Organization. 2010. http://www.who.int/uv/faq/sunbeds/en/index5.html. Accessed October 25, 2010.
31. Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE.  Promotion of frequent tanning sessions by indoor tanning facilities: two studies.  J Am Acad Dermatol 2003; 46:700-5.
32. Demierre MF.  Time for the national legislation of indoor tanning to protect minors.  Arch Dermatol 2003; 139:520-4.
33. Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, and Weinstock MA. Use of tanning devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst 2002; 94:224; doi:10.1093/jnci/94.3.224.
34. Swerdlow AJ, Weinstock MA.  Do tanning lamps cause melanoma? An epidemiologic assessment. J Amer Acad Dermatol 1998; 38:89-98.
35. Spencer JM, Amonette RA. Indoor tanning: Risks, benefits, and future trends. J Am Acad Dermatol 1995; 33:288-98.
36. Gloster HM, Neal K. Skin cancer in skin of color. J Amer Acad Dermatol 2006; 55:741-60.
37. Hu S, Soza-Vento RM, Parker DF, Kirsner RS. Comparison of stage at diagnosis of melanoma among Hispanic, black, and white patients in Miami-Dade County, Florida. Arch Dermatol 2006 Jun; 142(6):704-8.
38. Cress RD, Holly EA.  Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Cause Control 1997; 8:246-52.
39. Lange J, Palis BE, Chang DEC, Soong S, Balch CM. Melanoma in Children and Teenagers: An Analysis of Patients from the National Cancer Data Base. J Clin Oncol 2007; 25:1363-8.
40. Ferrari A, Bono A, Baldi M, et al. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics 2005; 115:649-57.
41. Strous JJ, Fears TR, Tucker MA, Wayne AS. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005; 23:4735-41.
42. Gilchrest BA. Skin and aging process. CRC Press. 1984; 124.
43. Chen C, et al. Economic burden of melanoma in the elderly population. Population-based analysis of the surveillance, epidemiology, and end results (SEER)—Medicare data. Arch Dermatol 2010; 146(3):249-256.
44. Worcester S. Possibility of melanoma in children often ignored. Skin & Allergy News. March 2008.
45. Reference removed.
46. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345:e4757. doi: 10.1136/bmj.e4757 
47. Centers for Disease Control and Prevention. Sunburn and sun protective behaviors among adults aged 18-20 years – United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2012; 61:317-22.
48. Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2010.
49. The National Cancer Institute. The cost of cancer; 2011. http://www.cancer.gov/aboutnci/servingpeople/cancer-statistics/costofcancer
50. Tierney P, Ferguson J, Ibbotson S, et al. Nine out of ten sunbeds in England emit ultraviolet radiation levels that exceed current safety limits. Br J Dermatol 2013; 168:602–08.
51. Wong JR, Harris JK, Rodriguez-Galindo C, Johnson KJ, et al. Incidence of childhood and adolescent melanoma in the United States: 1973–2009. Pediatrics 2013 May; 131(5):846-54.
52. Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Ann Intern Med 2013 June; 158 (11):781-790.
53. Fisher D, Geller A. Disproportionate burden of melanoma mortality in young US men. JAMA Dermatol 2013; 1-2.
54. Karia PS, Han J, Schmults CD. Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. J Am Acad Dermatol 2013 June; 68(6):957-66.
55. Wehner MR, Shive ML, Chren M-M, et al. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012; 345:e5909.
56. Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinoma of the skin: a randomized controlled trial. Lancet 1999; 354(9180):723-729.
57. Green A, Williams G, Logan V, Strutton G. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 2011; 29(3):257-263.

These facts and statistics have been reviewed by David Polsky, MD, Assistant Professor of Dermatology and Pathology, New York University Medical Center and Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ.

The Skin Cancer Foundation, SkinCancer.org, 212 725-5176

Last Updated: October 9, 2013