Reducing Skin Cancer

A chorus of “Whoas!” and “Wows!” filled the classroom, as a group of wide-eyed middle-schoolers peered at the eight once-colorless beads they had strung on a pipe cleaner not long before. After smearing sunscreen on four of the beads and running outside with their creation, exposing it to the sun for just 20 seconds, the students filed back in, finding their four unprotected orbs had taken on red and purple hues. Levi Bonnell, one of their hands-on activity leaders, explained that the special beads were solar-radiation sensitive, just like their skin.

“I’m going to start wearing sunscreen now,” some students vowed, as they observed the stark contrast between the bare beads and the sunscreen-slathered beads, which remained colorless.

Recalling his experience with the pilot CU SunSmart program in Aurora’s East and North middle schools last spring, Bonnell, now a researcher at the University of Vermont, says it was inspirational and rewarding. “I think if I had participated in this project during my master degree program, I might have switched courses in my career to more of a nonprofit or public-health side,” said Bonnell, a University of Colorado Master of Public Health graduate.

Slaying a State Spector

As skin cancer rates continue a relentless 30-year climb, striking at younger ages and outnumbering all other cancers combined, changing Colorado youth behavior is critical, says Myles Cockburn, the CU Cancer Center’s program co-leader for prevention and control who launched the SunSmart program. This year, Cockburn’s students could reach as many as 55 classrooms, including some Denver public schools.

“Colorado has among the highest skin-cancer rates in the country,” says Cockburn, who developed a SunSmart program in Los Angeles while working at USC, which he hopes to partner with the CU program. High altitude and outdoor-recreation rates contribute to the elevated incidence, which is as much as 30 percent higher than the national average, according to the Colorado Melanoma Foundation. “So it’s obviously a good place to do skin-cancer prevention,” Cockburn says.

By combining service-learning and research, the program’s ultimate goal is to prove that changing youth behavior reduces rates of skin cancer. Meanwhile, CU students advance research, learn public education skills, serve as role models for youth pondering health careers, and, most importantly, teach sun safety in the surrounding university community.

Targeting Colorado’s Youth

There are many types of skin cancer. Although their serious-ness varies, all require treatment. On one end of the spectrum, basal cell carcinoma grows slowly and is rarely fatal. The most common form of skin cancer, basal cell might be looked at as an unpleasant and expensive nuisance, Cockburn says. On the other end of the spectrum is melanoma, the deadliest of skin cancers, which becomes rapidly invasive when left untreated.

“Melanomas metastasize quickly to your liver, your lungs and your brain, as quickly as any other nasty cancer out there,” Cockburn says. Colorado ranks among the highest in the nation for death risk from skin cancer, and a clear link exists between UV exposure during youth and melanoma in adulthood.

“We don’t really understand the biology that well, but I think that part of it is that your skin is still developing when you are young, up until age 10 or 12. So if you bombard it with radiation, which is what ultraviolet is, when it’s developing, you are much more likely to end up with a melanoma in adulthood,” Cockburn says. Simple math explains another factor: The more sunburns over the course of a life, the higher the risk of skin cancer, he says.

Focusing on pre-teens, who are old enough to understand the science and still young enough to listen, could help with a “really disturbing” increase in skin cancer in the early-20 age group, Cockburn says. Tanning behaviors, especially tanning bed use, are largely to blame for the young-adult cases, he says.

Diversifying the Message

Although skin-cancer rates are much higher in the white population, Hispanic and African-Americans, who outnumber white students in the Aurora school district, are also seeing increased rates of skin cancer. What’s worse, possibly because of lack of awareness and lack of access to healthcare, the darker-skinned populations are more likely to die from it, Cockburn says.

“Our students need to be able to understand that even though we have more melanin in our skin because we’re African-American, it doesn’t mean that we are not able to get skin cancer,” says Fayette Augillard, college and career success coordinator for Aurora Public Schools, referring to the pigment responsible for skin darkening. “Being able to relay that to their parents is also important,” says Augillard, who says the SunSmart program works well with North and East middle schools, which have a health-career focus.

Cockburn hopes more parents will get the message, as research suggests parent engagement goes a long way toward shaping youth behavior. Toward this goal, the program’s CU student participants plan more handouts and homework this year. East Middle School teacher John Wolner says the addition of homework could have big implications for his students’ families. “I don’t think parents think about it either,” he says, adding that many of his students come from homes with multiple children and extended family members, and many parents work outside. “If everybody were educated, the skin-cancer chances would be lower.”

CU students participating in SunSmart have their work cut out for them. Cockburn and his L.A. colleagues found during their research that upwards of 70 percent of students reported having a sunburn in the past year, while fewer than 20 percent routinely used preventive measures, such as sunscreen. While a four-year observation with pre-and post-surveys of the young students found knowledge and behaviors did change for some, much room for improvement remains, he says.

But Bonnell, whose best friend growing up lost his mother to melanoma four months after diagnosis, says it’s a challenge worth pursuing. “It’s a devastating disease,” he says. “And kids don’t understand that choices they make as kids, in terms of skin protection, can ultimately affect them later on in life. They’re a great group to target. And they’re learning science and having fun, too.”