Can Schools Play Role in Skin Cancer Prevention?

Meg Watson, MPH

Today we are speaking with Meg Watson, MPH, an epidemiologist in the division of cancer prevention and control at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia, who specializes in skin cancer. Watson and colleagues at the CDC recently published an opinion piece in JAMA Dermatology suggesting that schools could have a major role in the prevention of skin cancer.

- Interviewed by Anna Azvolinsky 

Cancer Network: What do we know about sun exposure in childhood and the risk of developing skin cancer later in life?

Meg Watson: We know that sun exposure damages the DNA in our skin cells and that that damage adds up over our lifetimes. So kids, of course, have many more decades of life to live and to accumulate that damage. Only one bad sunburn in childhood can increase risk of melanoma decades later, in adulthood. And kids are outdoors a lot, they need to run around and be playing outside, but they can be sun safe while doing so. Childhood is a good time to be establishing those sun safety habits, and those habits can really extend well beyond school and into their adult life.

Cancer Network: Could you lay out the rationale as to why schools are a good venue for educating kids about skin cancer prevention?

Meg Watson: Kids spend so much time in school. It’s a place where they spend hours and hours and years and years. So we have good strong evidence to know that education programs that increase knowledge about and attitudes toward sun exposure and sun protection can be effective. And these programs don’t solely have to focus on skin cancer prevention or sun safety, they can really connect back to other topics in the school curriculum like the science of ultraviolet (UV) radiation or physical education. But in addition to educating kids, there is another piece that I think is really important to talk about and that is changes to policies and the school environment. Those kinds of changes are just as important as telling kids about skin cancer prevention.

Schools have a responsibility to protect kids while they are at school. And we know that it is pretty common for schools to promote healthy through lots of other kinds of policies. So, no tobacco policies are pretty common these days, some schools have taken out soda machines or snack machines, promoting fruits and vegetables is increasingly common, and we want kids to run around and to have recess because we know that that is effective in keeping them healthy and happy in school. But while they are outside, schools can do some things to protect kids from too much sun: trees and shade structures in play areas can reduce sun exposure. Of course shade structures are expensive, so if a school is planning for a new facility, that is something they want to keep in mind. If the school is already built and they don't have the luxury of building shade from the beginning, it’s a little harder because those shade structures cost money, so there are free changes that schools can make like switching outdoor time to a more shaded area outside or an earlier time of day when the UV is less intense. So there are other kinds of school policies that can help protect children while they are at school.

I was lucky enough to be able to travel to Australia this past winter and it was summer there and I saw lots of school children walking around in their uniforms which included floppy wide-rimmed hats and those cute floppy brims that protect the kids’ faces, necks, and ears. Here in the United States, school dress codes more often prohibit hats and sunglasses because they can be distracting and because people have concerns about gangs and things like that, so schools allowing and encouraging kids to wear floppy hats outside is one thing that schools can do to encourage sun protection and changing norms around sun safety. Another kind of policy that schools often have is they prohibit kids from bringing over the counter drugs to school or prohibit them from carrying these drugs while they are on school grounds. They have to give over the counter meds to the school nurse, and the nurse has to administer them. Sunscreens are considered over the counter drugs, so that means that with these kinds of policies, children can’t bring or apply their own sunscreen at school. This has been a topic of discussion lately. Recently, the state of Texas passed a law that exempted sunscreen from these policies, and it allows kids to carry sunscreens at school. California and Oregon already has this policy in place and this is something that is not forcing the kids to wear sunscreen, its just allowing them to carry it if they would like to.

Cancer Network: So you mentioned a few barriers in the United States for better sun protection in schools. Are there other potential barriers to education on sun protection in schools or barriers to messaging and education on sun protection?

Meg Watson: I think the biggest barrier to education on sun protection in schools is just competing priorities that people tend to expect. A lot of schools have more and more things on the agenda that teachers are supposed to be covering. And so for this reason, it might be easier to fold in sun safety with other topics like we talked about-folding it into physical education or science.

Skin cancer also has a general reputation of not being a big deal because it can be cut off easily. The truth is that basal and squamous cell carcinomas can be quite disfiguring and can cause some serious health issues, and melanoma can be deadly. Melanoma is also one of the most common types of cancers among young adults and adolescents so it can be a problem for younger people. So taking skin cancer seriously has been a barrier. And again, this is a preventable cancer. Skin cancer is one cancer that we know how to prevent, and we don’t have that kind of information for a lot of other cancers.

Cancer Network: Are there efforts from the CDC or other groups of researchers facilitating these skin cancer prevention strategies you discussed?

Meg Watson: The CDC’s role is primarily to describe an issue and try to address it. When it comes to schools, changes in policies and programs most often happen at the state and local levels and so to support changes and describe the issue, we collect cancer data. And from that data, we know that over 70,000 melanomas are diagnosed every year and over 9,000 people die from melanoma in the United States each year. We also collect information on health-related practices in schools across the country through a survey called School Health Policies and Practices Surve (SHPPS). And from SHPPS data, we learned that in 2014, two out of three schools reported having some kind of sun safety education program in their curriculum. However, most schools did not report having sun safety policies in place. So, another thing that the CDC does is we fund state-comprehensive cancer control programs to help support those kinds of activities in communities. The funding goes out to the state and then the state is able to distribute the funds locally. We also provide complimentary materials and tools online. For example, a shade planning for American schools tool kit that you can download for free, and a fact sheet about how schools can support sun safety and that includes links to lots of other programs. One example is the Sun Life program, which was originally developed by the Environmental Protection Agency and is now run by the Environmental Education Foundation. That is a free, evidence-based sun safety program for kindergarten up to 8^th grade.

Cancer Network: Thank you so much for joining us today.

Meg Watson: Thank you.