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Loraine Marrett, PhD Senior Scientist Enjoy the sun safely: protect your skin, protect your eyes The updated Recommended Core Content for Sun Safety Messages in Canada April 27, 2017 Maria Chu, MA, MISt Senior Policy Specialist
Outline Goals Context The consensus process Development of consensus for selected topics The Recommended Core Content What s new? Conclusions/Next steps 2
Goals Core content for stakeholders to tailor Updates based on current science Starting point towards integrated sun awareness campaigns for the public to prevent skin cancer and eye diseases 3
Context
Consensus last achieved in 1994 5
National Sun Surveys 1996 and 2006 Canadians increased time in sun without improving use of protection 2 or more hours per day in the sun during leisure time Spends < 30 minutes per day in the sun during leisure time 1996 2006 Always / often seeks shade Always / often wears protective clothing Always / often wears sunscreen Always / often wears sunglasses 0 10 20 30 40 50 60 70 80 90 100 Percent Of those spending 30 or more minutes per day in the sun during leisure time Source: National Skin Cancer Prevention Committee. Exposure to and protection from the sun in Canada: a report based on the 2006 Second National Sun Survey. Toronto: Canadian Partnership Against Cancer, 2010. 6
Melanoma cases projected to increase 72.1% increase in average annual new cases of melanoma in Canada, 2028 32 versus 2003 07 7
Need for consistent information Conflicting cancer prevention information: Increases pessimism, indecision and inaction Reduces perceived preventability of cancer 8
The consensus process
Ontario Sun Safety Working Group Reviewed existing recommendations Drafted recommendation statements in consultation with scientific panel and external review Focus tested draft with public health stakeholders Convened National Steering Committee Revised draft recommendation statements 10
Topics addressed in consensus process Time in the sun / UVR science Clothing Benefits of being outdoors Sunscreen Shade Eye health and protection Vitamin D Tanning equipment 11
The National Consensus Process Communications expert engaged Pre-workshop survey on revised draft Workshop (March 12, 2015) Post-workshop survey Consensus achieved Report published in the Canadian Journal of Public Health 12
Consensus process participants 28 organizations representing: Dermatology, pediatrics, eye health, public health and family medicine Health Canada, Public Health Agency of Canada, Environment Canada Provincial cancer agencies Canadian Cancer Society divisions 13
Development of consensus for selected topics
Pre-workshop survey agreements Time in the sun / UVR science Clothing Benefits of being outdoors Sunscreen Shade Eye health and protection Vitamin D Tanning equipment 15
Topics focused on at the workshop Time in the sun / UVR science Eye health and protection Sunscreen Vitamin D 16
Pre-workshop Primary Statements: Time in sun If outdoors for more than 15 minutes when the UV Index is 3 or higher (in general, from 11 am to 3 pm between March and October), cover up as much as possible. The UV Index can be 3 or higher even when it s cloudy. If you can, check the daily forecast for the UV Index before heading outside and protect accordingly. Whenever possible, plan outdoor activities for before 11 am or after 3 pm, between March and October. 17
UV Index Plots Due to copyright restrictions, please contact presenter for figure 18
Time in the sun Peak hours Centred on 1:00 p.m. DST despite differences in solar noon within time zones (vs 1-4 pm peak previously) for simplicity New measurements suggest UV Index variation across Canada is not very large Peak months Modified Mar to Oct Apr to Sep Balance caution with public acceptability 19
Time in the sun More than 15 minutes Most people don t burn until >15 minutes with UVI 3+ Recognize vitamin D production in skin Deleted - concern that people will spend longer without protection Cloud cover Partly cloudy skies can magnify UVR Benefit of being outdoors, e.g. physical activity Demoted planning around peak hours to additional recommendation to not discourage outdoor activities Tag line Enjoy the sun safely 20
Final primary recommendation: Time in the sun When the UV Index is 3 or higher, protect your skin as much as possible. In general, the UV Index in Canada can be 3 or higher from 11 a.m. to 3 p.m. between April and September, even when it s cloudy. 21
Post-workshop survey High degree of acceptance and support 22
The Recommended Core Content
The Recommended Core Content 1. Key Facts 2. Primary Recommended Protective Actions 3. Additional Recommended Protective Actions 4. Tips for Implementing Primary Protective Actions 24
Key Facts Sources and harms of ultraviolet (UV) radiation Skin cancer prevalence, incidence and preventability Knowing when UV radiation is harmful to the skin and to the eyes 25
Primary Recommended Protective Actions Enjoy the sun safely: Protect your skin, protect your eyes 26
Primary Recommended Protective Actions Protect your skin When the UV Index is 3 or higher, protect your skin as much as possible. In general, the UV Index in Canada can be 3 or higher from 11 a.m. to 3 p.m. between April and September, even when it s cloudy. Seek shade or bring your own (e.g., an umbrella). Wear clothing and a wide-brimmed hat that cover as much skin as possible, as appropriate to the activity and weather. Use sunscreen labelled broad spectrum and waterresistant with a sun protection factor (SPF) of at least 30, on skin not covered by clothing. Apply sunscreen generously and reapply when required. 27
Primary Recommended Protective Actions Don t use UV tanning equipment or deliberately try to get a suntan, and avoid getting a sunburn. Protect your eyes Wear sunglasses or prescription eyeglasses with UVprotective lenses. Wear a wide-brimmed hat for added eye protection. 28
Additional Recommended Protective Actions Check the daily forecast for the UV Index and protect your skin accordingly. Between April and September, whenever possible, plan outdoor activities for before 11 a.m. or after 3 p.m. Use sources of vitamin D that are safer than UVR exposure, e.g., dietary sources, including fortified foods, and vitamin D supplements. Intentional UVR exposure to meet vitamin D requirements is not recommended. 29
Vitamin D Full evidence review for vitamin D was out of scope for current work Referred to existing national recommendation from Health Canada, which assumes minimal sun exposure Health Canada Vitamin D and Calcium: Updated Dietary Reference Intakes: Currently, there is a lack of information about whether sun exposure may be experienced without increasing risk of cancer. 30
Tips for Implementing Primary Protective Actions Describes details to look for when selecting: Shade Clothing Sunscreen Eye protection 31
Tips for Implementing Primary Protective Actions Example sunscreen: Sunscreen should be used on exposed skin not covered by protective clothing. Consider using sunscreen for the lips (e.g., sunscreen lip balm) as well. Use a generous amount of sunscreen (e.g., the average adult requires approximately two to three tablespoons of lotion-formulated sunscreen to cover the whole body, and a teaspoon to cover the face and neck). Reapply after swimming, strenuous exercise, or towelling off. Use sunscreen that says on the label: Broad spectrum SPF 30 or higher Water resistant Sunscreen comes in a variety of formulations. Find one that suits you best and apply it properly with thorough coverage. Sunscreen formulations that you find easier to apply thoroughly will be more effective. 32
Tips for Implementing Primary Protective Actions Example eye protection: Because UVR that is harmful to the eyes is present in the sun s rays all year round and throughout the day, eye protection may be required even when skin protection is not. Eye protection is required around highly reflective environments, such as snow, sand and water. The best UV protection for eyes is offered by close-fitting wraparound sunglasses. Look for sunglasses or prescription lenses with full UVA and UVB protection. Examples of appropriate labels are UV400 or 100% UV protection. Contact lenses, even those with UV protection, do not provide full coverage for the eye and the skin around the eye. 33
What s new? Shorter peak hours, supporting acceptability (11 to 4 11 to 3) Sunscreen: increased SPF to 30 Acknowledge benefit of being outdoors Greater prominence for eye protection Statement on vitamin D 34
More details Link to full text 35
Conclusions Many and varied organizations, including several outside the usual sun safety community, engaged in the full consensus process High level of agreement on the final statements, and some uptake 36
Organizations that have updated messages Examples: Ontario Sun Safety Working Group Environment Canada Canadian Cancer Society Health Canada (in process) Alberta Health Services Cancer Care Ontario 37
Additional resource Toolkit Co-brandable presentations and factsheets in English and French: Link 38
Next steps Longer report on the supporting evidence Core content only need tailoring for different audiences Increased national-level coordination around sun safety messaging 39
Acknowledgements - Team Loraine Marrett & Maria Chu, Cancer Care Ontario John Atkinson, Rob Nuttall & Gillian Bromfield, Canadian Cancer Society Larry Hershfield & Cheryl Rosen, University of Toronto & other members of the National Steering Committee for Consensus on Content for Sun Safety Messages Sun Safety Message Content Scientific Committee Ontario Sun Safety Working Group Participants in the National Consensus Workshop for Sun Safety Message Core Content in Canada 40
Acknowledgements Funding support Canadian Institutes of Health Research Cancer Care Ontario Canadian Cancer Society (National and Ontario Divisions) Canadian Dermatology Association Saskatchewan Cancer Agency / Sun Smart Saskatchewan 41
Thank you! Questions?
Contact information Loraine Marrett loraine.marrett@cancercare.on.ca Maria Chu maria.chu@cancercare.on.ca Prevention and Cancer Control Cancer Care Ontario 43
1994 Statements: Time in sun Plan your outdoor activity to take place before 11:00 a.m. or after 4:00 p.m., when sun rays are the weakest. Consult the UV Index for daily forecasts of UVR intensity. Practice sun protection behaviours when you are outdoors between April through September, between 11:00 a.m. and 4:00 p.m. every day. 44
1994 Statements: Sunscreen Sunscreens should be used in conjunction with shade, clothing, hats and sunglasses, not instead of them. Sunscreens are not intended to lengthen the time spent in the sun, but to reduce exposure and provide some protection from sunburn when people need to be in the sun. Use a sunscreen with SPF #15 or higher that has both UVA and UVB protection. 45
Sunscreen Confirmed at workshop: SPF 30 (vs 15 previously) because people tend to not apply enough Reapplication every 2 hours necessary only if swimming, exercising or towelling off No recommendation to apply 2 hours before exposure to avoid having people not apply at all Sunscreen less effective than shade and clothing and should appear lower in priority Shorter and more specific statement than in 1994 46
Pre-workshop primary statement: Sunscreen Use broad spectrum, water-resistant sunscreen with an SPF of at least 30 on skin not covered by clothing. Apply sunscreen generously. 47
1994 Statement: Eye protection Wear sunglasses that absorb UVR. 48
Pre-workshop statements: Eye protection Wear sunglasses whenever it is bright outside all year round. This will also improve visual comfort. 49
Eye protection De-emphasized need for eye protection all year round to a tip for implementing Current strength of evidence does not support potentially unrealistic use of eye protection Added prescription eyeglasses with UVprotective lenses and broad-brimmed hat 50
1994 Statement: Vitamin D None 51
Pre-workshop statements: Vitamin D If outdoors for more than 15 minutes when the UV Index is 3 or higher (in general, from 11 am to 3 pm between March and October), cover up as much as possible. Use sources of vitamin D that are safer than UVR exposure. Health Canada recommends dietary sources of vitamin D, particularly fortified foods, and vitamin D supplements. While science has established UVR as the main risk factor for skin cancer, it is currently unclear whether there is a safe level of sun exposure to maintain vitamin D levels while not materially increasing the risk of skin cancer. 52