MUSIC Iskandar: Hello, I'm Dr. John Iskandar,
welcome to CDC's Beyond the Data.
I'm here today with Admiral Boris Lushniak,
Deputy Surgeon General of the United States.
Welcome Boris.
Lushniak: Great.
Great to be here, John Iskandar: So people...even people who may,
may know you from your public roll, may not know
that you're a dermatologist.
From that perspective can you give us some insight
into why skin cancer prevention is,
should be such a high public health priority?
Lushniak: Well certainly.
I've been in the public health service now
for twenty seven years.
And, part of my training is in the field of dermatology.
So I kind of bring in this angle of being a clinician
at the same time as being a public health official.
And from the clinical aspect is realizing that first
and foremost there is an epidemic
of skin cancer out there.
Each and every year we have
over five million cases being diagnosed in this country.
Cost of treatment over eight billion dollars.
And when you talk about the worst types of skin cancer,
the melanoma skin cancers,
we have over sixty five thousand people who are diagnosed each
and every year and nine thousand deaths.
So I've seen that from a clinical aspect
of realizing this is a deadly,
perhaps a maiming disease as well.
And that it is preventable because so much
of the skin cancer that we see in the clinician's office,
in the dermatologist's office comes as a result
of ultra violet radiation exposure.
Iskandar: While you were serving
as Acting Surgeon General you released a call to action
to prevent skin cancer.
Tell us about what is in that
and what action steps that translates into.
Lushniak: Well, I think first
and foremost it's really important to realize
that the Surgeon General's office has multiple tools.
All right, we come out with reports
and perhaps the most famous reports are reports on tobacco.
We in fact, when I was Acting Surgeon General issued the
fiftieth anniversary report for tobacco.
And, and the issue of smoking in this country and its effect
on the public's health.
At the same time, although the numbers are somewhat different
in terms of the impact on society,
certainly as a dermatologist I felt
that we have never really tackled the issue
of skin cancer prevention.
And a call to action, unlike a Surgeon General's report,
is exactly that.
Really, you know precisely looking at those words.
It's a call to action.
It's for us to put out the science
and to say here's what we know about skin cancer.
Here's what we know about skin cancer prevention.
And the call to action is really looking
at all facets of our society.
From the individual level, what can I do
to really emphasize prevention of that skin cancer?
What can local politicians do?
What can industry do?
Right? What can big government do?
It's a call to action
at all those levels including the clinical aspects,
including the scientific aspects, including the research
and surveillance aspects.
So a call to action is really multi focused.
It goes out there and says here's what needs to get done
to prevent skin cancer in this country.
Iskandar: So thinking about some of those groups: individuals,
clinicians, policy makers, what should they be doing
to prevent skin cancer?
Lushniak: Well let's, let's begin at the individual level.
Right? So, at the same time that I kind of say beware
of ultra violet exposure and a lot
of the exposure takes place from sunlight.
Right? I also send out another message and that's go out
and do things with your body.
Go out and be active.
So it's not a mismatch of concepts here.
Right? What I'm not saying is stay indoors
and just don't do anything.
Really, we have the ability for us to turn
into a healthy and fit nation.
And, one way of doing that is, yes, watching what we eat.
But, at the same time it's active living.
It's going and walking outdoors.
It's enjoying the outdoors.
And what I'm telling, true our call to action
to the individual levels, go and enjoy.
But there's ways you can protect yourself from that sun exposure.
And, it's really basic.
It goes back to the ideas prevent tanning
and prevent burning of your skin.
Although tanning often time is looked at as, oh,
a positive cosmetic thing.
You know, how many times have you come back from vacation
and they say hey John man you look so relaxed.
You're tan.
Look at ya'.
Right? Look at you and, but the reality is tanning
by definition is excessive ultra violet radiation exposure.
Now that's a strange sort of combination of words but that
in essence is you've exposed yourself to a known carcinogen.
And, so at the same time that I say go
and enjoy the outdoors but protect yourself.
And, from an individual level it's quite simple.
If there's shade, seek shade.
If you're gonna' be spending time outdoors,
put on a sunscreen.
Right? Put on a sunscreen of at least
of a sun protection factor of fifteen or higher.
Look at it from the perspective of protective clothing.
How can I block my skin from this radiation?
A wide brim hat, sunglasses, and then enjoy time outdoors.
That's at the individual level.
So bring it up a notch.
Learn it at the policy level.
What can we do?
Well, to a large extent it's introducing shade
into our outdoor recreational areas.
You know, how many times we go to, you know,
to see our kids play in outdoor sports.
And, we're sitting in some bleachers.
Little league baseball or other soccer games.
And, yet, we're there baking in the hot sun along with the kids.
Reality is you could easily put up shade structures.
Right? That's policy makers decision
to turn our recreational areas into areas that are protected
from this ultra violet radiation exposure.
From the clinical aspect,
we again work closely with clinicians.
Be aware of the diagnosis of skin cancer.
Be aware that when you're looking
at your patient what things do you need to look for in terms
of the signs and symptoms of skin cancer.
And refer them as necessary or handle them as necessary.
From a bigger scientific aspect,
as we have to increase our ability to do great surveillance
of skin cancers, right now the numbers are all estimates.
We have a good handle on what melanoma numbers are
in this country because those are reportable.
But the other skin cancers: the basal cell cancers,
and the squamous cell cancers,
the non-melanoma cancers are not reportable
and so we really do have to have a more vibrant
surveillance system.
So those are but three of the aspects that we put out there
of saying how we can change our society to be more aware
of this known carcinogen.
Enjoy the outdoors and protect yourself.
The last aspect from a policy perspective is artificial
exposure to ultra violet radiation.
And here, yes, I'm talking about tanning booths.
You know, in reality we have a known carcinogen
that people are paying money for to expose themselves to.
And, what I have to be able to do,
certainly as the Acting Surgeon General and continue to do
as the Deputy Surgeon General is to get the word out.
That in essence these are known carcinogens.
And, we know who's using these tanning booths
for the most part.
They're young women, between the age of fifteen and twenty six
who are out there and who are inducing this tan,
excessive ultra violet exposure, paying for it
and in fact putting themselves at risk.
And, there are policies that are being looked
at from various aspects of state governments, for example,
where we're looking at restricting the use
of these tanning facilities for example for those
under the age of eighteen.
You know, so that we do have warnings out there.
The Food and Drug Administration has looked at these devices
and has put further restrictions on them.
That's another one of these of aspects of kind
of saying we have a known carcinogen we have both natural
exposure through sunlight we have to be aware of
but certainly artificial exposure
through tanning booths need to be taken
into account here as well.
Iskandar: So that's very interesting.
So with indoor tanning, really, that's something
that can be worked at the policy level but people may also have
in their communities, their academic institutions,
their neighborhoods, the ability to have some influence about,
you know, opening of these businesses or, you know,
other factors as well.
Making people aware of the risk that's associated
with this type of voluntary tanning.
Lushniak: Absolutely.
And, I think, I mean there's two aspects to this.
One of which is, yes there's regulatory public health.
There's the ability to actually provide the information.
There's also this aspect from us as public health professionals
to make sure we get the right information out.
You know, I think there's in many circumstances the people
who are using tanning booths really don't quite understand
the risk they're putting themselves at.
And, I think we need to be better
from our public health communication aspect
to get the word out.
Which is, you know, what you're doing there by inducing this,
quote unquote pretty tan, or this lovely tan,
this attractive tan is in fact doing several things.
One of which is putting you at higher risk for skin cancers.
But also in the short run it's put you at higher risk
for wrinkling of the skin.
Right? You think you're gonna' look pretty
for the next few years?
After that you keep doing this the skin toughens up.
It gets thicker.
It gets wrinkled.
You appear older than you should be.
When at the same time your goal was to look better.
Iskandar: It's interesting because these sound
like actually some of the same arguments and strategies
that have proved successful
in helping young people smoke less...
Lushniak: Absolutely.
Iskandar: ...by focusing on these sorts of factors.
So can you, to sum up, can you paint us a picture a future
in which we're doing a much better job
with skin cancer prevention scientifically
and from a policy standpoint.
Lushniak: Well, again, I'm looking at the idea
of encouraging people to be outdoors people.
Right? Of going out and walking with their families.
Right? Getting into the fitness mode.
At the same time you're not being paranoid about sunlight.
But, being aware.
You know, that little Johnny,
that little Mabel get the sunscreen on.
That I put the sunscreen on this morning.
Right? Are we being protecting?
Right? Protecting ourselves, protective of our children,
protecting our children against this exposure.
Right? It's an awareness and it's the implementation of that
at the individual and family level.
Right? That's sort of what we're trying to achieve.
At the same time that our communities are built
around the idea of, for example, being walkable communities.
Safe areas to walk, walkability.
But in the midst of that where we have recreational facilities.
Neighborhood pools.
Places where people are going
to be stationary introduce the concept of shady structures
into the design of those areas.
You know it's so much more pleasant sitting
around the pool.
You get the exercise.
Now that, but when on a hot summer day, you're in shade
as opposed to as many pools are set up,
is nothing but open space.
Right? So it's the idea that we have a society that allows
for these choices to be made.
And, for ultimately the people to have enough information
that they make the right choice.
Am I sitting in the sun?
Or am I choosing the shady area?
From a further policy perspective that's looking
at a regulatory public health approach and how we deal
with tanning beds and the whole industry there is a lot
of similarities, I'll tell you right now between, you know,
what's going on there and what we've dealt
with with tobacco use in this country.
And then, and then finally from a scientific aspect is for us
to be much more robust.
For us to realize what are the preventive strategies that work.
How do we communicate them with people so people do understand
and ultimately make the right choice.
Iskandar: Thank you very much Admiral Lushniak for that call
to action and for the practical steps associated with it.
Lushniak: It's my pleasure, John.
Iskandar: Please join us next time for Beyond The Data.
MUSIC