Research shows that athletes are at a higher risk of skin cancers than the rest of the population. It’s time to take action, says Peta Bee

Be honest, how often do you slap on sunscreen before you train?

According to statistics from a major new campaign that aims to raise awareness of skin cancer among athletes, the likelihood is not often enough. All forms of skin cancer are on the rise in the UK. Protecting skin with high-factor sun creams even on the relatively dull days of a British summer, right through to at least the end of September, can render the disease more preventable. Yet sun-worshippers aren’t the only ones to flout basic sun sense rules – athletes are notoriously bad at covering up.

Last summer, a survey by the Sun Safety Code, a campaign backed by more than 80 sports governing bodies including England Athletics, revealed that 40% of young athletes still turn up for sessions without any sun protection whatsoever. It’s a habit, says Dr Bav Shergill, a spokesperson for the British Association of Dermatologists, that predisposes them to skin cancer in later life.

“It’s a gross misconception that sunbathing is the biggest risk,” Dr Shergill says. “Outdoor sports are right up there and athletes need to protect even when the sun isn’t blazing in the sky.”

Research

A study by dermatologists at the Medical University of Graz in Austria looked at 210 marathon runners and a control group of 210 non-runners who were matched for age and sex. Results, published in the Archives of Dermatology, revealed that the runners had more solar lentigines, or age spots caused by sun exposure, and more skin lesions suggestive of basal cell (BCC) and squamous cell carcinomas, skin cancers that are malignant and can spread, but are less aggressive than the more deadly melanoma. No cases of melanoma were found, but 24 of the marathon group and 14 of the non-runners were referred for surgery to remove other cancers detected.

Training time

By far the most obvious reason for the increased risk, the researchers suggested, was the fact that the runners spent so long outdoors during the day. Around one third ran up to 25 miles a week, nearly half ran 25 to 45 miles and the remained put in considerably more weekly mileage.

Most ran in shorts and vests that left their legs, arms, shoulders and upper back exposed for much of the year and throughout spring and summer. Yet only around half of the runners confessed to using sunscreen regularly.

Unsurprisingly, those who spent the most time training had the highest rates of skin lesions.

“A major issue is over-exposure to direct and indirect sunlight. Strong rays can cause skin irritations and burning in the short-term but can also lead to more serious problems in later life,” says Peter Stanley, head of coaching at England Athletics.

Who’s who

Statistics of high-profile athletes who have been affected by skin cancer reads like a who’s who of the sports world and, along with footballers, tennis players and golfers, many are athletes. Leanda Cave, the Welsh triathlete who was the 2012 world ironman and half-ironman champion, announced on Twitter in February 2013 that she had a BCC as “a direct result of too much sun exposure”. And Deena Kastor, the US marathon runner who won bronze at the 2004 Olympics, was also diagnosed with the disease in 2001 when two skin biopsies tested positive as BCCs.

She has since had “25 external stitches for BCC and early stages of melanoma”. Being in the sun was an unavoidable occupational hazard, Kastor said, as her training regimen meant she was “outside for four to five hours a day while living and training at 8000 feet altitude”.

Greater risk

Researchers think intense training exacerbates athletes’ risks of skin damage. In the study on marathon runners, it was suggested that their training regime may have left them more vulnerable by lowering their immunity. Although not precisely understood, some experts think that the kind of physical trauma resulting from hard workouts can trigger the release of cytokines, proteins that might limit the ability of the immune system to fight potential cancers.

Sweat can make matters worse. Any kind of moisture on the skin reduces damaging UV light to shorter wavelengths that are more easily absorbed. This lowers the minimal erythema dose, the lowest ultraviolet (UV) light exposure or level of radiation needed to turn the skin a risky shade of pink, making sunburn more likely.

A study last year showed that 40% of BCCs appear around the nose. “That is partly because the nose protrudes from the face, making it more exposed,” Dr Shergill says. “But also because sweat runs down the nose removing any sunscreen that is applied.”

Take action

Dermatologists advise wearing sunscreen from April through to late September and on all bright days at other times of the year, applying factor 50 half an hour before an outdoor session. Look for a brand with UVA and UVB protection and children’s sunscreens do the job for adults and are cheaper because no VAT is added. Clothing with integrated SPF is not worth the expense.

“An SPF 15 fabric only provides protection for around 15 minutes in strong sunlight,” Dr Shergill says. “Remember that sunscreen starts to lose effectiveness at about the two-hour mark, sooner if you are sweating heavily. Stick formulations are good to carry with you.”

» See oksunsafetycode.com