HEALTH / There is something new under the sun: Even in Britain, as weather forecasts now warn, the sun's rays can cause cancer. The tanning time-bomb is exploding in 1,800 deaths a year, reports Annabel Ferriman

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THIS IS the tale of two women - Julie and Jacqueline. Born in the late Fifties within a year of each other - one in east London and the other in Essex - they lived remarkably similar lives. After leaving school, they both became cashiers - one in a supermarket and one in a betting shop - and they both got married and had two children.

Like many other young couples in the Thatcher years, they took advantage of cheap package holidays and soaked up the sun in France, Italy, Majorca and Tunisia. They came back from holiday with beautiful tans, glowing with apparent fitness and health.

Like many other young women of their age, they also had innocent-looking moles - in Julie's case on her face and in Jacqueline's case on her chest. But unlike most of their young friends, they experienced the trauma of seeing these apparently harmless blemishes turn into the most dangerous form of skin cancer - malignant melanoma.

And this is where their stories diverge - for Jaqueline caught hers in time and had it removed before it had spread, while Julie's was removed too late. Jaqueline is still alive and looking after her family, but Julie is dead. She would have been 35 in September.

Jacqueline began to notice some changes in her mole, just before Christmas, 1991. 'I used to get a terrible itching on my chest whenever I got out of the bath. I used to scratch myself until it was red raw. My mother would say: 'Why don't you make and appointment to go to the doctor's?' But I never took any notice.

'Then all of a sudden, the mole started to change. It went rough to the touch and it had a sore on it. I went to my GP, who got me an appointment within two weeks at the London Hospital, in Whitechapel. The doctor at the clinic said that she thought it was cancerous, and rather than do a biopsy that day and have me back for the resu1t, she wanted the surgeon to do the operation that afternoon.'

Jacqueline, who now lives in Newbury Park, Essex, says: 'I had heard of skin cancer but never in a million years did I think it could happen to me. I was lucky because the doctors caught it in time. Now I go for a check-up every three months, and they have told me that there is only a 2 per cent chance that it might return.'

Julie was not so lucky. When she was pregnant with her second child, Nicky, the small beauty spot on the side of her face began to grow. By the time her son was born, it was quite large and she wanted it removed for cosmetic reasons. But she had a baby on her hands and delayed going to her doctor.

When she did finally go, about nine months later, her GP, after several more delays, referred her to St John's Hospital for Skin Diseases (which is now part of St Thomas's Hospital, London) where the doctors removed the mole.

A year later, it reappeared and this time it was itchy. She went back to her GP, who immediately referred her to Oldchurch Hospital, where the doctors diagnosed cancer and removed the mole the same day. Unfortunately, it was too late. The cancer had already spread.

Julie, who lived in Dagenham, Essex, developed secondary tumours in her brain and went blind. She was treated with the experimental drug Interleukin-2, which temporarily restored her sight, so she was able to see her children once more. But it was a short reprieve. In September 1990, at the age of 31, she died. Her children, Hayley and Nicky, were only 12 and six years old respectively.

Julie Hart and Jacqueline Young are just two victims of a growing problem. More than 40,000 people are diagnosed each year in Britain with skin cancer and about a tenth of these (4,500) have the most dangerous form - malignant melanoma - which, if not caught early enough, is almost invariably fatal. The most common types of the disease, basal carcinoma and squamous cell carcinoma, are usually curable, though they can be disfiguring if not diagnosed and treated early. A total of 1,800 a year die from cancer of the skin, more than 1,300 of them from melanoma.

The reason for the increase - a 150 per cent rise in cases of malignant melanoma since 1974 - cannot yet be attributed to the depletion in the ozone layer. It has more to do with our sunbathing habits, according to Rona MacKie, professor of dermatology at Glasgow University. 'In this country, we just do not understand how dangerous strong sunlight can be. People like to blame the rise in skin cancer on the hole in the ozone layer. But this is not true. People need to take responsibility for the care of their own skin and that of their children,' she says.

MacKie faces an uphill struggle in changing attitudes because most people cannot believe that a tan is anything but healthy. 'Part of the problem is that there is a long time lag between when the skin is damaged and when cancer develops,' she says. 'It can take between 10 and 20 years for the effects to be seen.' Added to that, people see skin cancer as a problem for hot countries, such as Australia, and do not realise that radiation levels can reach the same intensity in damp, cloudy Britain, when the summer arrives, as in the southern Mediterranean - but just not for as many hours a day.

Such is the scepticism of the average Brit that howls of derision greeted the announcement by the Meteorological Office earlier this year that it would issue radiation warnings during summer weekends and outdoor sports events, such as Wimbledon and golfing championships, as their opposite numbers already did in Canada. The Department of Health welcomed the idea because skin cancer is now the second most common form of cancer in Britain, after lung cancer. The department's aim, spelt out in its Health of the Nation white paper, is to halt the year-on-year increase in the incidence of skin cancer by the year 2005. .

So this weekend, we will see the Met Office's new system in operation, for only the second time this year - the first time being the May Bank Holiday at the beginning of the month. The weather map will contain unfamiliar figures, such as 20 minutes, 30 minutes and 40 minutes, forecasting how long it will take someone with a typical British skin to burn.

It is important to give warnings on the days when most people get caught out - when the sun is strong, but there is a north wind blowing, so people do not feel unpleasantly hot. 'On such days, people's in-built systems are not working,' says Malcolm Lee, the Met Office's environment consultancy manager.

We might also hear a warning about 'the wrong sort of cloud'. Little, white, fluffy clouds are killers, apparently. 'Cloud can usually cut out at least 70 per cent of ultra-violet radiation, but if you get the wrong sort of cloud, the cumulus cloud, far from making the intensity less, it can act like a mirror and increase the radiation,' Lee adds.

Clothing manufacturers are also doing their bit. A British company, Raw Clothing, is piloting a new system for labelling clothes to show which fabrics protect best against harmful UV light. Dark coloured, tightly woven fabrics are safer than light-coloured, loosely woven garments. The new labels, developed by the Nationa1 Radiologica1 Protection Board (NRPB), will carry protection factor numbers, from 0-30, similar to those displayed on suntanning creams and lotions.

This summer, too, the Health Education Council, Boots and the Pharmaceutical Society are all running high-profile campaigns promoting 'safe sun'.

But despite the good work that is done by so many health educators and enlightened companies, habits are proving hard to change. All the evidence suggests that despite the constant warnings, the 'brown is beautiful' message still persists - witness the large expanses of brown flesh in women's fashion magazines at this time of year.

Worried by people's slavish devotion to tanning, the Health Education Authority commissioned research to discover why people should still want a tan when it has been shown to be dangerous. The replies suggest that it will be many years before the 'pale and interesting look' catches on. 'Corpses are white. You think of dead people,' was the comment of one 17-year-old. 'People who sit indoors are white, weedy people with no energy,' said another. 'White legs looks disgusting,' said a third.

Not all doctors are discouraged, however. Dr John Hawk, consultant dermatologist at St Thomas's Hospital, London, thinks there is hope yet. 'Look at how long it took for the smoking message to get across. Just as you do not think it is glamorous anymore to see someone hanging round on street corners with a cigarette in their hand, soon you will not think it is glamorous to be brown. Your response will be: 'What an idiot'.'

While the doctors' first message is prevention - 'Do not stay in the sun too long, especially in the middle of the day and do cover up' - their second message is early detection. If skin cancer is caught early, the chances of a cure are excellent, with 93 per cent living more than five years.

Those most at risk are fair-skinned people, especially those with red hair and freckles, who are not normally exposed to the sun but who have been exposed to sudden blasts of sun on holiday or who have suffered several burns as a child. The key symptom to look out for is any change to the skin surface. If a pigmented spot appears that was not there before, or if there is a change in a pre-existing mole - if it gets darker, paler or changes shape, itches or bleeds - you should see a doctor, they say.

The twin themes of prevention and early detection are essential if we are to reduce the death rate from skin cancer, according to Professor MacKie, because no treatment for advanced melanoma is very effective and so-called vaccines (which are really types of treatment for people who already have the disease) are at a very early stage of development.

'At the moment, if the tumour is adequately removed and it is thin, nothing more is done. Where the cancer returns or has spread, there is no proven successful method of treatment, so most people are entered into drug trials, in which their treatment is monitored.'

There are about nine vaccines being developed at - among other places - Glasgow, Newcastle in Australia and Philadelphia. They are made from part of the patient's own tumour, called tumour antigens. These tumour cells are injected into the patient and, it is hoped, provoke an immune response and produce antibodies which then attack the tumour.

At the Thomas Jefferson University, Philadelphia, doctors have produced a vaccine formed from the patient's own de-activated tumour cells, coupled with a chemical compound. In a study of 47 patients, with malignant melanoma which had spread to the lymph nodes, 60 per cent were disease-free after three years, compared with only 20 per cent of those who had not been given the vaccine.

At Glasgow University, dermatologists are testing a vaccine known as GD3. These antigens are produced in greater quantities by melanoma tumours than by normal cells. By giving patients a purified form of these antigens, it is hoped that they will produce antibodies to their tumours.

All these vaccines are very much at the experimental stage, however. For the time being at least, doctors agree that the emphasis must be on prevention, rather than cure. I will know that people are changing their attitude and things are improving, when, on my family's return from our annual trip to Florida, instead of everyone greeting my husband with the words: 'My goodness, aren't you wonderfully brown,' as he usually is, they greet me with the words: 'My goodness, aren't you wonderfully white,' which I usually am.-


A checklist to identify malignant melanoma

ITCH: This symptom is common to all melanomas, but early melanomas are not painful.

SIZE: Most melanomas have reached 1cm before they are recognised, whereas most benign moles are smaller. Larger moles, however, can be of the congenital type, which some people are born with or which develop shortly after birth; these are no cause for concern.

INCREASING SIZE: If a mole is growing in someone over 35 years old, it is likely to be melanoma, because benign moles tend not to grow after that age. In the teens or twenties, new moles are quite likely to appear and grow.

SHAPE: Most melanomas have an irregular outline, sometimes with a notch in them.

COLOUR VARIATION: The majority show a lot of pigment variation and speckling.

INFLAMMATION: Many early melanomas have a red inflammatory flare around the edge.

CRUSTING OR BLEEDING: Slight oozing, causing crusting, is very common. Adults often first seek help when this oozing causes clothing to stick to the skin.

If four out of seven features on this checklist, drawn up by Professor MacKie of Glasgow University, are present, then the diagnosis is positive in more than 90 per cent of cases.

(Photographs omitted)