The Kind of Cancer the Surgeon General Wants You To Care About

The vast majority of skin cancers can be prevented, and yet the numbers in the U.S. keep growing, especially among young people. Recently, Acting Surgeon General Dr. Boris D. Lushniak, himself a dermatologist, released a call to action on skin cancer. TIME Spoke to Dr. Lushniak about what it’s going to take for skin cancer rates to drop in the U.S.

TIME: Why do we need to be proactive about skin cancer now more than ever?

Dr. Lushniak: First of all, we see a lot of cancers decreasing in terms of their rates, but skin cancer is one of those that stands out. In the last 35 years we’ve seen a tripling of the number of cases of melanomas in this country, and it’s the most severe of the skin cancers. And yet, there’s this 200% increase. It really causes alarm, and it’s my view as the acting Surgeon General that it’s a public health crisis we need to react to. On top of that, we have 5.1 million people every year who are being treated for skin cancers in this country. There’s 63,000 cases of melanoma this year, of those, 9,000 people will die of melanoma. That’s one person every hour. The resulting economic impact is $8.1 billion. We know that most skin cancers are preventable, and that’s the reason for this call for action.

TIME: Why is skin cancer on the rise?

Dr. Lushniak: If 90% of all skin cancers are caused by ultraviolet radiation, I have to look at that exposure. That comes in two forms. One is exposure to sunlight and the other is artificial sources, which includes tanning booths. I enjoy the outdoors and spending time in nature. So I need people to do that for the good of their physical and mental health. But at the same time, I need to emphasize the fact that sunlight is a source of that ultraviolet radiation and there are ways people can protect themselves from that sunlight. At the same time, there’s a needless exposure that goes on, and that’s in the tanning booths. It’s a needless, non-necessary exposure, and part of our call to action is to bring in the spotlight the fact that tanning booths are a source of this known carcinogen.

TIME: Is there any cooperation from the indoor tanning industry?

Dr. Lushniak: It’s unclear. At this point we certainly want to have discussions to see what we can do for the betterment of public health. These machines are out there … and I am not sure what we can do at this point. In certain states, there are regulations to not allow people under the age of 18 to have that exposure. At the same time, I have to reach out to industry and make sure they are warning individuals over 18 about this exposure. So, it really is matter of: Do people know what they are being exposed to, and do they understand the health ramifications of that exposure?

TIME: Besides the medical community, what other stakeholders do you want action from?

Dr. Lushniak: When we put out a call to action, we really reach out to all the sectors of our society. We have a public health issues, and we want people to contribute their part to making things better. Examples include employers who have outdoor workers. What can they do to decrease the amount of UV exposure to their workers? It’s about the induction of shady areas, educating their workers and making sure they use protection. It’s hats, sunscreens. We also look at other groups like recreational facilities. I would love to see a continued expansion of shady areas at pools, I would love to see more shady areas at amusement parks as you’re standing in line for roller coasters. At schools, perhaps recess can be during a time of less ultraviolet radiation exposure. Policymakers at the state level can look at its role in regulating the tanning industry.

TIME: Are you a supporter of the Sunscreen Innovation Act? Do you think the FDA’s sunscreen ingredient approval process needs to be revamped?

Dr. Lushniak: Right now sunscreens are available and they have the necessary ingredients, and they have gone through a regulatory process that has proven they are safe for us and that they work. We are not in the midst of a shortage in this country. The ingredients are there and they work. But I am a 21st century guy and I would like to see new ingredients out there and I would love to see improvements of those ingredients.

TIME: How does the U.S. compare to other countries when it comes to skin cancer protection?

Dr. Lushniak: One country that really stands out is Australia. It really had an incredible increase in skin cancers. It was an outdoor-oriented community and because of its placement in terms of being in an area with ozone issues, there was a lot of ultraviolet exposure. They really got aggressive over a decade ago with pushing the idea of protection and getting in shade. We’ve seen incredible results in terms of decreases in skin cancers. They’re an example of where the numbers have propelled them to improve the situation. That’s where I’d love to be as a nation.

TIME: Any obstacles in our way of achieving that?

Dr. Lushniak: When I was a kid, I ran around on beaches and mom and dad did not put sunscreen on me, and I got burned. We are in a society now where people are cognizant of not burning. It’s not perfect, but people are sunbathing without burning. Where we have an issue is that we still live in a society where we thinking tanning is OK. And that it’s a sign of health and leisure. It’s a concept of social norms. We need to look at tanned skinned as damaged skin.

TIME: People are often more concerned about cancers like breast cancer. How does skin cancer stack up?

Dr. Lushniak: We are getting a lot more young people getting diagnosed with melanoma. So the concept of its impact is quite devastating. These are people at the primes of their lives getting diagnosed with this disease. This is a preventable cancer.

TIME: What should people look for in a good sunscreen?

Dr. Lushniak: We recommend broad spectrum, water resistant, that’s over the SPF 15. And this needs to re-applied on a regular basis, every one to two hours and perhaps even more often if you’re sweating or going into the water.