by Cynthia Bartus, MD, and C. William Hanke, MD, MPH
With nearly half a million people finishing a marathon and over one million completing a half-marathon in 2010, distance running has become increasingly popular in the US. Training for distance races requires many hours outdoors; and as the miles rack up, so does sun exposure.
Outdoor athletes’ substantial exposure to the sun’s harmful ultraviolet (UV) radiation increases their risk of developing basal and squamous cell carcinoma, the two most common skin cancers. In addition, marathoners tend to have more small moles and large atypical moles, which are both increased risk factors for melanoma, the deadliest form of skin cancer. Plus, runners’ excessive UV exposure and intensive training can lead to depressed immune systems, which may leave them more susceptible to skin cancer as well.
Hours of running in the sun wearing minimal clothing while sweating profusely make it difficult to stay sun-safe. Cynthia Bartus, MD, and C. William Hanke, MD, MPH, asked elite runners Jackie Dikos and Jeff Galloway about the challenges they face in sun protection. Jeff Galloway (jeffgalloway.com) was a member of the 1972 Olympic team, competing in the 10,000 meter race. He is also the author of over a dozen training books, a race director, and a contributor to Runner’s World magazine. He resides in Atlanta, GA. Jackie Dikos, a mother of two, is a 2:45 marathoner who qualified for the 2008 and 2012 Olympic Team Trials, and is a registered dietician and sports nutritionist at Nutrition Success in Indianapolis, IN. Both Jackie and Jeff have sustained countless hours of sun exposure in the course of their very successful running careers without developing skin cancers.
What do you enjoy most about running?
Jeff Galloway (JG): The sense of freedom, the attitude boost, the burst of vitality, and the improved mental clarity. I prefer to be outdoors, on trails. I like to run in daylight and love the way that sunlight creates patterns with trees and water.
In addition to aesthetic pleasure, trees can also provide shade, which not only offers relief from the heat but significant sun protection for exposed skin.
Jackie Dikos (JD): I really enjoy running with my kids. I push my youngest in a jogging stroller and my older son rides his bike beside me. When my husband is available, we all run together. I protect my 2-year-old with the jogging stroller hood and sunscreen on his legs. My 6-year-old wears a helmet and usually has a good portion of his body covered with a t-shirt, shorts to his knees, and biking gloves.
The stroller hood, bike helmet and clothing all block the sun’s rays. Clothing, in fact, has been shown to be the single most effective form of sun protection. Long sleeves, long pants, UV-blocking sunglasses, and wide-brimmed hats are at the top of the list.
How much time do you spend out in the sun training?
JG: Six hours per week, usually in the afternoon. My schedule is crazy and I must run when I can, so it varies.
JD: I’m out about 12 hours per week. I train most often in the early morning and late afternoon. As a working mom running 70-100 miles a week, I fit running in when I can!
Running in the early morning and late afternoon (before 10 AM and after 4 PM) allows you to train under less intense sunlight.
Describe your experience with sun exposure as a young runner and how you became aware of the sun’s harmful effects.
JG: I wasn’t encouraged to practice sun protection. I did burn once or twice a year. I became more aware of the effects of the sun in the 1970s, and now I don’t spend so much time in the sun.
JD: My parents reminded me about sun protection only when I went swimming, or when I was outside for a prolonged time. My coaches encouraged sunblock use only during long track meets. I did burn occasionally.
I became more concerned when I had children. I heard that kids’ skin is more sun-sensitive, and that by protecting their skin, you decrease their skin cancer risk.
Jackie is correct: One or more blistering sunburns in child hood or adolescence more than double a person’s chances of developing melanoma later in life. Five sunburns in childhood increases lifetime melanoma risk by 80 percent. Sun-protective behaviors, such as wearing sunscreen and proper clothing and accessories, can cut down on the UV exposure kids receive. Infants under six months, whose skin is very sensitive, should be kept out of the sun.
How have you altered your sun protection behavior over the years?
JG: I’m more careful about using sunscreen! I also wear clothing that helps protect me from the sun.
JD: I always wear lotion that includes SPF [sun protection factor, a measure of protection from the sun’s harmful UVB rays] on my face and lips. When I’m swimming or out for longer periods of time, I wear what my kids wear, a sunscreen with an SPF of 50.
For anyone over the age of six months, a broad-spectrum UVA-UVB sun- screen with an SPF of 15 or higher is an important part of anyone’s daily sun protection routine. For more extended sun exposure, The Skin Cancer Foundation now recommends SPFs of 30 or higher.
Dr. Bartus is a graduate of the University of Pennsylvania School of Medicine. She did her dermatology residency training at Emory University, where she served as Chief Resident. She is a marathoner herself, having run 10 marathons to date. She is currently the Mohs Micrographic Surgery/Procedural Dermatology Fellow at the Laser and Skin Surgery Center of Indiana under the mentorship of Dr. C. William Hanke.
Dr. Hanke is the Director of the Laser & Skin Surgery Center of Indiana in Carmel, IN, and Senior Vice President of The Skin Cancer Foundation. He was the first physician in the US to earn triple full professorships in Dermatology, Otolaryngology, Head and Neck Surgery, and Pathology and Laboratory Medicine. He is past President of the American Academy of Dermatology and has served as President of the American Society for Dermatologic Surgery, the American College of Mohs Surgery, the International Society of Cosmetic Laser Surgeons, the International Society for Dermatologic Surgery, and the Association of Academic Dermatologic Surgeons. He has written more than 350 publications, including 91 book chapters and 20 books.