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Melanoma can be deadly. But experts say it’s easy to protect your skin and catch it early

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Across the country, the days are getting warmer, and soon you may be digging out your straw hat and reaching for last summer’s bottle of sunscreen.

But did you know that melanoma experts recommend wearing sunscreen 365 days a year?

“The first thing I did this morning was get up in the dark and put on my sunscreen,” said Dr. Julia Carroll, a dermatologist in Toronto.

Carroll said she doesn’t bother checking the weather first, because ultraviolet, or UV rays — the main risk factor for melanoma — can harm your skin no matter the season.

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“It’s the [ultraviolet] B levels that go up and down, and ultraviolet A levels are the ones that go deep in and can damage the DNA,” Carroll told Dr. Brian Goldman, host of CBC’s The Dose.

Melanoma is a type of skin cancer that occurs in our melanocytes, the cells in our skin that make pigment.

UV rays from either the sun or from tanning beds damage the melanocytes, said Dr. Elaine McWhirter, a medical oncologist at the Juravinski Cancer Centre in Hamilton and associate professor at McMaster University.

“Their inability to repair that damage to the DNA is what leads to overgrowth and tumours,” said McWhirter.

Rates of melanoma are going up in Canada, but experts say this type of skin cancer is highly preventable if you protect yourself from sun exposure and check your skin for irregular moles.

Who is most at risk?

If you have fair skin that burns easily, many freckles or moles, or you’ve had more than two blistering sunburns before the age of 20, you are at higher risk for melanoma, say experts.

Simon Blakesley was diagnosed with melanoma in 2015. He believes he developed it from many years of sun exposure as a child growing up in southern Ontario.

“We ran around outside, got thoroughly sunburned and then in the evening, sprayed with pain-relieving kinds of things or rubbed with butter where it was really badly burned,” said Blakesley, who now lives in Whitehorse and is a retired educator.

“There was really no understanding or awareness about the longer term effects of sun exposure.”

After Blakesley had his melanoma removed and learned more about the risk factors, he talked about it with his three older brothers and his father.

His brothers got checked, but his dad refused.

“Being the youngest, I think he thought ‘Ah, I don’t need to listen to you,'” said Blakesley.

But about a year later, “he started developing lesions on his back, which once they started bleeding, he knew that he had to go see a doctor.”

Simon Blakesley of Whitehorse, right, with his dad, Peter Blakesley, in 2018. (Tim Blakesley)

Blakesley’s father was diagnosed with an aggressive melanoma that had already spread to his lymph nodes.

After a number of painful surgeries, he chose medical assistance in dying in 2018, said Blakesley.

“The melanoma was so aggressive, so disfiguring, so demoralizing. It basically destroyed his outer body on his back and his shoulder,” he said.

Blakesley said after his father’s death, he felt guilty about not pushing his father to go to the doctor sooner.

He now tries to spread the message about melanoma as often as he can.

“I don’t think people have taken it seriously enough because it’s often seen as a cosmetic or a vanity kind of thing,” he said.

“I know through my own first-hand experience … how melanoma can basically deconstruct your body.”

Early detection is key

Experts say since melanoma shows up on the skin, it is easy to spot it early and get it treated before it spreads.

“What happens with a melanoma is when you first start to see those changes, it grows along the surface of the skin,” said Carroll.

“Over time it starts to grow down and that’s when it then metastasizes and can become deadly.”

Experts recommend putting a reminder in your calendar to check your skin for irregular spots or moles once a month.

You can follow the ABC’s of mole evaluation, said Carroll and McWhirter.

  • A — Asymmetry. The mole should be symmetrical, or a uniform shape.
  • B — Border. The mole should have smooth borders, not jagged or fuzzy edges.
  • C — Colour. The mole should be a uniform brown colour. Melanomas are often black, blue, reddish or bleeding.
  • D — Diameter. The mole should be no more than 6 mm across, or about the size of a pencil eraser.
  • E — Evolution and Elevation. Melanoma often changes over time, unlike a benign mole which will stay the same. Melanomas can also rise above the surface of the skin.
  • F — Family. If you have a grouping or family of moles, they should all look the same. Melanomas tend to stand out.

If you spot any of these signs while checking your moles, you should see a dermatologist, experts say.

How can you protect yourself from the sun?

Along with checking his skin regularly for moles and seeing a dermatologist yearly, Blakesley now takes a very different approach to sun protection.

He works as an aviation photographer and often spends all day outside.

“I always wear full cover. I’m always wearing a hat. Any exposed skin, it’s always a minimum 30 SPF,” said Blakesley.

Experts say there are three key strategies for sun protection:

  • Avoid peak hours.
  • Cover up as much as you can.
  • Wear a high SPF sunscreen.

Peak hours for sun exposure are 10 a.m. to 4 p.m., said McWhirter, so try your best to plan outdoor activities earlier or later in the day.

“But we have to be practical. Our summers are short, people like to get outside,” she said.

A woman puts sunscreen on a child's nose at the beach.
If you’re outside, reapply sunscreen every two hours or after swimming or sweating, experts say. (wavebreakmedia/Shutterstock)

That’s why she recommends SPF-based clothing, which have a weave that blocks UV rays, and a wide-brimmed hat.

If you are outside during the middle of the day, Carroll recommends seeking shade, covering up, and of course, applying sunscreen.

Which sunscreen is the best?

Both Carroll and McWhirter said the most important thing to look for in a sunscreen — beyond an SPF of at least 30 — is a product you like.

“The best sunscreen is the one you’re willing to wear. And there are sprays, there are lotions, there are sticks, there are powders,” said Carroll.

It’s key to reapply every two hours when you’re outside, or after you sweat or go swimming.

“Putting that on once in the morning and being out for the day is insufficient,” said McWhirter.

 

P.E.I. has the highest rates of skin cancer in Canada

 

Dr. Ivan Litvinov speaks with CBC News: Compass host Steve Bruce about the ‘culture shift’ that needs to take place to keep people safe in the sun.

If it’s not a sunny day, you might assume you don’t need sunscreen, but that’s a myth, added McWhirter.

“If it’s cloudy you might not feel that same heat in your skin but unfortunately the UV rays are still getting through,” she said.

If you have darker skin you can still get melanoma, experts say, but it is more often a type that’s not caused by sun exposure.

It’s called acral lentiginous melanoma, found on areas of the skin that aren’t typically exposed to sun, and scientists aren’t yet sure what causes it.

“Bottoms of the feet, between the toes, skin cancers in those areas are more common in people with more darkly pigmented skin,” said Carroll.

Experts recommend that everyone wear sunscreen, regardless of the shade of your skin.

What happens after a melanoma diagnosis?

Dermatologists like Carroll, along with primary health care providers, are on the front lines of identifying and diagnosing melanoma.

If Carroll sees something suspicious on a patient’s skin, she gets it biopsied, she said.

If the mole turns out to be a melanoma, Carroll said she tells her patients it’s not the worst news.

“It would be worse if it was on you and we didn’t know. So now at least we know and we can move forward and do something about it,” she said.

Some dermatologists do surgery in their offices to remove melanomas, and surgical oncologists also perform surgery, depending on the severity, said Carroll.

A medical oncologist such as McWhirter sees patients whose melanoma is at least stage 2, meaning it has started to spread below the skin.

Advancements in melanoma treatments

Over the past 15 years, there has been a significant evolution in the treatments offered for melanoma, said McWhirter.

Chemotherapy doesn’t work for melanoma, she said, but there are two broad types of treatments: immunotherapy, which is intravenous, and molecularly targeted therapy, which comes in pill form.

Before these newer types of treatments were offered, only about 25 per cent of patients with stage 4 melanoma would live for one year after being diagnosed, she said.

“Now when we offer treatments, we’re seeing in the range of about 50 per cent of patients alive and well five years after starting treatment,” said McWhirter.

It’s rewarding to be in a field with such considerable improvement in treatments, she said.

“They’re not perfect. Patients do still die of metastatic melanoma, but we’ve really made significant and important gains in the lives of our patients who are dealing with melanoma.”

 

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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