Amy Behrhorst, Aspen Valley Hospital’s Employee Health & Wellness provider, is passionate about skin cancer prevention.
In addition to wellness and health coaching, Amy conducts annual skin checks for employees. We spoke with her on National Sunscreen Protection Day to urge people to think about the best ways to protect their skin when they are outside.
An Aspen native, Amy is a physician assistant who has been with the Hospital since 1996. She has also worked in primary care and emergency medicine.
1. How does sunscreen and sunblock actually work to protect people who use it?
Sunscreen and sunblock are two different things, which is important to clarify. Sunscreen is a chemical that screens the sun’s rays — some get in and some are blocked out. Sunscreen actually absorbs the harmful UV radiation before it penetrates the skin. Sunblock sits on top of the skin and reflects the sun and UV rays.
Sunblocks like zinc oxide and titanium dioxide are the most effective in blocking ultraviolet radiation because they truly don’t let any rays in. Both zinc- and titanium-based sunblock have been determined to be safe and effective by the FDA.
The term broad spectrum means that the product is targeted to minimize exposure to both types of ultraviolet radiation, UVA and UVB. UVA is a type of radiation that causes aging. It breaks down layers deep in our skin. That’s what causes us to wrinkle, where as UVB is the type that causes skin cancer.
2. What’s the difference between SPF 30 and SPF 50 and SPF 80?
“SPF” stands for Sun Protection Factor. It indicates protection against UVB, the burning rays. A higher SPF factor technically means you can be in the sun for longer periods of time. Using a sunscreen that’s SPF 30 theoretically means it would take you 30 times longer to burn than if you weren’t using sunscreen at all. That’s not how it really works, but is how it was originally defined.
A higher SPF is going to protect you for longer in the sun, but it’s really a micro-difference between SPF 30 and SPF 50 in terms of percentage of rays that come through. Under ideal conditions you would want to use a higher SPF to be in the sun longer, with the caveat that we’re all supposed to be reapplying sunscreen, no matter its strength, every two hours, and more frequently if you’re swimming or sweating.
3. Is there a minimum level in terms of getting real protection from the sun?
At our elevation, an SPF 30. Anything less than that is more of a tanning lotion versus a sunscreen. I recommend that people don’t go above SPF 50 because all you’re buying is more chemicals for what really is a miniscule gain in terms of percentage of protection.
4. What should people think about when choosing a sunscreen to purchase?
I would say the number one question people should ask themselves is: Are they going to use it? The best sunscreen you can have is the one you’re going to use. If you have sensitive skin, you want to look for something that doesn’t harm sensitive skin. If you don’t like the white appearance of a zinc or titanium dioxide sunblock, then I recommend using a high SPF sunscreen.
In particular, you want to avoid sunscreens with oxybenzone. It is believed to be quite carcinogenic and has been banned for years in Europe, where its possible effects as an endocrine disrupter are being studied. It is still used in the United States in some sunscreens.
5. What are the best practices with sunscreen — if you’re outside all day, or swimming at a pool or the beach?
It’s recommended you apply sunscreen 20 minutes before you go out. Reapply every two hours, and more frequently if you’re swimming or sweating a lot.
Be sure and apply sunscreen or sunblock on cloudy days, which is something people don’t always think about. The UV rays can still penetrate on cloudy days, so people think they are not getting any sun when in fact they are, particularly the UVA rays that cause aging and skin damage over time.
Also, people typically apply too little sunscreen. It’s recommended you use one ounce for your whole body, which is equal to a shot glass. If you think about a shot glass full, that’s a lot.
6. What can you tell people about the chemicals and minerals used in sunscreens?
I prefer combination sunblock and sunscreen, which you can find. That way you’re getting the UV block with things like titanium and zinc, but you’re also getting UV reflection that comes with the sunscreens, so you’re using everything possible in your toolkit.
The other thing is if people are going to the beach or lakes, you want to look for “reef-safe” sunscreen, because some of the chemicals in sunscreens are detrimental to the water we swim in — fish species and coral can be badly affected. Oxybenzone, which I mentioned above, is one of the chemicals that harm coral reefs.
I generally look for that label, because if it’s not safe for the reefs, I don’t want it on my body either. Most reef-safe sunscreens are chemically safer for us as well.
7. What are some of the most common concerns people express, and how much should they really worry?
Some people say that sunscreen is worse for you than exposure to the sun. That is an absolute myth. Here at elevation, Pitkin and Eagle counties have some of the highest rates of skin cancer in Colorado, in part because we’re closer to the sun. We also tend to recreate more outside which over time can be detrimental to our skin’s health, so it’s important to protect yourself.
Our skin is our largest organ, so if you smear something all over your body, you’re probably going to absorb some of it. Some of the chemicals in sunscreens can be dangerous, so it’s important to be aware.
8. What are the recommendations for people who have had skin cancer in the past?
People should protect themselves as much as they can. They definitely want to avoid the peak sun between 10 a.m. and 2 p.m.
I am a huge fan of SPF clothing. There’s so much available now compared to what there used to be. You can buy shirts and hats that are SPF 30 or SPF 50. The difference between regular clothing and SPF clothing is the tighter weave of the fabric. So there is much less penetration of UV rays through to the skin with SPF shirts and hats than with other clothing.
I personally wear SPF shirts as much as possible when I’m outside, because I don’t like being slimed with sunscreen all day. Plus, you don’t have to reapply.
Any other thoughts?
Don’t forget your lips! A lot of people will go out and bike or hike all day long and forget that their lips are exposed skin as well. Lip cancers are not uncommon here in the Roaring Fork Valley. Same rules apply, a high-quality SPF 30-or-above sunscreen.