This summer, the American Cancer Society (ACS) has become embroiled in a scandal over its advertising practices. Based upon input from various focus groups, the ACS decided to place ads in 15 national magazines strongly implying that skin cancer is a fatal disease but that these deaths can be prevented by mass screening.

A young woman in the advertisement holds up a picture of a smiling blonde. "My sister accidentally killed herself. She died of skin cancer," reads the headline. The ad cautions: "Left unchecked, skin cancer can be fatal." It urges readers to "use sunscreen, cover up and watch for skin changes."

Much of the public already has an almost obsessive fear of the sun. I have a friend who, even after the liberal use of sun block, a Tilley hat and other protective clothing, will never venture out into direct sunlight. To take a walk with her means to run from the shade of one tree to another. Apparently this kind of fear will drive people to spend serious money. This summer a Canadian company, Solestrom, is even marketing a bikini with a built-in UV meter and an alarm that beeps to tell the wearer when it's time to head for the shade. The cost is $189 - if you can find it. At the moment it's sold out. (To me, it looks more like a high-tech chastity belt than an anticancer device.)

"There's so much concern about sun exposure and skin cancer that we saw the demand and designed something to be safe for the wearer," Solestrom spokeswoman Emily Garassa said.

The attractive blonde in the ACS ad is not really a real skin cancer victim at all, but a professional model. Another dubious aspect of this so-called "public service announcement" was that it was paid for by the sunscreen manufacturer, Neutrogena, which stands to profit directly from any ensuing skin cancer panic. The relationship between ACS and its corporate sponsor is reciprocal: Neutrogena pays for the ACS ad campaign and in return gets to place the ACS logo on its products. But Neutrogena's sponsorship of the skin cancer ads was not disclosed to the public until it was revealed in the New York Times.

The manipulation of public opinion through advertising is nothing new for the ACS. After all, ACS became the nation's wealthiest charity largely through its public relations acumen. The man who primarily created the modern-day ACS was Albert Lasker, the celebrated Madison Avenue executive still remembered for his devastatingly effective cigarette advertising campaigns incorporating the slogan, "Reach for a Lucky [cigarette] instead of a sweet."

But isn't the ACS correct in telling the public that skin cancer is deadly? Well, yes - and no. There are certainly some kinds of skin cancer, such as malignant melanoma, that are deadly. But deadly forms of skin cancer comprise only 6 percent of the overall number of skin cancer cases in the US each year: the remaining 94 percent are not life-threatening. The trouble is that most people have only a fuzzy grasp of the difference between the rare but potentially fatal forms of skin cancer, like melanoma, and the much more common non-fatal kinds that afflict more than a million Americans each year.

These more common types of skin cancer, basal cell and squamous cell skin tumors, are not even counted as cancer in the National Cancer Institute's SEER database, which gathers epidemiological information on the incidence and survival of cancer in the US. Basal cell and squamous cell skin cancers rarely metastasize, are almost always readily cured, and very rarely ever kill anyone. I encountered a single fatal case 17 years ago, and it was so exceptional that I have remembered it all these years. (As a confirmation of this, try typing the phrase "deadly squamous cell skin cancer" or "deadly basal cell skin cancer" into the Google search engine (include the quotation marks). You will get exactly zero hits.)

Thus, to warn the general public that sun exposure will cause deadly skin cancers that are cutting people down in their prime - without distinguishing between rare melanomas and the much more common, garden variety, curable skin tumors - seems deliberately aimed at creating public anxiety, if not panic.

To be concluded, with references, next week.

--Ralph W. Moss, Ph.D.

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