Compressed, the ozone measures only 3mm, no thicker than the skin of a grapefruit. This protective shield, billions of years in the making, has been damaged in less than fifty, in large part, due to the breakdown of chlorofluorocarbons (CFCs) as they reach the upper atmosphere and upset the fragile balance of molecules.
Developed in the 1930s, CFCs were used in everything from aerosol cans to air-conditioners and refrigerators, among many other goods. On the surface, they seemed harmless. But as they make their 3-year journey upward, CFCs break down into chlorine, bromine, and triflouroacetic acid (TFA) - substances that eat away at our radiation shield. One chlorine atom can destroy up to 100,000 ozone molecules.
Since the 1960s, the worldwide averages show ozone depletion at a rate of between 5 and 7 percent. Once this shield is damaged the earth and everything on it is exposed to dangerous levels of radiation. Both UVA and UVB rays have been proven to damage both humans and other life form. If you think the ozone doesn’t matter or it’s not that bad, think again. UVB rays have been proven to alter DNA cells in people and other animals, and while these cells generally repair naturally, it only takes one or two rogue cells to cause lethal malignant melanoma, among other potential threats. Even plants, with contained cell wells, have shown significant damage after exposure to UVB. Long-term studies of several generations of plants showed a recombining and mutating of genetic DNA material in the seedlings that carried from one generation of plant to the next. Not a promising sign for the future.
Further, other plants and crops, aquatic life, and the developmental stages of fish and other life forms in shallow water show signs of radiation damage. UV rays penetrate tens of meters deep into the ocean. Most significantly, UVB has seriously depleted the ocean’s phytoplankton – the basis of the aquatic food chain. So it follows that those creatures that feed on phytoplankton will be depleted, and the sequence chain is set in action. Other, perhaps more disturbing, studies show ozone-related damage observed in the developmental stage (and embryonic form) of frog larvae, star fish, sea urchins, coral, and other sea-life, as well as ill-effects on animals similar to those found in humans. Scientists predict that even a small change in the ozone could have a profound effect on the animals that depend on these for sustenance. As noted, we are already seeing reduced fish and crop yields.
In 1985, a British survey team made an astonishing discovery; a hole in the ozone over Antarctica at the South Pole is 2.5 times the size of Europe. Regional studies of the area show disturbing trends. There are reported UV storms, occurring especially at the poles. These chaotic, unpredictable storms, allow a DNA-damaging amount of radiation to penetrate that exceeds that of summer in San Diego, showing a 60 percent reduction in ozone during the Antarctic spring.
The statistics are frightening: 7% ozone depletion significantly raises the incidence of illness of all kinds. It causes a 3-4 percent increase in cataracts, non-melanoma skin cancers, and melanoma. Chronic exposure to ozone and pollutants significantly raises immune system problems, and rates of deadly infection and disease. Even a 1% depletion in the ozone, increases melanoma rates anywhere from 3 to 7 percent every year. When ozone depletes at a rate of 5 percent, skin cancer rates soar exponentially.
Unlike other skin cancers which usually develop over long-term sun exposure, melanoma is likely to be caused by only one or two bad burns in a lifetime. Generally, these are sunburns that blister and are severely red. It is most often seen in green-eyed, freckled, light skinned individuals of Northern European and in fair-complected immigrants to sunnier climates.
***
I am an immigrant. When I moved from North London to America, I had long auburn hair, skin so pale it was transparent and light hazel eyes. There is no beach in North London and our family trips were usually to Scotland where the land is wet and cold and rocky. The beaches I remember as a child are of mud and overcast days and wrapping a towel around me to stay warm. I built mud-castles, I played under over-cast skies, protected and dejected.
The day I left my country it was, considerately, overcast. These were the grey skies of my homeland. They suited my introverted temperament, my mood. We boarded a Pan-Am jet and, seven hours later, touched down in the land of sun and big cars. Every summer, my new step-father took my brother and me to the beach at Ocean City, Maryland, where the temperature regularly reaches 102 on your average summer day. I spent hours riding the waves to shore with my brother, the sun-screen my mother so delicately applied, spirited away by strong waves. I emerged from the beach blonder, pink-cheeked, be-freckled.
My white skin had never seen the sun and it reddened fast. A couple of times, it blistered across my shoulders, nose, and chest leaving scars I would have for years. All of this from playing in the ocean, from building sandcastles, from riding the waves joyously. But while I played, my body and my DNA began to fight. Despite “Best of the British”, my body was never ready for this American sun. Never mind. I used Solarcaine. I saw a doctor. I peeled for over a month. I got over it. Or so I thought.
***
Though malignant melanoma is far less common than other types of skin cancer, the rates are still alarming. The ACS estimates that in the year 2000, about 47,700 new cases of melanoma will be diagnosed. Since 1973, the rate of melanoma has soared from 5.7 percent to 13.8 percent and mortality rates have increased 44 percent. Melanoma accounts for about 4 percent of all skin cancer cases, but 79 percent of skin-cancer deaths.
There is no doubt that UV damages DNA. In melanoma tumors, doctors routinely find DNA damage and altered gene structure. In most cases, when the body burns, it is able to fight the damage. But all it takes for cancer to begin is for one cell to go unrepaired. Unrepaired, and then, as it turns out, altered by UVB, as findings of melanoma tumors have shown genetic abnormalities within the DNA sequence. Over time, this cell may develop into a pre-cancerous cell or into dysplasia, the stages before melanoma. All doctors and the ACS recommend that any “spots on the skin that are changing in size, shape, or color, should be evaluated promptly.”
***
I have thousands of freckles and little moles. They are my constellations. I have the big dipper on my right thigh, a matching butterfly pattern on both legs, somewhere the Plaedies and Orion. They have been with me through riding lessons, high school track. Lovers have either loved or hated them… usually loved, and so I too learned to make my peace.
***
I am in the bath reading a magazine. They have photographs of moles alongside an article about skin-cancer. The model they have chosen to illustrate the piece is fair. She has hazel eyes and freckles. One photo is of a dark, oddly shaped mole. It looks like the one on my right shin, only much larger, more misshapen. Still, it is dark as a coffee bean like mine. I’ll go to the doctor. No big deal. They just take skin cancer off and then you’re free! I call the doctor, tell her about the mole. “Do not cancel!” she tells me. She knows me too well. I promise her I won’t. I don’t.
A week later, I go. The doctor surgically removes the mole and a small margin. I’ll go back in a few weeks to get my stitches removed. This is no big deal, and though I’m sorry to see my favorite mole go, I’ve congratulate myself on doing the responsible thing. I drive home and don’t think about it again.
***
While you may be thinking what does phytoplankton depletion, DNA mutations, and lethal cancer, have to do with me, just remember that this radiation is the same one that hits you every day of the year, even on overcast days in February. In fact, it is this ‘incidental’ daily, exposure that proves to be the biggest threat. When we run to the shop without sunscreen, talk a stroll on a sunny day, the times we sit in our car – summer and winter – with radiation glaring through the windshield.
There is also what they call “ozone down here”; highly polluted areas, city smog in areas of congested traffic that are causing more fatal asthma attacks. Synthetic chemical production has increased 3000 percent since 1940. Live in any industrialized city and you’ve probably seen the weather man warn of “Ozone Alert Days”; days when we are told to “stay inside.” It’s dangerous to go outside. Think about that for a minute.
In Brooklyn, childhood asthma rates have tripled and the infant mortality rate is now comparable to Estonia, Bulgaria, and the Czech Republic. A 1993 New York Department of Public Health Study indicated that there, childhood cancers are 22 times the national average ; all from “pollution down there.”
The effects on people are clear. Damage from UV radiation and subsequent environmental damage causes the following conditions, among others; eye abnormalities, immune-system weakening (which particularly affects children), increased infectious diseases like malaria, dengue, certain meningitis viruses, and more. Moreover, the climatic changes brought about by ozone depletion see an increase in various fungi and pollen spores contributing to asthmatic conditions, particularly among children and the elderly.
***
According to the American Cancer Society, melanoma usually appears on the lower legs of light skinned females.
***
The doctor closes the door and asks the nurse to leave. It’s a sunny day and I’m happy, in a strappy dress and sandals. She says there was a problem with my mole. She says it was melanoma. I think: okay, but you took it off, and look down at the small scar on my right lower shin. She explains it’s not that simple. That I need more surgery. Then she says the word “serious”, then “cancer”. I have cancer. They have found a deep and very aggressive melanoma.
I am whisked down to nuclear medicine and my leg is injected with a dye. A big panel scans my leg. At first, there are only dots, then big oblong shapes light up the screen in one area. “What are those?” I ask. The technician says he doesn’t know. The doctor will tell me.
My surgeon, David Lautz, is a kind and quiet man. He dresses like a secret agent in nifty, peg-leg suits. He explains “the pathology” of my mole. Then he says there may be ‘lymph node involvement’. I am in another world. These words mean nothing to me; all I know is that they are serious. He says I may need a skin graft and I think, but it was just a tiny mole! Smaller than Cindy Crawford’s mole. I hear his words: probably chemotherapy, Dana Farber, prognosis. I hear but I don’t hear. He tells me they are going to remove lymph nodes from my groin. I will be in the hospital for a “while”. I leave, and despite everything, feel strangely calm, until I get outside and it is then that I realize I am not the same person anymore. I am a cancer patient. It is stamped in indelible ink on my forehead.
When I get to my car, I break down. I kick the inside panel (while I still can). I am a crazy woman, alone in her car in a parking space in the pouring rain with the world crashing down all around her. I call a friend and say the word for the first time, “Cancer,” and I can hear the fear in his voice too. It is July 18th, 2000.
***
In the week before my surgery, I read everything I can find about melanoma. I still don’t think it can kill me, until I read that it accounts for 79% of all skin cancer deaths and is one of the most aggressive cancers there is, and mine is particularly aggressive. I learn that approximately 8,000 people will die from melanoma in 2000. I learn that I may or may not be one of them.
A pamphlet from the ACS tells me people with “light skin, blonde or red hair and who freckle easily are at especially high risk.” Yes, I think, I know. I learn that mutant DNA changes that are found in melanomas can be inherited, so I wonder about every sunburn my blonde mother and father ever had.
The ACS pamphlet has tips for “Sun Safety.” They warn that while sunscreen reduces UV exposure, people tend to stay out longer because they feel protected. They tell me that not all sunscreens are the same. I need one with UVA and UVB of at least 30 SPF. They say wear a broad-brimmed hat. I learn the word “wide-excision, which means they will keep taking from my leg until the ‘margins’ are cancer free. I learn about sentinel node biopsy; how they will dissect my lymph nodes. I also learn that there is little evidence that even chemotherapy will help people with melanoma live longer, that early detection is key. It was a mole, smaller than the size of a pencil eraser.
I stop reading. It’s my excuse not to feel; to intellectualize, and I can’t help but feel. My husband holds me while I cry. His eyes water and red.
***
It is July 28th. I am lying on a hospital gurney and the have injected a medicine into my IV that makes everything seem okay. I feel ‘just fine.’ I see my secret agent surgeon behind his blue mask. I seek out his eyes through the haze. Then a nice man sitting next to me gives me more medicine and I want to laugh; he asks me to count. I get to two.
***
Ian and Mark are standing at the end of the bed. I am in a hospital room and the pain is intolerable. I’ve had meningitis, and this is worse. Ian hands me a black cord with a red button, “Try this,” he says, and pushes the button. I keep pushing. Waves of relief begin to wash over me and I am on a raft at sea, floating, and Ian and Mark seem far, far away. Soon a nurse comes to check my dressing. It is the first time any of us see my leg. There is a huge chunk missing, like a shark bite. It has angry black-Frankenstein like stitches running the length of it – about ten inches. I am deformed. I cry for the lost part of my leg, I cry because this isn’t fair, I cry because I feel sorry for myself.
Later, my mum rings. “I’m dying of freckles,” I sob into the phone, and then the absurdity of the statement makes us laugh. The rest of the hospital is a twilight-blur.
***
At home, I am under the care of a nurse and later, a physical therapist who will teach me how to walk again. I am a child. My two incisions have gotten a serious infection, so at home, I have an IV next to my bed that drips antibiotics into my veins. Mark and I learn to change the IV three or four times a day. We become expert. One nurse tells me about all the melanoma patients she has had that have died; she is convinced I too will die. I’m not sure, but I am scared. I take Demerol and oxycontin and life becomes a blur. I know I need the medicine when the pain comes back. These drugs become my protectants; my hired thugs; they keep pain away – the mafia of the drug world, and I am grateful for them.
After a few weeks, I meet my physical therapist. Amazingly, she is from the same small town in Scotland as my family. She makes me twist my ankle, try to move my toes, but the pain shoots like an electrical bolt (later I learn I will have permanent nerve damage and pain in this leg.) “You have work through it,” she says in that familiar brogue that has rang through my whole life. In time, she has me on the garden path using a walker with wheels. I’ve been in my wheelchair for months now. My leg won’t do what I want it to do. I really do have to learn how to walk again.
“It’s time for this to go…” she says one day and points to my wheelchair. “But…” I begin to protest. But she won’t have it. It’s symbolic of giving up to hold on to it. I am afraid without it, but consent to put it in a corner.
One day over tea she tells me that she lost her fiancé to melanoma. She shows me his photo. He is on a boat off of Scotland, in the bright sun. He has ginger hair, green eyes, and freckles. She cries, and I use my good leg to support myself and make us more tea. I think she wants to keep me alive because he died. It has only been two months or less since his passing, and here she is, teaching the babe how to walk. And she does, and when the day comes when I won’t need her anymore, I will miss her.
Because I can’t be left alone all day because I can’t walk, friends take shifts to take care of me. They make me tea and fruit salad. They help with my IV. They meet my nurses. Every last one of them, at some point, breaks down. When the nurse changes the bandage and B. sees my leg, she hides in the hollyhocks in the garden and breaks down. C. watches James Bond films while I sleep in a narcotic haze, but I hear him sniffle. Ian sobs openly and says he’s not ready to lose me. I’m not ready to lose him either.
Through all of this, I learn that it is not me that I care about the most, but the people I love and who love me and who I will have to leave behind. I don’t want them to suffer. I think, if someone had to get cancer, then I’m glad it was I – I can handle that. I can handle anything but seeing those I love in pain, but now my pain is causing them pain, and this kills me.
***
As it stands, one in five Americans will get some form of skin cancer. One severe burn in childhood greatly increases the risk of developing skin cancer later in life. Between 1979 and 1993, non-lethal skin cancer rates rose, on average, 10 percent in the Northern Hemisphere, higher in the Southern. A 10 percent reduction in ozone will result in a 25 percent increase in non-melanoma skin cancer by the year 2050. The EPA predicts that over the next fifty years, 12 million Americans will develop skin cancer and 200,000 will die from malignant melanoma. It is a fact that morbidity rates increase in direct correlation with UV exposure, the rate of which increases as the ozone depletes.
Because of the Montreal Protocol and similar agreements with unified nations that call for a halt on CFCS, ozone is predicted to have reached a minimum at the turn of the century (2000). As a result, skin cancer rates will steadily rise until the year 2060, at which point they should fall. But this assumes compliance of all nations, which simply is not the case. Emissions of CFCs and agricultural methyl bromide are used in developing nations and are also sold illegally. Such use will lead to a dramatic rise in skin cancer rates which would be expected to quadruple by the year 2100.
***
It took a long time, but I did learn how to walk again, and I recovered – sort of. Every three months, I am examined by one of the top melanoma oncologists at Dana Farber. Harley tells me I have thousands of freckles, and his students ‘oohh and ahhh’ over my draped, naked body. He scans for odd shapes, blurs of color, irregular borders. Before each visit, my husband circles the freckles and moles that look ‘different.’
Since my first surgery, I have not gone one year with out another melanoma surgery somewhere on my body. But I know the procedure well. Almost every visit, I expect them to find ‘something’, and usually they do. They have found pre-cancer, severe dysplasia, and melanoma. Any time I go to the hospital, the doctors are told I am a melanoma patient and soon, a team from Dana Farber arrives on the scene to make sure my cancer has not spread.
I wear big hats, baggy clothes, wrap sunglasses with special lenses, and the ‘golf ball size’ amount of sunscreen every day. I am so dead white, I look ill, which is ironic, because risking a tan would be risking my life. A slight reddening of the skin from a long drive and I worry, because I know it is this incidental exposure that is the most dangerous.
When I learned how to walk again, Mark and I traveled to Greece, and I was careful as hell, shielding myself from the sun. People stared at me. I overheard whispers, “she’s so white…”. As I rode my scooter, young boys laughed and said something like “Palo! Palo!”
But here, in the white-white Northeast, even in the winter, people stare. I am luminous as the moon with a sort of translucent overlay of freckles. Never again will I build sandcastles on the beach or emerge, be-freckled, in my white bikini, from a thundering ocean. I want to look that good…have that “healthy glow,” but I know in the final account, it will kill me.
Let me live like Snow White with my army of Dana Farber doctors, my broad-brimmed hats, my long-sleeved shirts, my sun-screen in my car, my bag, my briefcase, everywhere…But let me live.
--Sadi Ranson-Polizzotti
Much of the statistical information contained in this article is from the American Cancer Society, Harvard Medical School Center for Health and the Global Environment, The World Meteorological Association, The World Health Organization, the FDA, and the EPA. Any of these sites can be visited on the Web or reached through 800 numbers.
