Golf’s silent killer (and how to fight it)

By the time you finish reading this, somebody somewhere will have received the devastating news that they have skin cancer.

Inevitably, the words will hang in the air, suspended in an instant of horrified disbelief as their impact and implications sink in.

Skin cancer has become the most common form of cancer in the UK, with 100,000 new cases diagnosed every year. In the US, that number exceeds four million, with between 40% and 50% of all Americans who live to be 65 expected to develop some form of the disease.

Recent research has identified golfers as one of the groups most ‘at risk’ of skin cancer and yet so many who play the game remain blissfully ignorant as to either its causes or the likelihood of contracting it.

It is time for that ignorance to end.

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Broadly speaking, there are three main different types of skin cancer. The most common (and mildest) of these is Basal Cell Carcinoma. It is a cancer that grows on parts of your skin that are exposed to a lot of sun, particularly your nose and face. They typically start off as small, shiny bumps and have a tendency to grow slowly. They are also unlikely to spread to other parts of your body.

The second most common form of skin cancer is Squamous Cell Carcinoma. Again, it’s usually found on areas of the body damaged by UV rays – either from the sun or tanning beds – and is a fairly slow-growing skin cancer. Unlike other forms, it can spread to the tissues, bones and nearby lymph nodes, which makes treatment more difficult. However, caught early enough, it’s eminently treatable.

Then there’s the third type: melanoma. It is the most dangerous form of skin cancer, which develops when unrepaired damage to skin cells – mostly caused by UV rays – triggers genetic defects that cause the skin cells to multiply rapidly and form malignant tumours. According to Cancer Research UK, there are 15,419 new cases of melanoma skin cancer diagnosed in the UK every year, of which as many as two-thirds are associated with exposure to UV radiation from the sun.

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Mortality rates for the disease have more than tripled since the 1970s, with around 2,500 deaths – approximately seven per day – recorded in the UK in 2014. Cancer Research UK estimates that one in 54 people will be diagnosed with malignant melanoma in their lifetime.

Skin cancer is also an extremely indiscriminating disease. Anybody can get it. The risk, though, is thought to be higher amongst people with: fair skin and/or light-coloured eyes; an abundance of large and irregularly-shaped moles; a family history of skin cancer; and a history of excessive sun exposure or blistering sunburns. Those who have lived at high altitudes or with year-round sunshine and those who have received radiation treatments are also a ‘high risk’ group.

So, too, are golfers.

According to one study, professional golfers receive an estimated 217 times the amount of UV radiation required to cause sunburn over the course of a year. Likewise, typical club golfers can receive as much as 5.4 times the amount of UV exposure required to cause sunburn for every single hour that they’re on the course.

That’s relevant because, without taking appropriate preventative measures, such as applying sun cream and so on, a golfer’s skin can and will burn when exposed to such high levels of radiation – and, according to a 2014 report published in the US, five serious cases of sunburn can increase the risk of developing skin cancer by up to 80%.

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There’s also this. Men over the age of 40 have the highest annual exposure to UV radiation, with the majority of people diagnosed with melanoma being white men over the age of 50.

Melanoma, meanwhile, is one of only three cancers with an increasing mortality rate amongst men.

The upside – and there is an upside – is that 99% of all skin cancers are curable. Again, according to Cancer Research UK, Approximately 90% of people who are diagnosed with melanoma skin cancer will live for a further ten or more years. But early detection is critical. Knowing what to look for, where to look for it and then having the good sense and courage to get it checked could, quite literally, be the difference between life and death.

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Perhaps unsurprisingly, given the amount of time they spend on the golf course and practice range, many professional golfers have been diagnosed with skin cancer down the years.

Less than two years before he won the Masters, Adam Scott had a Basal Cell Carcinoma removed from his face. The surgery required 30 stitches and has left the Aussie with a scar on his nose. “The procedure made me less lazy with applying sun protection because it was quite painful to have removed,” he said.

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South African Rory Sabbatini had a Squalous Cell Carcinoma removed from his own face in 2010, whilst PGA champion Jimmy Walker, English pro Brian Davis, Tiger Woods’ former coach Hank Haney and three-time major winner Padraig Harrington have also received skin cancer treatment, Harrington on more than one occasion.

Early in 2007, just a matter of months before he won his first major and less than two years after he lost his father to oesophageal cancer, the Irishman had a square-inch of skin removed from his forehead after noticing a spot that wasn’t healing. That was the first of four ‘things’, as he puts it, that he had removed.

“Mine were non-melanoma, fortunately, but of course it’s a concern when the doctor first tells you that there’s something they need to cut out of you and send away to get checked,” Harrington told bunkered. “I tried my best not to worry about it until I got the results. There was nothing I could do at that point so what use was worrying?”

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In the end, he got the all-clear but admits that the experiences have changed him. “I’m definitely a lot more diligent about protecting my skin these days,” he added. “In fact, if I was starting over, that would be the main thing I’d change.

“It’s not that I didn’t wear sun cream. It’s more that I didn’t always pay attention to just how often I needed to apply it. I’d be more careful about that if I got my chance again. That and wearing sunglasses.”

Harrington has even ‘spotted a few things’ on fellow players and caddies that he has brought to their attention and suggested they get checked.

“That’s just the way I am,” he said. “If I’m in someone’s company and I see something, I’ll say, ‘You know what, you need to get that checked out.’ I’ll say it to spectators, too. If I’m signing autographs and I see somebody who’s cooking, I’ll say to them, ‘Hey, you’d better watch’.”

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Harrington now wears sun cream pretty much every time he’s outside. He keeps spray-on cream by both the front and back doors of his house and also makes sure to carry either a spray-on on roll-on stick – if not both – in his bag so he has, in his words, ‘no excuses’ for getting burned.

“For a lot of people, it’s a time thing,” he said. “You know, ‘Do I have time to put on sun cream, go and wash my hands and then go and get ready?’ Most times, the answer’s ‘no’. We don’t spend enough time warming up, never mind anything else. But you’ve got to make time. Catch it early and skin cancer is very treatable. Leave it long enough and, well, it’s a cancer and it can spread into your body and kill you.”

He also says that attitudes towards skin protection are changing on tour.

“Guys used to joke about Tony Johnstone, saying that an acupuncturist wouldn’t be able to get a needle in his neck. His skin was that hard. Coming from Zimbabwe, he was well used to the sun. But the way people spoke about that back then, it was almost a badge of honour. It’s not like that anymore. People are a lot more aware of the risks.”

As its players have become more aware of the dangers posed by long, sustained exposure to the skin, the game’s main organisations have started to put practices and procedures in place to both raise awareness and better monitor the risks of skin cancer.

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In 2013, the PGA Tour joined forces with the Skin Cancer Foundation for precisely those purposes, creating a promotional video featuring the likes of Rory McIlroy, Luke Donald and Adam Scott talking about the importance of sun protection on the course. At the time, Perry Robins, the president of the charity, described the association as a ‘natural fit’. “Both playing and watching golf entail a lot of time spent in direct sunlight, so it’s important that players and enthusiasts incorporate sun protection into their lives on and off the course,” he said.

The European Tour, meanwhile, is upping its game with regards to how much it knows about what players are doing to protect themselves against the dangers of unprotected sun exposure.

Dr Roger Hawkes, the chief medical officer for the tour, told bunkered that a review was undertaken in recent times to ‘fully understand the issues so that we can get our house in order’.

“Whilst we offer screenings, we don’t really have a handle on what other measures players are taking, from going for their own private screenings to wearing sun cream,” said Hawkes. “We don’t really know quite how seriously they take it. This review will help to establish that. I think we’ve got to do two things, in particular. One, we’ve got to make taking preventative measures easier to do and, two, we’ve got to make them available.”

The screenings he refers to are carried out multiple times per year on-site at European Tour events by Screen4Life, a mobile private cancer and health screening clinic.

The screenings are non-compulsory, non-invasive and are carried out using a SIAscope, a hand held scanner that provides colour ‘bitmaps’ called SIAscans. These scans provide accurate images of the melanin, blood, and collagen below moles or lesions to quickly and accurately evaluate how dangerous they may or may not be.

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English golfer Philip Golding decided to make use of the screening service in 2012, not long after he became eligible for the European Senior Tour. It turned out to be a very good decision.

“I never expected any problems but I was immediately given a referral to see my GP,” explained Golding. “That, in turn, led to me visiting a dermatologist in London, who confirmed that I had a Basal Cell Carcinoma. I finished that season in Mauritius and went to get the growth cut out over the winter. It was a relief to know that the Senior Tour can provide such an invaluable service to our players, who have been exposed to the sun for 30 to 40 years.”

In 2015, he again visited the Screen4Life team, this time at the SSE Enterprise Senior Wales Open, where another BCC was identified.

Dr Hawkes added: “We’ve got a duty of care as employees of the tour to make sure people are educated and there’s a trickle-down benefit of that, too. If our players are educated and doing the right things, then the general public will hopefully get the message, too.”

The question is: are you?

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For more information about staying safe on the golf course, check out the Melanoma Fund’s “Slip! Slap! Swing!” campaign. Click here for details.