Public's ignorance of sun's impact gets under MD's skin

The need to man “battle stations” on Canada's beaches may seem far-fetched, but not to Dr. Jason Rivers.

The 45-year-old Vancouver dermatologist's knowledge of the impact of direct sunlight on the skin began emerging after medical school, but it came to the fore when he spent 2 years Down Under. In Sydney alone about 1000 residents were developing melanoma every year, and the sun-loving Australians were starting to take drastic action on the education front.

Rivers returned to British Columbia in 1990 primed with the realization that Canadians were woefully unaware of the dangers posed by melanoma — 3800 new cases are expected this year, along with 820 deaths — and his goal was to bring Australia's growing sun-savvy home with him.

He began by organizing “battle stations” on Vancouver's beaches, where sun bathers and swimmers could have their skin examined by volunteer dermatologists and receive free sunscreen. The concept was a hit, even if it requires a lot of work. In a 1995 article in Cancer, Rivers reported that “even though the screenings are difficult to organize, they continue . . . because they provide an excellent venue for the dissemination of educational material.”

One recent Saturday, Rivers and 6 other dermatologists set up shop in a white tent at Vancouver's English Bay, where they welcomed a steady stream of curious passersby. About 20% of the people screened were told to make a follow-up visit to a dermatologist, and Rivers says that result is typical. He also found 2 cases of skin cancer that day.

Today Rivers is national director of the Canadian Dermatology Association's Sun Awareness Program, a job that has taught him to appreciate the importance of effective media campaigns. “The media will work with you if you give them the time,” he says, “but you have to be accessible.” He has also spread the word to colleagues in journals ranging from the Lancet to the Journal of the American Academy of Dermatology.

Every year the association's public campaigns aggressively pursue a new angle, such as the need to wear protective clothing or to provide sun protection for athletes and babies. Rivers also recommends which sunscreens should be allowed to carry the association logo.

Although the programs have reached an estimated 25 million Canadians, Rivers is far from satisfied: he worries about the lack of shade trees in the country's schoolyards, that poor families cannot afford sunscreen, about the need to educate physicians.

In pursuit of that last goal, Rivers developed a video, Spotting a Killer, that was distributed to selected family doctors across Canada. Eventually, he hopes to distribute it to all family physicians in BC.

Rivers also makes numerous public appearances, where he teaches and spreads the skin cancer gospel to undergraduate medical students, dermatology residents, family physicians and the public.

Rivers, who became a full professor at UBC in July, would like to triple the number of dermatology residents in BC, and then send them to communities throughout the province. He also wishes that medical students received more than a week's worth of dermatology training during their first 2 years in medical school.

Even his own interest in dermatology took some time to develop. Rivers considered becoming a veterinarian before deciding to pursue a medical career, and his interest in dermatology did not arise until after he graduated from the University of Ottawa. Originally he intended to enter family practice, and while interning in Halifax he discovered that about 15% of his cases involved skin problems. At the time — 1981 — there were only 4 dermatologists in the Maritimes.

Rivers responded by applying for a dermatology residency position in 1983. After completing his residency at the University of Ottawa, Rivers worked at the St. John's Hospital for Diseases of the Skin in England. In 1987, before heading to Australia, he became the first melanoma fellow at the New York University Skin and Cancer Unit.

Eighteen years after entering his field, he says the art of dermatology is the same as the art involved in analysing a painting. “What it takes,” he says, “is to be able to read the skin.”

For Rivers, dermatologic oncology offers a constantly changing landscape, with the new anticancer drugs that are being developed becoming the new paints that he can add to his palette.