When CVS announced their decision to stop selling cigarettes in their stores starting in October, I was surprised to find a heated debate on Facebook among some of my friends. Some thought this was discrimination against smokers and called CVS hypocritical by drawing parallels to CVS selling candy and beer, as sugar and alcohol are also known to be “bad for you.” Yes, too much sugar or too much alcohol can have serious health consequences.
But it didn’t seem right to equate these to cigarette smoke, where any amount, or even being near someone else who smokes, has been proven to be dangerous. Furthermore, CVS is still allowing smokers into their stores; they are simply choosing not to sell something that is so addictive and unhealthy. I don’t consider that discrimination.
The debate raised the question for me: Can things that are bad for you, or even known to cause cancer, ever be enjoyed in moderation?
As a dermatologist who specializes in skin cancer and sun damage, I’d like to use sun exposure as an example of something that can potentially be dangerous but can be enjoyed safely, and in moderation. Skin cancer is the most common cancer diagnosed in the United States. It is estimated that 1 in 5 Americans will develop some form of skin cancer in the course of their lifetime. And, the risk extends to individuals of all skin types, not just those with fair skin.
Skin cancer is unique, because we know the major culprit, and because of that, skin cancer is one of the most preventable types of cancer. It is estimated that up to 90% of non-melanoma skin cancers are associated with overexposure to UV radiation, or sunlight. For this reason, the American Academy of Dermatology recommends wearing a broad-spectrum sunscreen with an SPF of at least 30 every single day – 365 days a year. Daily sun protection is a primary means of lowering your chance of developing skin cancer, as well as minimizing premature skin aging.
When I tell my patients about my year-round sun protective behaviors, they often assume that I hide in the attic, or avoid being outdoors all together. This couldn’t be further from the truth. As a marathon runner and a mother of three young children, I love to be outside. Being outside exercising or playing on the beach with my kids is so important for my physical and mental health. But, it has to be done safely; I never run without SPF, a hat and sunglasses. And my children are never on the beach without their UPF protective sun shirts. So, even though UV radiation is carcinogenic when you don’t take the proper precautions, being outside in the sun can have positive benefits on the mind and body. Similarly, one can enjoy the occasional chocolate, candy or glass of wine in moderation, and in some cases, even with a possible health benefit.
On the other hand, cigarettes can never be beneficial, even in moderation. Cigarette smoking can directly cause lung cancer and other cancers of the head and neck. Smoking can also lead to other respiratory diseases like emphysema and low birth weight in some babies born to mothers who smoke. Through the dangers of secondhand smoke, cigarettes even affect innocent bystanders, exacerbating conditions like asthma, just by being near or living with a cigarette smoker. So, unlike candy, alcohol and sunlight, smoking is always dangerous and cannot be enjoyed, even in moderation.