Sun Safety

July 06, 2021

Information

July 4, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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00:00Funding for Yale Cancer Answers
00:02is provided by Smilow Cancer
00:04Hospital and AstraZeneca.
00:08Welcome to Yale Cancer Answers with your
00:10host, doctor Anees Chagpar. Yale Cancer
00:13Answers features the latest information
00:15on cancer care by welcoming oncologists
00:17and specialists who are on the forefront
00:20of the battle to fight cancer. This week
00:22it's a conversation about skin cancer and
00:24sun safety with Doctor Kathleen Suozzi.
00:27Doctor Suozzi is an assistant professor
00:29of dermatology and dermatologic surgery
00:31at the Yale School of Medicine,
00:33where Doctor Chagpar is a professor
00:36of surgical oncology.
00:39We've been waiting for this for a long time.
00:42Tell us what we should know in
00:45order to keep ourselves safe
00:47during the summer.
00:48Yes, I think as we're emerging
00:51after this difficult COVID year,
00:53people are really looking forward
00:55to spending the summer outdoors and
00:58doing activities that have been
01:00really limited over the past year.
01:02And I fully encourage that, but we
01:05want to do it safely and there's a few tips
01:09I think that will help people be sun safe
01:12during their outdoor activities this summer.
01:15The first thing to talk about is
01:18sun protection and sun protection
01:21comes in a couple forms.
01:23So when we think about sun protection,
01:26most people think about sunscreen and this
01:29really is the main first line of defense.
01:33But the key for sunscreen is using
01:36it properly and what I think
01:39people misuse is in terms of the
01:42amount of sunscreen they use and the
01:44frequency in which they apply it.
01:47So in general,
01:48when we're recommending
01:49appropriate sunscreen use,
01:50people want to look for an SPF.
01:53This is sun protective factor
01:55and is the amount of
01:58increased protection the sunscreen
02:00is giving you to prevent sunburns.
02:03So, for example,
02:04if you're using an SPF of 15,
02:07that means it's going to
02:09take 15 times longer
02:11to cause a sunburn,
02:12then it would without any sunscreen,
02:15and so in general I recommend that patients
02:19or people look for SPF of 30 or above.
02:23This is going to be giving you
02:26coverage for about 98% of UV rays,
02:29so with application number one you
02:31have to apply enough and so the general
02:35recommendation is about 1 to 2 ounces.
02:38So this is about a shot glass size
02:41or a golf ball sized amount of
02:44sunscreen to cover exposed skin
02:46and this sunscreen needs to
02:48be reapplied every two hours.
02:50And so Katie, just a couple of
02:53questions on that. The first is, is
02:56the bigger the number for the SPF better?
02:59So if you have a choice between 30 and
03:0250 and maybe even 70 that you should
03:05pick the higher number.
03:07No, that's really not always the case.
03:10So as I mentioned at an SPF of 30,
03:13you're blocking approximately 98%
03:15of the ultraviolet radiation,
03:16and so at increasing numbers,
03:18there's diminishing return.
03:20And in order to
03:21achieve higher sun
03:22protective factor,
03:24say your SPF is 100 or 70 or greater,
03:27the consistency of the product changes.
03:29It becomes more tacky, more opaque.
03:31It's not as wearable,
03:33and so in my experience my patients
03:35aren't as likely
03:37to use it as a more wearable,
03:40say SPF 30, which goes on easier,
03:42is more shear,
03:43and they're more likely to keep
03:45it on every day and reapply
03:47every two hours as recommended.
03:51So the next question I have is when
03:53we're looking at the sunscreen bottle,
03:56some of them will say broad spectrum.
03:59Some of them will say UVA and UVB.
04:02What do all of those terms mean and
04:06how important or not are they?
04:09Broad spectrum is not just a marketing label,
04:13it actually is really important and what
04:16broad spectrum means is that the sunscreen
04:19is blocking both UVA and UVB rays.
04:22So UV radiation comes in a few forms.
04:26The main ones that reach
04:29the Earth are UVA and UVB.
04:32UVB radiation is what causes sunburn
04:34and is also associated with skin cancer.
04:38UVA Is the ultraviolet radiation that
04:42is associated with sun damage in the skin,
04:46so the development of wrinkles,
04:48sunspots, and is also associated
04:51with skin cancer.
04:53UVC really doesn't penetrate to
04:55the earths surface,
04:57so really talking about UVA and UVB
04:59and so broad spectrum means that
05:02that sunscreen product is going to
05:05protect you from both UVB and UVA rays.
05:08And so this is really important and
05:10the type of sunscreen you will also
05:13find on your sunscreen label and in
05:16general sunscreens come in two forms so
05:19we have our chemical based sunscreens
05:22and our physical based sunscreens.
05:24The physical base are also referred
05:26to as mineral based sunscreens.
05:28Mineral based sunscreens are the
05:30ones that contain zinc or titanium.
05:33That's why they get their name of
05:35mineral based and the way mineral
05:37based sunscreens work is they are
05:39literally just reflecting the UV
05:41radiation off the skin and this is
05:43why you think about the traditional
05:45zinc based sunscreens that were very
05:47white and opaque because they would
05:49go on and just reflect off the light.
05:52Now we have a lot more elegant
05:54formulations where the minerals are
05:56micronized and they go on much more
05:58shear on the skin and these are in
06:01general my preferred forms of sunscreen
06:03because they are not just reflecting UV,
06:06they are by nature broad spectrum.
06:09The main reason why I prefer the
06:11mineral based to the chemical based
06:14is that chemical based sunscreens
06:16can cause skin irritation,
06:18both irritant and allergic types of reactions.
06:21Recently there has been
06:23some controversies about some sunscreens.
06:26The chemical variety causing cancer.
06:28Is that true? And how much
06:30stock should we put into that?
06:34So we have a lot more research needed into
06:38that to really determine
06:41if there is any inherent harm in
06:45these chemical based sunscreens.
06:48So the initial concern came out when
06:51it was found that the chemical based
06:54sunscreens could be detected at very
06:58very low levels in the bloodstream and
07:01what does this mean?
07:09Does this pose any health risk is still very,
07:12very unknown.
07:14It's very unlikely that these chemical
07:17sunscreens pose any real risks to human
07:20health because we would have seen a
07:23signal come up over all of these years of use
07:26and so the next question has to do
07:29with sunscreens being waterproof.
07:31Are sunscreens waterproof?
07:33And if they say so on the label,
07:37does that mean that you don't need to reapply
07:39them necessarily after you get out of
07:41the water?
07:43Sunscreens can label themselves as water resistant,
07:45but it's not perfect and
07:47certainly it will wash off and
07:49in general those water resistant
07:51formulations tend to have a thicker,
07:54more tacky feel to them,
07:55so they're harder to apply,
07:57so you know if someone is a
08:00swimmer and going to be in
08:03water for long periods of time,
08:05I will say seek out these
08:07water resistant formulations,
08:08but in general I still recommend
08:11that once you come out of the water
08:14dry off and reapply.
08:16What about if you are going outside but you're
08:19going to be indoors for part of the time?
08:23Do you still need to wear sunscreen,
08:26or is that only when you're going
08:29outside to the beach you're
08:31going to be exposed to
08:34the sun for a prolonged period of time?
08:38So, interestingly,
08:39you can even have UV exposure indoors,
08:42and that is because UVA radiation
08:44can penetrate through windows,
08:46so our car windshields by law have to
08:49have filters to protect against UVA,
08:52but the side windows, sunroofs, back windows,
08:55generally don't have UV protection.
08:57Same goes in office buildings.
08:59So if you're working next
09:01to a window every day,
09:04you have significant UVA exposure and
09:06so I do recommend to all of my patients
09:10that they wear a daily facial sunscreen
09:13and this is applied in the morning.
09:17And you could have it in
09:19your office to reapply.
09:21Sometimes this becomes problematic,
09:23especially for women who wear makeup and
09:26just the practicality of reapplying
09:29a cream based sunscreen multiple times
09:31through the day is just not feasible.
09:34So we do have some newer formulations
09:37that help mitigate that problem.
09:39For example,
09:40there are powder based sunscreens that can
09:43be used for reapplication during the day.
09:47But if you're using a mineral based
09:49sunscreen on your face in the morning,
09:51that mineral composition is
09:53really going to stay there until
09:55you wash it off your face.
09:57So it's better than nothing if you're
09:59at least applying it every morning.
10:02What about you know the reapplication
10:04part seems to be one of the
10:07issues that many people face.
10:09I know that when I go out into
10:11the sun I may start out the day
10:14with all of the best intentions.
10:17Put my sunscreen on,
10:18but when you're outside and
10:20you're having a good time,
10:22you often forget to reapply
10:24it every two hours.
10:25How critical is it that you
10:28reapply every two hours?
10:29Can you up the SPF and then not reapply?
10:34So upping the SPF and not reapplying
10:36isn't going to be helpful,
10:38because what is causing the sunscreen
10:40to need reapplication is related
10:42to what activities you're doing.
10:44For example, if you're sweating,
10:46if you're swimming,
10:47which we already mentioned,
10:49these are things that are
10:51going to lead to the SPF
10:53either washing off or breaking down.
10:55Wiping down with a towel,
10:58for example, and so yes,
11:00it can be really hard to
11:02continuously reapply while you're
11:04outdoors, but I typically recommend
11:07that before your outdoor activity,
11:09give yourself a head to toe
11:12cover in a broad spectrum,
11:14cream based SPF, preferably a mineral,
11:17but chemical is fine as well,
11:20and then when you're out we
11:22have to take a little bit more care
11:28about convenience and so
11:30the spray based sunscreens,
11:32the aerosolized sunscreens,
11:34which aren't perfect for initial
11:36application because they don't
11:37always go on fully evenly,
11:39they're really easy to reapply to
11:41spray it on your exposed skin,
11:43and so those are a great option
11:45to have in your purse or bag so
11:48that when you're out and about
11:50you can easily reapply without having to strip down.
11:58The other thing which we haven't
12:00touched on yet is protective clothing,
12:02and so this is a great way to minimize
12:05the need for reapplication because of
12:07course if you have the clothing on it
12:09will stay with you during your activity.
12:13So all great tips and we're going to
12:15pick up that conversation right after we
12:18take a short break for medical minute.
12:21Please stay tuned to learn more about
12:24skin cancer and sun safety with
12:26my guest doctor Kathleen Suozzi.
12:28Funding for Yale Cancer Answers comes
12:31from Smilow Cancer Hospital promoting
12:33sun safety and skin cancer screening
12:35in honor of UV Safety Month. For information
12:38and to learn if you should be screened,
12:41visit yalecancercenter.org/screening.
12:44This is a medical minute
12:46about smoking cessation.
12:47There are many obstacles to
12:49face when quitting smoking
12:51as smoking involves the potent drug nicotine.
12:54But it's a very important lifestyle change,
12:57especially for patients
12:58undergoing cancer treatment.
12:59Quitting smoking has been shown to
13:02positively impact response to treatments,
13:04decrease the likelihood that patients
13:06will develop second malignancies,
13:08and increase rates of survival.
13:10Tobacco treatment programs are
13:11currently being offered at federally
13:14designated Comprehensive Cancer Centers
13:16and operate on the principles
13:17of the US Public Health service
13:20clinical practice guidelines.
13:21All treatment components are
13:23evidence based and therefore all
13:25patients are treated with FDA
13:27approved first line medications
13:29for smoking cessation as well as
13:31smoking cessation counseling that
13:33stresses appropriate coping skills.
13:35More information is available at
13:37yalecancercenter.org. You're listening
13:39to Connecticut Public Radio.
13:41Welcome back to Yale Cancer Answers.
13:44This is doctor Anees Chagpar
13:46and I'm joined tonight by my
13:48guest doctor Kathleen Suozzi.
13:50We're talking about skin cancer and
13:52sun safety and right before the break,
13:55Katie you were starting to talk
13:57about protective clothing.
13:59So when I think about going outside,
14:01you know part of the reason is
14:04that it's warm and it's beautiful
14:06and nobody really wants to wear a
14:09long sleeve shirt and full length
14:11pants and a hat.
14:13How important is it to keep
14:16really covered up?
14:18Well, the great thing about protective
14:21clothing is the convenience factor that
14:23you put it on and don't need to reapply.
14:26And so for example,
14:28a regular white T shirt.
14:30So when we talk about protective clothing
14:32instead of SPF, we talk about UPF.
14:35UPF measures the transmission of ultraviolet,
14:38so it's ultraviolet protective factor
14:40and so a regular white T shirt has a
14:43UPF somewhere on the order of five to seven,
14:46whereas the Sun protective clothing,
14:49the UPF factor is around 50,
14:51so it doesn't mean that you don't need
14:54sunscreen in the areas of exposed skin,
14:56but by choosing that specific sun
14:58protective clothing instead of the
15:00normal clothing you would wear,
15:02you're better protected in the
15:04areas that are covered.
15:05So tell us
15:06more about Sun Protective clothing
15:08because I think a lot of people,
15:10when they think about
15:12wearing protective clothing from the
15:14sun are thinking well instead of a T shirt,
15:17I'll grab a long sleeve shirt.
15:19Or instead of short shorts,
15:22I will grab cotton pants,
15:25but I think what you are talking about
15:27is really clothing that is specially
15:30designed to protect against UV rays.
15:32Can you tell us more
15:34about where we find that?
15:36How are they labeled?
15:37Can we see how much protective
15:40factor we're getting and what
15:42should we be aiming for?
15:44Yeah, so the market for some protective
15:47clothing has really grown in recent years.
15:50There used to be limited brands that
15:53had this technology that has to do
15:55with the weaving and the material,
15:58the type of material that they use,
16:01but now even more mainstream brands
16:04are carrying clothing that are
16:06specifically UPF rated and that
16:08UPF is what you want to look for.
16:10So on the label it will say
16:13that this garment
16:14is UPF X and usually they'll carry
16:17around a UPF of 30 to 50 and
16:21UPF 50 that's corresponding to
16:23blocking 98% of UV transmission,
16:25which is about equal to what
16:28I said at SPF 30 is doing,
16:30so that's what you want to look for
16:33when you're looking for clothing.
16:36So the
16:37next question I have,
16:38Katie is with regards to when you
16:41say covering up and applying
16:43sunscreen head to toe.
16:46Let's talk about toes.
16:48You know we generally
16:50speaking do not wear socks,
16:52and you know covered shoes
16:54when we go to the beach.
16:57And yet we know that some
16:59skin cancers can occur on
17:01peoples feet and peoples toes.
17:03Can you talk about
17:05how we protect our feet?
17:07Yeah, so this is actually
17:09an interesting discussion.
17:10So when we think about skin
17:13cancers that occur on the feet,
17:15there are the non Melanoma
17:17type of skin cancers which we could
17:19get into a little more detail,
17:21but these are the basal cell and
17:24squamous cell type of skin cancers
17:26and as a skin cancer surgeon
17:28often I'm treating these types
17:30of skin cancers on the back of a
17:32person's foot and just as you said,
17:34I think that's related to the increased
17:36sun exposure that these areas are getting.
17:39And probably many people could remember
17:41getting a bad sunburn on their feet
17:43at one point in the summer months.
17:45But then there's also the
17:47type of skin cancers
17:48that occur in and around the nail,
17:51and these include both Melanoma and
17:53squamous cell type of skin cancers and
17:56the ones that occur around the nail
17:58they have drivers that aren't just
18:01sun related and this might be outside
18:04of the scope of our talk today,
18:06but they have different genetic
18:08causes for the squamous cell type.
18:10They can be virally related and for
18:13the Melanoma type these are the type of
18:15melanomas that we see in increased frequency
18:19in African American patients,
18:20Bob Marley is the
18:23famous person who died from
18:25a subungal Melanoma,
18:26and so these are not necessarily sun related.
18:29But one thing that is interesting and
18:32is an area of active research is if UV
18:36light that is used in nail salons to harden,
18:39nail polish,
18:40or help dry nail polish,
18:42particularly for these longer wear,
18:44nail polishes might have any meaningful
18:46increased risk for skin cancers
18:49in and around the toes and hands so
18:51does that mean that we should be wearing
18:54sunscreen on our hands before we go
18:57to a nail salon?
18:58I think we need some more data,
19:01but there are these great gloves that
19:04you can get that cover the
19:06skin on the hands while your hands
19:09are under those light beds, but again,
19:11that's not protecting the nail unit.
19:13So in general, what I recommend is if
19:16patients are getting these type of manicures
19:19rarely or infrequently,
19:20it's probably not increasing their risk,
19:22but for those people who get these
19:24type of manicures every single month,
19:26we may find that their risk of skin cancer
19:29in and around the nail is increased.
19:31But we don't quite have that data yet.
19:35My next question has to do with hats.
19:37Back in the day when we used to talk
19:40about slap on some sunscreen and
19:42slap on a shirt and slap on a hat.
19:45But the truth of the matter is,
19:48how much benefit
19:50do we get from a wide brimmed
19:52hat when we go outside.
19:53Clearly, unless we don't have hair
19:56we can't use sunscreen there.
19:57And certainly skin cancers
19:59can occur on the scalp.
20:01But how frequent is that and how much
20:04does a hat really help us?
20:06Skin cancers on the scalp are
20:08actually quite frequent.
20:09You can imagine in patients
20:11like you said, who are bald,
20:13that's going to be a very common
20:15site where we see skin cancers,
20:18but I treat many women
20:20with full heads of hair that developed
20:22skin cancers on the scalp and again
20:25this harkens back to childhood
20:26where you can probably remember
20:28getting a bad burn within the part
20:31of your scalp 'cause it wasn't
20:33protected and so hats are actually
20:35very effective for this purpose and
20:37the type of hat you wear matters.
20:39So you mentioned a wide brim hat,
20:42so this is something that is
20:45different than just a baseball cap.
20:47A baseball cap, for example,
20:49doesn't even give you full coverage
20:51down to the tip of your nose
20:53so it is effective for
20:55the top of the scalp but is
20:58not going to protect the lower face.
21:01And again,
21:01they're now making hats that
21:03have UPF rated factors,
21:04so look for ones that have a UPF
21:07rating that was going to be better
21:09than a white baseball cap,
21:12which is not going to give
21:14you full protection.
21:15So the other thing to know though,
21:17is that you can have reflected UV off
21:20the ground, particularly on the water.
21:22And I see this in boaters all
21:25the time that have a hat on,
21:27but they're getting a lot of reflected
21:30UV that's coming off the water.
21:32Or swimmers, etc.
21:33And also the other place is when
21:35you're on the ski mountain,
21:37the UV reflection off the snow and even
21:40off concrete or different surfaces.
21:42There is reflected UV,
21:43so that's going to come up
21:46and under your hat.
21:47But I am a big advocate for wide
21:49brim hats, we're trying to make
21:51them cool and stylish again.
21:55And then finally the other question has to
21:58do with, you've talked a
22:00little bit about people getting
22:02sunburn and we know that sunburn,
22:04particularly in childhood,
22:05will increase your risk of skin cancer.
22:08But there are some people,
22:10particularly who are darker skinned
22:12who rather than burning, tan.
22:14So how important is it for them
22:16also to engage in all of these
22:19sun protective measures?
22:20Is it just as important,
22:22or do they have some
22:24protection already?
22:26Let's go back to your
22:28point about sunburns.
22:30I think that it's really important
22:32to focus on this for a second.
22:35If you have had more than
22:37five sunburns in your life,
22:39your risk of Melanoma doubles.
22:41If you have had more than
22:43one blistering sunburn,
22:44your risk of Melanoma doubles.
22:46So that's really, really significant,
22:48and these sunburns are most
22:50often in your youth.
22:52We know that that damage
22:55occurs early,
22:56and that's why sun protection for our
22:58kids is so critically critically important.
23:01So let's talk about the
23:02other forms of skin cancer.
23:04Basal cell carcinoma is also associated
23:06with intense intermittent sun exposure,
23:08so the sun exposure
23:10you get on your summer holiday,
23:13and this includes going back into your youth.
23:16But this doesn't even need
23:17to necessarily be a sunburn,
23:19just that intense intermittent
23:21exposure squamous cell,
23:22on the other hand,
23:23is more associated with chronic lifetime
23:25exposure and so that's an exposure
23:29that accumulates with time and leads to
23:32increased risk of squamous cell carcinoma.
23:34So patients who have higher endogenous
23:37pigmentation, have darker skin types,
23:40do have inherent UV protection,
23:42but that doesn't mean
23:44that they're fully immune,
23:46so for example,
23:49we see many Hispanic patients that
23:51develop non Melanoma skin cancer.
23:53In fact,
23:54the statistics for Hispanic populations
23:57are about four to 5% of all cancers
24:00in the Hispanic population,
24:01or skin cancers, that's lower
24:04for African American patients.
24:05That's somewhere on the order of 1 to 2%.
24:09So you know,
24:11while they do have protection
24:13from their darker skin type,
24:15Ii's not perfect and we still see
24:17skin cancers in these populations.
24:19You had mentioned earlier
24:22that African Americans going back to the
24:25example of Bob Marley can get skin cancers
24:27or melanomas in other places as well.
24:30So under the nails and you had
24:33mentioned that some people can get
24:35even with a full head of hair,
24:37skin cancers on their scalp.
24:39So I want us to move a little bit from
24:42how do we protect ourselves from the sun?
24:46To how do we survey our skin and
24:48nail beds and other areas to try
24:51to find these skin cancers early?
24:54Because certainly,
24:57they may not cause problems in the sense of causing a
25:00lump or bleeding or things like that
25:03that we may notice with other cancers.
25:05And yet, early detection is
25:07probably still important.
25:08So how do we find them early?
25:12So early detection is critically important,
25:14and to date, the US preventative task
25:17Force that gives us guidelines on
25:19cancer screening does not yet have a
25:22recommendation for skin cancer screening,
25:24and this is a little bit problematic
25:27because it's hard for people to know
25:29if and when they need to see a dermatologist,
25:32and so there's two parts of surveillance.
25:34So number one is self screening and
25:37we can talk about that in a minute.
25:40But #2 is screening by a dermatologist,
25:43and so what I recommend is that everyone
25:46have a baseline full body skin exam by
25:50a board certified dermatologist after
25:53that exam and with a review of the
25:57patients background and other risk factors,
25:59the dermatologists can then recommend whether
26:02that patient needs annual exams,
26:05more frequent exams or
26:07needs less frequent exams.
26:08So that's very important.
26:11Then in addition,
26:12self exam is also very important
26:14and what is probably the most
26:17important factor for detecting skin
26:19cancer is evolution of a lesion,
26:21and as a dermatologist
26:23when we're doing skin exams,
26:25we're only seeing any lesion on
26:27the skin at one point in time,
26:30so I put a lot of stock in when
26:33a patient tells me look this mole
26:35used to be pinpoint and now it's
26:38the size of a pencil eraser.
26:41I know it's worrying,
26:42and even if my exam does
26:44not elevate a lot of alarms,
26:47that history of evolution of the
26:49lesion is going to put me at a higher
26:52alert that it might need a biopsy.
26:55But in general,
26:56there's different things
26:58to look for when we're talking about
27:00non Melanoma type of skin cancers
27:03versus Melanoma type of skin cancers.
27:05So for non Melanoma type of skin cancers,
27:08again this is the basal cell and
27:11squamous cell type of skin cancers,
27:13these can present really with a
27:15variety of clinical presentations,
27:17but often what I tell patients is to
27:19report anything that bleeds spontaneously,
27:22so a lesion on the skin that keeps
27:24developing a scab and you can't really
27:27point to any trauma that that lesion
27:30has had that should be evaluated.
27:32Also a lesion on the skin that's
27:35tender to touch.
27:36Have that evaluated sooner rather than later.
27:39In terms of the Melanoma type of skin
27:42cancers, we have the mnemonic ABCDE,
27:45and this refers to
27:46when you're evaluating moles at home,
27:49things to look for.
27:50So a stands for asymmetry of the lesion.
27:53You know if you were to cut the
27:56lesion in half in any direction,
27:58does it look the same on both sides?
28:01B is for border.
28:02Is it a smooth round lesion or
28:04does it have some jagged edges?
28:06C is for color. Is the color uniform?
28:09Are there different colors within the lesion,
28:11particularly are there areas of blue,
28:13red or white in addition to
28:16different shades of brown?
28:17D is for diameter.
28:19When the lesion is greater than
28:215 millimeters or about the size
28:23of a pencil eraser
28:24and E is what I already mentioned,
28:27evolution, has this lesion been changing?
28:30Doctor Kathleen Suozzi is an assistant
28:32professor of dermatology and dermatologic
28:34surgery at the Yale School of Medicine.
28:37If you have questions the addresses cancer
28:39answers at yale.edu and past editions of
28:42the program are available in audio and
28:44written form at yalecancercenter.org.
28:46We hope you'll join us next week to
28:49learn more about the fight against cancer
28:51here on Connecticut Public radio funding
28:54for Yale Cancer Answers is provided by
28:57Smilow Cancer Hospital and AstraZeneca.