When Maureen Brewer thinks of her friend Amy Dunn's melanoma diagnosis, one question keeps coming up: Why her?
Before she got sick, Dunn was the healthiest person Brewer knew. She played soccer for Boise State University for four years and loved skiing. But in 2008, Dunn was diagnosed with stage III melanoma. After remission, the cancer came backin July 2011, and Dunn passed away in March 2012. She was 29.
It doesn't make sense, Brewer said. While Dunn was active and loved the outdoors, she was also sun-conscious.
"Certainly she was more fair-skinned and had freckles, but she also took care of herself," Brewer said.
It doesn't take much to bring on melanoma - a fact theIdaho Department of Health and Welfare is trying to emphasize. According to the Skin Cancer Foundation, it takes only one blistering sunburn to double a child's risk of getting melanoma later in life.
It's a message that may have been missed by Idahoans in recent years.
According to the Environmental Protection Agency, Idaho had the highest melanoma death rate nationally between 2001 and 2005. Idaho also has one of the highest incidence rates, according to the Centers for Disease Control and Prevention.
That suggests Idahoans need to be vigilant about protecting themselves from the sun and have frequent skin checkups.
The state's health professionals and educators are trying to figure out why the rates are so high - and what can be done about it.
LOOKING FOR REASONS
Why are Idaho's melanoma rates so high?
"We've had the same question in the dermatology community," said Boise dermatologist Dr. Steve Mings, who said there is no smoking gun but plenty of likely factors.
Idahoans enjoy easy access to outdoor recreation, no matter where in the state they live. Many Idahoans earn their living working outside, too, from farmers and ranchers to construction and highway workers.
While that active lifestyle has big payoffs overall, the one downside is skin damage potential, Mings said. The danger doesn't go away in winter, added Patti Moran, cancer program coordinator with the Idaho Department of Health and Welfare. A sunburn from the ski slopes in February is just as dangerous as one from a day on the river in July.
Add to that Idaho's temperate climate, which encourages more outdoor activity than in states like Arizona and New Mexico, where the incidence of melanoma is lower. While those states are known for their sunny weather, it's so hot that not as many people recreate outdoors. Idaho's high altitude also increases exposure to harmful sun rays, Mings said.
Demographics also factor in. Skin cancer rates are higher in people with lighter skin, Moran said. According to 2011 census data, 93.9 percent of people living in Idaho identify as white or caucasian, compared to 78.1 percent nationwide.
An independent, rugged spirit among older men may also contribute, Mings speculated. Farmers and ranchers in rural areas who spend all day, every day outdoors might be less likely to get moles or skin spots checked by a dermatologist.
But it's especially shocking when skin cancer strikes young, otherwise healthy people, like Christina McEvoy.
McEvoy grew up in California and worked as a lifeguard during her teen years, spending eight or nine hours in the sun a day for much of her youth. Like many of her peers, she would lie in the sun and go to tanning booths to get bronzed skin.
McEvoy was diagnosed with melanoma at 30 years old, when she was nearly eight months pregnant. After remission, the cancer came back in her lymph nodes two years later. Doctors gave her a 10 percent chance of survival.
McEvoy beat the odds. In August, she will have been in remission for three years.
"I feel pretty lucky," she said.
STRIKING A BALANCE
After Dunn's death, Brewer changed her approach to sun protection. Brewer used to sit in the sun to tan, but not anymore.
"It's not worth it. That vanity is 100 percent gone. Don't care," she said. She's also vigilant about keeping her 6-month-old out of the sun.
Dunn's friends also continued an organization that had initially been set up to help with Dunn's medical bills. Get It Dunn's long-term focus is still taking shape, Brewer said. Part of the goal is to keep Dunn's memory alive, but Dunn's friends also want to educate others about the dangers of melanoma and provide screenings at Get It Dunn events.
Last year, her friends put together a fun run in Dunn's memory, where they provided skin cancer screenings and raised money for an endowment fund in Dunn's name. In its second year, Run for Dunn drew more participants - a trend Brewer hopes will continue for what they hope will be an annual event.
After her battle with cancer, McEvoy has made sure to avoid the same mistakes. She no longer tans, and avoids spending time outdoors when the sun is most intense. Her children have never had a sunburn, she said, but that doesn't mean they are cooped up inside all day.
Instead, McEvoy takes common-sense precautions that allow her kids to enjoy swimming, cycling and other outdoor activities.
"I don't think that you need to be scared of the sun," she said. "But you just need to be aware."
Freelance writer Melissa Davlin has been reporting about Idaho and its people since 2005. A graduate of University of Idaho, Davlin lives in Boise. She's currently writing a book about Bhutanese refugees in Idaho.