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Sunscreen vs. Skin Cancer: What’s Going On?
Skin cancer rates continue to rise — despite the fact that more sunscreen is being used today. That seems to prove that sunscreen doesn’t work. Therefore, we don't need sunscreen. That thinking could kill.
Let's try to figure out what is really going on. We'll take a closer look at the numbers and the ways in which sunscreen use affects behavior.
Is More Sunscreen Being Used Today?
More sunscreen is indeed being used today. In the United States, for example, there has been a reported increase in sunscreen usage from approximately 25 percent to 33 percent since 2000. Researchers have documented similar trends in various countries — such as a study that looked at sunscreen use among beachgoers in Denmark.
Are Skin Cancer Rates Going Up?
Yes, skin cancer rates — specifically melanoma diagnoses — are rising in the U.S., the U.K., Australia, and other countries.
When you combine those two trends, it looks confusing. If sunscreen effectively blocks damaging UV radiation, wouldn’t we expect to see a decrease in skin cancer rates as more people begin to use sunscreen?
Therefore, skeptics say sunscreen is simply ineffective. However, that line of reasoning completely disregards the many important variables involved.
Variable #1: Older Populations
Demographically speaking, populations are growing older. As people live longer and have fewer children, the number of adults above 65 grows proportionally. Since skin cancer becomes more prevalent with age (as well as with cumulative UV exposure), an older population is likely to produce more cases of skin cancer.
As an example, many researchers report that melanoma diagnosis peaks in the 70s. Even if sunscreen was effective in preventing skin cancer, an older population would generate more cases simply based upon the greater prevalence of the disease.
However, aging alone is insufficient to explain the entirety of the trend.
After adjusting for the aging population trend, researchers have found that overall skin cancer incidence has increased annually by roughly 2% from 1990 to 2021. What is more disturbing is the fact that melanoma incidence has also increased among younger individuals. Specifically, in the U.S., melanoma incidence in young males during 2009 was significantly higher than in 1970. Similarly, the increase in young females was even larger.
Thus, something else is occurring.
Variable #2: Increased UV Radiation
Perhaps the greatest driving force behind skin cancer is UV radiation. The more UV radiation skin is exposed to over time, the greater the risk of developing skin cancer.
And here we find ourselves once again considering the impact of sunscreen. Why is UV radiation exposure increasing even though more sunscreen is being used? Because sunscreen use often influences behavior.
Three Myths About Sunscreen That Increase UV Radiation Exposure
It is possible to think that using sunscreen will protect you from skin cancer. Unfortunately, that is not true. There are three myths surrounding sunscreen that cause people to increase their UV radiation exposure even when using sunscreen.
Myth #1: Tanning Beds Provide A Safe Way To Get A Tan
They Do Not.
Multiple large-scale studies have established a link between the use of tanning beds and an elevated melanoma risk. A comprehensive review of the literature found that people who had previously used a tanning bed were at a significantly higher risk of developing melanoma.
Tanning beds are particularly hazardous because they emit a great deal of UVA radiation. While most people are not exposed to that level of UVA radiation from normal sunlight, tanning beds deliver it in concentrated doses.
Because of the risks associated with tanning beds, they have been designated as a Group 1 Carcinogen by the International Agency for Research on Cancer, in the same category as substances such as tobacco and asbestos.
Myth #2: Sunscreen Allows You To Tan Safely
Many people believe that sunscreen allows "good" UV radiation to pass through while blocking the "bad" UV radiation. Unfortunately, that is not accurate. A tan is a result of the body's response to UV radiation — UVA and UVB. Both types of UV radiation can damage DNA. When you get a tan, you have already accumulated enough UV radiation to induce DNA damage.
A tan is not indicative of your health. A tan is an indication that you have sustained damage from UV radiation.
Myth #3: As Long As I Wear Sunscreen, I Am Protected From The Sun
Unfortunately, that is not true. Sunscreen does not offer complete protection. Even high SPF sunscreen does not block all UV radiation. Many commercial sunscreen products do not provide adequate protection against UVA radiation. UVA radiation is responsible for causing premature aging of the skin and is believed to contribute to skin cancer. For more information regarding the visible effects of UV radiation damage, please visit our science-based skincare guide that actually works.
While the biggest issue with sunscreen is its misuse, it is not the only issue. People tend to apply sunscreen and then remain outside in the sun for extended periods of time than they would have prior to applying sunscreen. Consequently, the amount of UV radiation that is absorbed can be greater than if they had remained indoors.
This may be one of the reasons why sunscreen appears less effective in population-wide studies. Sunscreen is frequently seen as providing a license to spend more time in the sun.
Does Sunscreen Work?
Yes, sunscreen is helpful — as long as it is used properly and is not viewed as a justification for spending more time in the sun.
One of the strongest real-world studies was performed in Australia. Approximately 1600 participants were randomly assigned to either wear sunscreen daily or to use sunscreen as they normally would. Following the completion of the original study period, participants were followed for a longer duration.
Participants in the daily sunscreen group experienced nearly half the risk of developing melanoma compared to the control group.
Other studies — including meta-analysis — have produced mixed or non-significant results for sunscreen and skin cancer prevention. However, this area of study is inherently difficult to research. Ethical considerations make it impossible to conduct long-term randomized trials in which one group is intentionally exposed to UV radiation. Additionally, population-based studies are plagued by multiple confounders, including tanning habits, an individual's outdoor lifestyle, and the quality of their sunscreen application.
We can confidently state two things:
- UV radiation causes skin cancer risk in a dose-response manner.
- Sunscreen reduces UV radiation exposure when applied appropriately.
Sunscreen’s Most Direct Visual Proof Of Effectiveness: Photoaging
Another method of evaluating sunscreen effectiveness that is easier to quantify than assessing cancer outcomes is assessing photoaging, which refers to the visual signs of skin damage resulting from UV exposure. The same UV radiation that causes skin cancer also causes fine lines, wrinkles, pigmentation, loss of collagen, and decreased elasticity. These changes occur rapidly and can be easily measured.
A groundbreaking study demonstrated that people who wore sunscreen daily demonstrated virtually no detectable photoaging over several years — whereas the other group did. In addition to the study referenced above, multiple systematic reviews demonstrate that sunscreen protects against photoaging.
If sunscreen prevents photoaging, it is preventing UV damage. And if it is preventing UV damage, it is preventing a significant factor contributing to skin cancer risk. Additional evidence supporting the relationship between sunscreen and photoaging is included in the advanced skin rejuvenation article.
The Most Effective Way to Use Sunscreen in a Safe Manner
Sunscreen should never be the sole tool within an overall sun safety strategy; it should only be one of many tools utilized.
A safer alternative would include:
- keeping out of direct sunlight during peak hours (10-4) when UV is at its highest
- putting on protective clothing, hats and sunglasses
- utilizing sunscreen as an additional protective layer for exposed skin
- never utilizing a tanning bed
- never using sunscreen as an excuse to spend more time in the sun
Final Takeaway
Although usage of sunscreen has increased, the amount of UV exposure people are receiving has also risen as a result of cultural/behavioral reasons such as utilization of tanning beds, extended periods spent in the sun, and the misconception that sunscreen makes tanning safe.
Utilizing sunscreen can assist with reducing UV damage and will lower your risk for developing melanoma if used properly. The issue is that we have stopped viewing sunscreen as the tool that it was intended to be and instead view it as a means of providing "full" protection from the sun.
If this were to occur, sunscreen would become a valuable tool to assist in reducing our risk for sun related issues, rather than a "false" shield that encourages us to continue spending more time in the sun.