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Skin cancer

Americans are being diagnosed with melanoma, the deadliest form of skin cancer, at steadily rising rates.

According to the National Cancer Institute, the rate of new melanoma cases among American adults has tripled since the 1970s, from 7.9 per 100,000 people in 1975, to 22.6 per 100,000 in 2017 (NCI 2020).

The reasons for this trend are unclear, as are strategies for preventing it. Although we don’t know the exact cause of melanoma, scientists have established that risk factors include family history, indoor tanning, fair skin, freckles, moles, ultraviolet radiation and severe sunburns (CDC 2014).

In early 2019, the Food and Drug Administration released its final draft sunscreen monograph, which states that there is growing evidence linking ultraviolet A, or UVA, exposure to skin cancers. In an effort to protect consumers, the agency proposed to strengthen the required UVA protection of sun protection factor, or SPF, products. EWG has long urged the FDA to establish these stronger standards, but since the monograph has yet to be finalized, products that provide inadequate UVA protection are still legally allowed for sale.

Sunlight and skin cancer

More than three million Americans develop skin cancer each year (ACS 2017). Most cases involve one of two disfiguring but rarely fatal forms of skin cancer – basal and squamous cell carcinomas. Studies suggest that basal and squamous cell cancers are strongly related to UV exposure over a period of years.

Each year an estimated 91,000 Americans will be diagnosed with melanoma, and 9,000 will die from it (NCI 2018). Men have higher rates than women, and the American Cancer Society estimates that for 2021, about twice as many American men are expected to die from melanoma as women.

Melanoma is a complex disease with many unanswered questions, but sun exposure appears to play a role. One puzzling fact: Melanomas do not usually appear on parts of the body that get daily sun exposure.

Both UVA and UVB rays can cause melanoma. In the general population, there is a strong correlation between melanoma risk and how often a person has been sunburned, particularly during childhood (Dennis 2003).

The use of artificial tanning beds dramatically increases melanoma risk (Coleho 2010), and starting to use tanning beds before age 30 increases the risk of developing melanoma by 75 percent, according to calculations by the International Agency for Research on Cancer, or IARC. For this reason, in 2014, the FDA reclassified tanning beds to require new warnings stating that they can damage skin and shouldn’t be used by anyone under age 18.

Several factors suggest that regular sun exposure may not be as harmful as intermittent and high-intensity sunlight. Paradoxically, outdoor workers report lower rates of melanoma than indoor workers (Radespiel-Troger 2009). Melanoma rates are higher among people who live in northern American cities with less year-round UV intensity than among residents of sunnier cities (Planta 2011). Researchers speculate that higher vitamin D levels in people regularly exposed to the sun may help lower their melanoma risk (Godar 2011, Newton-Bishop 2011, Field 2011).

Don’t rely on sunscreens alone to prevent skin cancer

Every major public health authority – the FDA, the National Cancer Institute and the IARC – has concluded that the available data do not support the assertion that sunscreens alone reduce the rate of skin cancer (FDA 2011a, IARC 2001b, NCI 2011).

A 2011 study of sun-savvy Australians found that they cut their risk of melanoma in half by age 50 when they applied SPF 15 sunscreen daily, wore hats and avoided the sun in other ways (Green 2011). Additional studies show that sunscreens protect against melanoma (Autier 1995, Green 2010, Westerdahl 2000, Wolf 1998). Other studies have not reached such clear conclusions. Some suggest that sunscreen users are at increased risk of melanoma (Gorham 2007).

Stanford University dermatologists who reviewed data from a national survey by the Centers for Disease Control and Prevention concluded that people who relied solely on sunscreens for sun protection got more sunburns than people who reported infrequent sunscreen use but wore hats and clothing to shield themselves from the sun (Linos 2011).

Sunlight and skin damage

In addition to skin cancer, exposure to sunlight – including both UVA and UVB rays ­– is associated with damage to skin cells and DNA, and to advanced skin aging. To prevent skin damage and skin cancers effectively, American sunscreens should provide better UVA protection. This won’t happen in all products until the FDA sets higher standards for UVA protection and approves modern sunscreen ingredients with superior UVA filtering and stability.

In the absence of truly protective regulations, consumers are in the worst possible position – likely to think their sunscreen is providing more protection than it is, then staying out in the sun longer, thereby increasing their risk of skin cancer and skin damage.

 

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About the ratings

EWG provides information on sunscreen products from the published scientific literature, to supplement incomplete data available from companies and the government. The ratings indicate both efficacy and the relative level of concern posed by exposure to the ingredients in this product - not the product itself - compared to other sunscreens. The ratings reflect potential health hazards but do not account for the level of exposure or individual susceptibility, factors which determine actual health risks, if any. Methodology | Privacy Policy | Terms & Conditions

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