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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 this deadly cancer. 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). It’s possible to control just three of these risk factors: indoor tanning, exposure to UV radiation and severe sunburns.
In early 2019, the Food and Drug Administration released its final draft sunscreen monograph, which states that since 2011, the evidence linking UVA exposure to skin cancers has increased. In an effort to protect consumers, the agency’s most recent draft reverts in part to its 2007 proposal to strengthen the required UVA protection of sun protection factor, or SPF, products. These improvements to UVA protection have been put on hold by the sunscreen legislation passed within a coronavirus stimulus bill. This new legislation delays for at least a year any changes consumers will see in products.
EWG has highlighted the need for strong UVA protection and for close to a decade has incorporated it into our top products list. In contrast to FDA, we implemented changes to our methodology to further strengthen the requirements for UVA protection in products that make our top list.
Every major public health authority – the FDA, the National Cancer Institute and the International Agency for Research on Cancer – 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).
More than 3 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 people will be diagnosed with melanoma, and 9,000 Americans will die from it (NCI 2018). White Americans have much higher melanoma rates than people of other races. Men have higher rates than women. Sun exposure appears to play a role, but melanoma is a complex disease with many unanswered questions. 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 the number of sunburns a person has had, particularly during childhood (Dennis 2010).
The use of artificial tanning beds dramatically increases melanoma risk (Coleho 2010). The risk of melanoma goes up with the use of a tanning bed at any age, but the International Agency for Research on Cancer calculates that starting to use tanning beds before age 30 increases the risk of developing melanoma by 75 percent. 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 with regular sun exposure may play a role in reduced melanoma risk (Godar 2011, Newton-Bishop 2011, Field 2011).
Since scientists don’t know for certain whether sunscreen alone can help prevent melanoma, EWG strongly disagrees with the FDA’s decision to allow sunscreen makers to claim their products prevent cancer.
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 indicate that sunscreens protect against melanoma (Autier 1995, Green 2010, Westerdahl 2000, Wolf 1994). 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 CDC national survey data 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).
Today’s sunscreens do not fully protect skin from all types of UV damage. High-energy UVB rays burn skin and directly damage skin DNA, but they make up just 3 to 5 percent of UV radiation striking the earth’s surface.
More numerous UVA rays, by contrast, can be equally damaging without blistering the skin. UVA radiation penetrates skin tissue more deeply and can generate free radicals – energized molecules that are highly reactive and can damage DNA and skin cells, advance skin aging and cause skin cancer.
Avobenzone and zinc oxide are the two best UVA filters in American sunscreens, providing the desired protection from free radical formation, and titanium dioxide is moderately effective at protecting against UVA rays. Yet even they are far from perfect. UV rays can break down avobenzone, although it’s almost always mixed with a stabilizer to slow down the process.
Skin damage also depends on whether the sunscreen is applied correctly. One study found that free radical generation dropped by 55 percent when the recommended thick coat of sunscreen was applied, but benefits were reduced in cases of a more typical coating (Haywood 2003).
European sunscreens seem to provide greater free radical protection, because they can contain superior UVA filters.
Many sunscreens currently on the US market contain anti-inflammatory and antioxidant chemicals that can boost SPF values without necessarily preventing UV rays from hitting the living skin cells the way an FDA-approved active ingredient in sunscreen would (Kobo 2015). Anti-inflammatories like botanical extracts from licorice, chamomile and aloe, for instance, reduce skin reddening (Couteau 2012). Antioxidants like vitamins E and C can be added to “quench” or absorb the free radicals caused by UV rays, but the forms or amounts they are added in may not be effective (Wang 2011a). Given the increasingly widespread use of these SPF boosters, EWG wrote to the FDA in 2016 urging it to investigate the protection they offer from other types of long-term skin damage.
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. Current FDA regulations require sunscreens to have a critical wavelength value of 370 nanometers for them to be considered “broad spectrum,” or offer effective UVA protection. This is a very low bar. However, in 2019, the agency recognized the skin damage consumers risk with UVA protection and proposed a more stringent test.
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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Take EWG's Sunscreen Guide with you! Download the Healthy Living App Today