sunscreen prevent skin cancer

If you ask dermatologists who needs sunscreen? The answer is automatic: EVERYONE! The official word from the American Academy of Dermatology (AAD) is that “Sunscreen use can help prevent skin cancer by protecting you from the sun’s harmful ultraviolet rays.” You cannot get any clearer than that. But does slathering on the sunscreen prevent skin cancer? Is there solid scientific proof to support the AAD position that you should use sunscreen every day you are outside and reapply it every two hours.

A Reader Had a Seemingly Simple Question: Will Sunscreen Prevent Skin Cancer?

We stirred up a hornet’s nest when we answered a reader’s question about sunscreen. He wrote:

“It seems to me that sunscreens may prevent burning, but I’m not sure they prevent skin cancer. The incidence of all types of skin cancer has increased since sunscreens were introduced.”

Here is the original Question and Answer:

How Well Do Sunscreens Work to Prevent Skin Cancer?

When we went searching for solid scientific proof that vigorous sunscreen use prevents skin cancer, we were shocked to discover that we didn’t find much. We assumed that there would be dozens of large, well-controlled clinical trials designed to answer the question: does sunscreen prevent skin cancer?

The Cochrane Database of Systematic Reviews:

The first place we searched was The Cochrane Database of Systematic Reviews (July 25, 2016).  This organization is one of the most independent and trusted sources of medical evidence. Read about Cochrane at this link.

In trying to answer the question does sunscreen prevent basal or squamous cell skin cancer, the authors reviewed the available literature and found only one study worthy of analysis:

“We included one RCT [randomized controlled trial] that randomised 1621 participants. This study compared the daily application of sunscreen compared with discretionary use of sunscreen, with or without beta-carotene administration, in the general population. The study was undertaken in Australia…”

Their conclusion:

“In this review, we assessed the effect of solar protection in preventing the occurrence of new cases of keratinocyte cancer. We only found one study that was suitable for inclusion. This was a study of sunscreens, so we were unable to assess any other forms of sun protection…

“We were unable to demonstrate from the available evidence whether sunscreen was effective for the prevention of basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC).”

What About Sunscreen vs. Melanoma?

Basal cell and squamous cell carcinoma are serious cancers, but they are common and rarely life-threatening if discovered early and treated appropriately. Melanoma is a different matter. This skin cancer can be lethal. That is why it is so important to try to prevent melanoma.

Another meta-analysis examined whether sunscreen use reduces the risk of melanoma and non-melanoma skin cancer. The outcome was also inconclusive (European Journal of Dermatology, April 1, 2018).  The authors wrote:

“While the current evidence suggests no increased risk of skin cancer related to sunscreen use, this systematic review does not confirm the expected protective benefits of sunscreen against skin cancer in the general population.”

Dermatologists Are NOT Happy with Us!

Not surprisingly, some dermatologists were dismayed by this message. One wrote:

“After spending over 40 years treating skin cancer and counseling patients on sunscreen use, I feel that the ‘data’ you reported needs interpretation in real life terms.

“Sunscreen use in many studies does not necessarily mean adequate use. A good British study done years ago showed that the average person applies only about 25 percent of the recommended amount of sunscreen. I suspect that the subjects in the studies you cited did not apply sunscreen half an hour before going outside, reapply it every two hours, or put it on more often if they were swimming or perspiring.

“My favorite advice to patients is if you can see without a flashlight, you should have sunscreen on.”

Not Enough Sunscreen?

One reader shared the dermatologist’s skepticism about the sunscreen studies. She wrote:

“What if the positive correlation between sunscreen use and skin cancer were caused by overconfidence of sunscreen slappers-on so that they stayed in the sun much longer than the non-slappers-on? Did the studies include average time spent in the sun, and time of day outdoors?”

She might very well be right.

Another reader chimed in:

“As a result of reading your article, I checked the labels on all our sunscreen bottles. They claim to prevent sunburn but say nothing about skin cancer.”

Avoiding Sunburn!

Avoiding the immediate pain of a sunburn is in itself worthwhile. But if we want to prevent the much greater and longer-lasting harm of skin cancer, especially life-threatening melanoma, we’ll need better research to answer the question: Does sunscreen prevent cancer?

The American Academy of Dermatology should sponsor a very large, well-controlled clinical trial (with optimal sunscreen applications) to show us whether sunscreens are truly effective at preventing skin cancer!

We live in an era of “evidence-based medicine.” That means physicians are supposed to rely on solid science to inform their recommendations. The public deserves better research when it comes to sunscreen to prevent skin cancer.

While We Wait:

In the meantime, perhaps we should all follow some simple common-sense approaches. Don’t go out in the sun between 10 and 2, when you are more likely to suffer a sunburn.

To encourage you to follow this challenging advice, take 30 seconds to listen to this famous Noel Coward song:

Mad Dogs and Englishman

Use a hat with a brim, a long-sleeved shirt and long pants for protection if you must venture out. (If that sounds too hot, as well as too old-fashioned, look for some of the specialty clothing that has ultraviolet protection built in.)

When you put on your hat, don’t forget your sunglasses. And be aware that some popular medications may increase the likelihood of a sunburn. The diuretic hydrochlorothiazide (HCTZ) for example has been linked to an increased risk of squamous cell skin cancer (Journal of the American Academy of Dermatology, April, 2018).

Read more about HCTZ and skin cancer at this link:

Hydrochlorothiazide Side Effects: Skin Cancer and More!

Share your thoughts about sunscreen in the comment section below. We especially welcome data from dermatologists that might answer the question: does sunscreen prevent skin cancer?

* * *

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. Here is a link to the podcast so you can subscribe for free.

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  1. Naomi
    S. Florida
    Reply

    I have never understood why exposure to the sun is supposed to be the major cause of skin cancers when my husband who never went without a shirt (or more covering) on his body, never sunbathed, may not have reached 12-15 days total at any beach/pool – in short, his shoulders and upper chest never experienced much sun light – why did he get a melanoma under his left clavicle?
    I just don’t “get it”.

  2. Marie S
    CA
    Reply

    I make my own sunscreen by adding zinc powder to skin lotion. It’s a sun blocker and doesn’t stain your clothes yellow like the chemical store bought. It’s much more effective too. During the time I was using store bought spray on, I never got burned, but I developed a lot of age spots. I think moderation is the key, like people are saying. I play tennis but I try to be done by ten, or at least 11 AM. At the beach I prefer to stay in the shade, unless I’m swimming.

  3. Janice
    NC
    Reply

    By using sunscreen you may limit the amount of Vitamin D your body may produce and there are studies that indicate lower Vitamin D may contribute to cancer. So while you are studying the sunscreen you may want to monitor Vitamin D in participants. There are many variables to consider here.

  4. Susan
    Florida
    Reply

    I grew up practically living on the beach in Okinawa. Lived in Texas and Florida the other half of my life. I am a blonde with medium toned skin color and have never used sunscreen. I am 63 and have great skin and no cancers.

    I personally follow be safe in the sun by the times of the day for exposure to avoid burning. I do question the sunscreen industry for profit. I am a retired R.N. and also question most physicians advice on the use of sunscreen. I think many Docs only repeat what they were taught and often don’t question or think outside the box.

  5. Thomas
    Kingwood TX
    Reply

    Sunscreen came on the scene in the early 70’s. The rate of Melanoma incidents has increased steadily from 6.8 per 100,000 in 1972-3 time period to 18.3 in 2002 and it is still climbing to 26 in 2016. ( Source National Cancer Institute) Just the opposite of what one would expect. I am 86, grew up with full sun, no sunscreen. I play golf in shorts and polo shirt. No sunscreen. One tiny squamous cell hicky removed. I think sunscreen chemicals are to blame. Titanium dioxide is a known carcinogen in the presence of UV.

  6. Paula
    Hillsborough NC
    Reply

    I’m 55, blond, blue eyes, pale. I’ve used sunscreen for as long as it has been available. I think in the 70’s only Coppertone “Suntanning”oil or lotion, which provided little protection, was around. I have no wrinkles, no saggy skin, no sun spots, no signs of being more than 35 years old. Use sunscreen to preserve your youth, if you’re vain. Even if it doesn’t prevent cancer, it prevents ageing.

  7. Nellie
    USA
    Reply

    Avoiding sunburn is a good idea, but slathering chemical soup on my skin in huge amounts is not. At the beach I use SPF 15 in northern climate, and SPF 30 in tropical and make sure I don’t burn. I will not douse my skin with chemicals every time I go outside; this is baloney. Then we wonder why so many people are vitamin D deficient.

  8. Bob
    South Carolina
    Reply

    Two points. As a kid we all played in the sun for years and years and usually for several hours a day. Never knew of anyone who came down with skin cancer. Later on in life I rarely saw anyone playing sports put on sun screen. Again they were usually out in the hot sun for at least an hour or two and never knew of anyone with skin cancer. About the only time my acquaintances used sun screen was at the beach. Dermatologists need to answer these observations before advising their patients to basically go all day with sun screen on their bodies which some have.

    Second, like the other post I am concerned about chemical absorption. The chemicals that are in sun screen do get absorbed into the body. This is fact and something most people do not take seriously or even know about. While the effects are unknown why even take a chance?

  9. james
    Colorado
    Reply

    Sunbathing is one of the most self-destructive behaviors ever, ranking right up there with smoking cigarettes. The only sunscreen that works is shade. If prolonged exposure to direct sunlight is required then a high intake of polyphenols (tea, cocoa, berries, etc) offers some protection. Otherwise, wear long sleeves, long pants and a hat, just like our grandparents.

  10. Sara
    Tampa, FL
    Reply

    I like getting my daily essential dose of free vit D from the sun. I never use sunscreen, but I always use the dminder app so I don’t get burned. Not getting enough vit d is linked to a whole host of health problems including cancer. I am angry with dermatologists in America who seem to only want to treat symptoms and not the problem.

  11. pam Caldwell
    PENNSYLVANIA
    Reply

    The seeds of the issue are in your write-up above: the fact that most people only use 25% of the amount required by the dermatologist standards. I submit to you that if “everyone” is using only 25% of the product needed to be effective against skin cancer or even sunburn, that’s a problem. The reason most people don’t like using sunscreen is it feels cruddy on the skin– sticky, makes sand and dust and dirt and grass clippings and bugs stick to you, increases the feeling of being hot when you’re already in the sun and/or exerting yourself, and feels icky in the water and mixes with your sweat and makes you feel hotter rather than cooled by the breeze moving over your skin. Yuck!
    Instead of telling us to put on more of a product most of us and esp kids find repulsive, fix the product so it’s more concentrated, and doesn’t come off when you swim or sweat. I’m 66 and never wear the stuff except at the beach and then only an oil free product for my face and a spray elsewhere which is all I can tolerate, and despite spending lots of time outdoors, I have no issues with skin cancer.

  12. John
    Croydon, PA
    Reply

    I choose to cover up, and make minimal use of sunscreen. I noticed that my face still gets tan, in Pennsylvania, even with a my wide brim hat… reflection off roads.

  13. Margaret
    Wisconsin/Mexico
    Reply

    I have used no sunscreen for many years, even though there is melanoma cancer all over in my family. I know that all the chemicals in sun screen are absorbed into my skin, and I don’t trust that they are all harmless. I take a B vitamin supplement PABA (para-amino benzoic acid) orally and try to stay out of the sun during mid-day. I get some tanning but have not burned my skin in many years. I am now 70 yrs old and have had a couple of basal cell cancers removed. I have been a ‘snow-bird’ for 20 years, so am in sunny weather all year long. This works for me. I always follow the money. Sunscreen is a billion dollar plus industry. Of course they promote it.

    • Paul
      Goochland, VA
      Reply

      I absolutely agree. No one seems to be studying the long term effects of “slathering” sunscreen “every two hours” anytime you go outside. Using “common sense”, this is ridiculous. I work outside every day, and never put ANYTHING on my skin, near the frequency they suggest for sunscreen, not even moisturizer or soap. These dermatologists need to get real.

      • Sally
        WA
        Reply

        Well, you are lucky. If I don’t put any sunscreen on I get burned after 20/30 minutes.

    • Susan
      Florida
      Reply

      Agreed,totally my thoughts!

  14. Michael
    Raleigh
    Reply

    Given that over-exposure as a child (or young adult) may result in middle-aged cancer, I don’t know how to do this experiment. If nothing else, it sounds impossibly long and uncontrollable.

  15. Philip M.
    Dallas, Texas
    Reply

    It seems to me that researchers could study 1000 hairless rats, by taking a third of the group and slathering on a SPF 30, another third with SPF 60 and not treating the balance as control. Then putting all rats outside in moderate sunlight at the same time and studying them over the course of their lifetimes of 4-5 years. Rats are considered to be good models of human biochemistry. The results of this study would give us a start on answering whether sunscreen can prevent cancer. The problem is finding funding for such a study, because the results, one way or the other, will not result in an increase of sunscreen sales, and could result in the opposite.

  16. Jackie
    Frisco, texas
    Reply

    I understand that European sunscreens are much more effective but they are not available here. Why not?

  17. Luke
    Florida
    Reply

    Sunscreen definitely helps prevent sun spots. I would say it can help prevent skin cancers. Better than nothing. I think many people do not use it correctly and it has to be 30 SPF or above. I like to ride my bike for exercise and I use it on my face and arms to prevent age spots. and it works.

  18. C.
    usa
    Reply

    Who would have known. Who would have questioned?

    I have gotten in trouble when assuming rather then truly knowing.

    It takes some one like the people’s pharmacy to ask a question when all assumed.

    Goes back to the who, what, where and why we should all be asking.

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