by Ian Wishart
Remember, it is primarily melanoma that kills. The sunscreen in your cupboard is not lowering your risk of dying from skin cancer, no matter how many times a smiling person on TV urges you to slop on the sunscreen because of the dangers of melanoma. At best, the protective effects of sunscreen appear to be largely cosmetic in terms of slowing down solar aging. But at worst, sunscreens may be dangerously lulling you into complacency. Could it be that our massive melanoma rates are largely the result of a worldwide public health campaign encouraging people to use sunscreens that turn out to have been ineffective against melanoma?
Even the effectiveness against SCC cancers is far from total. A reduction of only 40% amongst people who use sunscreen religiously and well, still leaves a substantial relative risk of developing it.
It’s not the first time a major public health awareness campaign has been launched on the back of erroneous data and backfired tragically. Another live example that many readers will be familiar with is the global promotion of condoms in “safe sex” campaigns. Medical studies actually show condoms are next to useless against many sexually transmitted infections, with the result that sexual infection statistics have risen rapidly amongst teenagers who’ve been lulled into a false sense of security because of desires by health authorities to present simple, dumbed-down safe sex messages.[4]
In the case of melanoma, the embarrassment for public health officials actually gets even worse. Studies are showing that – ironically – people who get the most exposure to the sun are more likely to survive melanoma if they develop it, than people who slip, slop, slap religiously.
Let that one sink in for a moment as well.
If you regularly sunbathe and build up a tan and vitamin D reserves, your chances of surviving melanoma are much higher than if you are a 50 year old wallflower with the skin of a 20 year old who has sheltered away from the sun all her life. Researchers at the University of Leeds discovered this in a major study published in conjunction with the US National Institutes of Health in September 2009. People who regularly sunbathed and got melanoma were found 30% more likely to survive than non-sunbathers.[5]
Part of the reason for this enigma appears to be, yet again, the protective effect of vitamin D. Melanoma patients found to have the highest levels of vitamin D in their blood turned out to have the thinnest melanoma lesions on their skin – and the shallower the melanoma the less risk there is of it spreading deeper and further into the body.
“Higher [vitamin D3] levels, at diagnosis, are associated with both thinner tumours and better survival from melanoma,” reported the Leeds study. “Patients with melanoma, and those at high risk of melanoma, should seek to ensure vitamin D sufficiency.”
This also explains one of the mysteries to arise from Australia and New Zealand. At this current time in planetary history, the southern hemisphere is – because of Earth’s tilt angle – closer to the sun during summer than the northern hemisphere is during the northern summer. That means the southern nations are getting a stronger dose of UV radiation each year than Americans or Europeans.[6] It’s one of the reasons that the antipodes share the highest rates of melanoma in the world. Yet here’s the strange thing: they don’t have the highest death rates from melanoma. Far from it.
This apparent contradiction was one of the first clues that led researchers to suspect vitamin D had a protective role against dying from cancer. How else could one explain the highest rates of melanoma in the world yet also the best survival rates?
For inquisitive scientists like Leeds University’s Julia A. Newton-Bishop – the lead author on the original study, these paradoxes opened up fresh grounds for investigation. If sunbathers were more likely to survive melanoma, could it possibly be that sunbathing might actually help prevent melanoma from developing in the first place?
The idea seems ludicrous – we all know that sunbathing causes melanoma, don’t we? The reality is, we know less about the complex causes of melanoma than the simple messages published via the news media each summer imply.
Newton-Bishop’s team continued to dig deeper for answers and, in late 2010, they made a bombshell discovery: British residents who sunbathed for five hours or more without sunscreen per day each weekend during summer reduced their risk of developing melanoma by an incredible 33%, compared with people who stayed out of the sun.
That’s another of those let-it-sink-in moments.
If you look at it another way, people who obeyed the ‘sun smart’ message, slopped on the sunscreen and stayed out of the light, were a staggering 50% more likely to develop melanoma than people who actively sunbathed without sunscreen. This too might explain why so many melanoma victims in the media say, “but I only sunbathed occasionally, and I always tried to use sunscreen, it only took one time…”.
“When the data were analysed for tumours in different body sites,” reported the European Journal of Cancer study, “the protective effect of increased weekend sun exposure was strongest for limb tumours and tumours on rare body sites [those melanomas that frequently pop up where the sun don’t shine].”
Sun-shy people had more than double the risk of developing head and neck melanomas than their tanned, beach-going compatriots.[7]
Which brings us back to the issue raised at the start of this chapter: why are those people who religiously use sunscreen the most likely to develop the deadliest skin cancer? The answer appears to lie in a battle between Nature and Big Pharma.
If you adhere to the ‘nature’ argument, humans have been living naturally under the sun for tens of thousands of years. Indeed, all life on earth is dependent on solar radiation and our bodies are highly attuned to deal with it. Why then, are we dealing with a sudden explosion in the number of skin cancer cases?
In humankind’s quest to tame Nature, and indeed to advance ourselves, we have moved from a simple agricultural outdoors lifestyle to a mostly indoors one, particularly within the past 100 years. We no longer spend long hours each day outside in the sun, developing protective suntans that last year-round. Instead, we creep from house to car to office to car to house, five days a week, barely getting a few minutes of genuine sun a day, if that.
As a result of our indoor lives, we find we now need protection from the sun because we don’t have the time to build up tans gradually and naturally in the daylight in time for the summer break, we are simply too busy. So we reach for a pharmaceutical solution, trusting that the chemists have got it right and that human intelligence has beaten Nature.
This scenario would be all well and good – if sunscreens worked. The truth is, however, they have a lot of limitations. If your chances of getting melanoma were one in 1500 in 1935 (before the invention of sunscreens), and as high as one in 33 now, something has clearly gone wrong with the Big Picture.[8] In losing the protective effect of a long-lasting suntan, we have placed our trust in imperfect chemical formulations.
And here’s where it went wrong. For decades, sunscreens were quite good at blocking UVB radiation, but utterly useless at blocking UVA radiation, which actually makes up nearly 95% of the total UV light reaching the surface of the earth. UVA penetrates glass (and sunglasses, incidentally), which UVB doesn’t, and it penetrates more deeply into the human skin and so “may have greater destructive potential”. It’s known that UVA is more likely to age your skin and cause wrinkles. It is UVA that fades your carpets. UVB, on the other hand, is primarily responsible for causing sunburn but will also cause photo-aging of your skin.
However, here’s the important part. It is UVB that primarily stimulates your body to produce more melanin, the darker protective pigmentation we call a suntan. UVA radiation will also create an instant same day tan, but it uses existing melanin in the skin to achieve this and thus doesn’t actually stimulate a protective tanning response because it does not generate new melanin. This is one of the criticisms of sunbeds, which are mostly UVA driven – they’re very good at creating a rapid tan, but the tan is not a protective one. You cannot take a sunbed tan
out into the great wide open and assume you are protected.
So here’s the twist. Sunscreens that blocked UVB actually prevented your body from defending itself from total solar radiation. Many of the melanomas appearing in Baby Boomers and Gen-X today are arguably a direct result of dodgy sunscreen products from the sixties onwards that gave people a false sense of security. They were doing more damage to themselves by lying in the sun all day with a UVB sunblock on, mistakenly believing that because they were not burning then they were safe. In the meantime, UVA radiation poured into them utterly unmolested.
“UVA may have a greater potential for carcinogenesis”, reports the Cleveland Clinic Journal of Medicine.[9]
If this was an episode of Star Trek, a UVB sunblock while sunbathing (thus fooling the body into not generating a protective tan) is the equivalent of leaving the Enterprise “shields down” and unarmed while the enemy UVA sneaks aboard.
That, then, was strategic error number one. “A common misperception is that sunscreens decrease the risk of burning and allow people to increase their exposure to UV radiation. This results in increased exposure to UVA and thus increases the risk of skin cancers and facilitates photo-aging.”[10]
Hands up everyone who has languished on the beach for hours, thinking that their sunscreen is protecting them.
For that reason, the industry has moved predominantly to “broad spectrum” sunscreens that claim to block both UVB and UVA rays. For those who regularly apply broad spectrum SPF-16 or higher every day, studies have shown a long term 38% reduction in the incidence of squamous cell carcinoma – one of the least harmful kinds of skin cancer.[11]
Sadly, that might be all that sunscreens do.
“Although sunscreens appear to be effective in preventing actinic keratosis [sun spots on the skin] and squamous cell carcinoma, the evidence that they also prevent basal cell carcinoma and melanoma has been inconclusive,” reported researcher Paul Jou in June 2012.
Melanoma is the real killer when it comes to skin cancer. The mortality rate from melanoma is as high as one in five (20%). In contrast, the mortality rates from basal cell carcinoma (the most common skin cancer) and squamous cell carcinoma are around 1 in 333 (a 0.3% mortality rate). Melanoma is responsible for 75% of all skin cancer deaths. To discover that the primary weapon in the fight for a summer lifestyle is largely useless against the most common and deadliest skin cancers is disconcerting, to say the least.
A study from 2011 made the same point:[12]
“Safety of sunscreens is a concern,” reports study author Dr Marianne Berwick, of the University of New Mexico’s Cancer Centre and Department of Internal Medicine. “Sunscreen companies have emotionally and inaccurately promoted the use of sunscreens.”
With global sunscreen sales in the multi-billions of dollars every year, there’s money to be made in selling products that can be linked to public health campaigns. The problem for consumers and regulators is whether in fact sunscreens are worth what we are paying for them, or whether consumer fears have been overhyped.
More disturbing in my view, however, is that sunsmart promotions are not passing on this inconvenient truth to the public. New Zealand’s Cancer Society, for example, which as we’ve seen operates a very lucrative business in that country selling its own brand of sunscreen lotions, implies on its website that sunscreen protects against melanoma:
“New Zealand has the highest rate of melanoma in the world, and other skin cancers are also very common. You can help reduce your risk of skin cancer by using sunscreen the right way.”[13]
If New Zealand’s Cancer Society didn’t have the reputation of a major medical charity to save them, they’d probably be at risk in my view of a false or misleading advertising prosecution – especially given the deadly impact of the claims.
Similar claims are made in Australia: “Skin cancer is one of the most preventable cancers, yet Australian adolescents have by far the highest incidence of malignant melanoma in the world,” a spokeswoman for Sunsmart Australia said in a recent news release.[14]
On the basis of the science above, why are health agencies continuing to make these statements?
An Australian study often quoted by supporters of sunscreens was published in 2011.[15] It looked at an initial five year trial period and then a 10 year follow up, and found that regular users of broad spectrum sunscreens were less likely to develop primary melanomas. Critics, however, remain unconvinced.
“The study had serious limitations: the authors admitted that the results were marginally statistically significant; intervention sites of sunscreen application were chosen for nonmelanoma skin cancer and excluded the trunk and extremities, where melanomas often occur; and the entire body was analysed for melanomas, not just the intervention site. Thus, despite providing some of the first evidence supporting sunscreen’s ability to prevent melanoma, these results are controversial and by no means conclusive.”[16]
In addition, a follow-up analysis published in the same journal working from the same Australian data actually found a higher rate of melanomas on areas that had been allegedly ‘protected’ by broad spectrum sunscreen.
You’ll recall the studies quoted earlier where schoolchildren who used sunscreen regularly in controlled studies were actually more likely to develop melanoma precursors. The reason for this can possibly now be seen in context. By building a sun-safety message anchored primarily in the need for pharmaceutical companies to make a buck out of sunscreens, we have created a false but widespread public belief that sun exposure is easily controlled through sunscreens. It just isn’t true. There are screeds of studies that prove sunscreens are effective at protecting against ageing of the skin, and against largely harmless forms of skin cancer. But let’s face it, the real reason most people slop on the sunscreen is because they fear the Big-M that the media constantly warn them about.
So what happens when people swap their natural defence against melanoma (a suntan), for a solution obtained from a bottle that turns out to be ineffective? Melanoma rates go up despite increasing usage of sunscreens, and that’s exactly what has happened since 1935.
The weight of scientific evidence overwhelmingly suggests sunscreens don’t protect you from melanoma and, worse, may actually increase your risk of developing it. In addition, because sunscreens are so good at blocking the vitamin D producing UVB rays, they may actually be seriously increasing your risk of dying from melanoma if you do develop it, because your body now lacks D’s cancer-fighting protection.
Some of the same pharmaceutical companies who sold you the ineffective sunscreen in the first place will also make money from the hugely expensive cancer drugs or other medication you might later need.
It gets worse, however. You’ll recall that sunscreens have an SPF factor, supposedly to reassure you of their relative strength and duration of protection. What most people don’t know is that the SPF relates only to UVB radiation, not UVA. That means your SPF30+ sunscreen “might” give you all day protection from UVB (if applied under laboratory conditions), but it’s doing nothing of the sort against deadly UVA rays.
“But they’re all broad-spectrum sunscreens now, aren’t they?” you ask. Only to a point: studies have shown that titanium dioxide, the most effective block against UVA known to man, was only able to muster up a protection factor of 12 for UVA radiation when used as directed in a recent experiment,[17] yet the same mineral managed to hit an SPF of 38 in another experiment. To draw an analogy, relying on a broad spectrum sunscreen to protect you from cancer-causing radiation is like playing Russian Roulette using a gun where four of the six chambers contain live bullets. And they don’t tell you that on the back of the bottle.
Scientists actually don’t know how much UVA is being blocked, and sunscreen manufacturers are arguing amongst themselves about the problem:
“To this day, SPF lotions vary greatly in their broad-spectrum protection,” says a Procter & Gamble briefing. “Many SPF products claiming to reduce exposure to UVA do n
ot even contain an FDA-recognized UVA sunscreen, such as avobenzone or zinc oxide.”[18]
Now, here’s the important bit:
“Currently, there is no universal test method or standard product label to indicate the level of UVA protection.”
You read it right. We don’t know how effective UVA sunscreens actually are. The labels on the bottle promise the earth, but it’s unclear how much protection they are really delivering.
“Despite these variances in protection,” reassures Procter & Gamble, “experts still agree that everyone should practice sun-safe strategies.”
California-based dermatologist Lawrence Samuels is another bemoaning the lack of hard and fast data on UVA protection:
“Unfortunately, at the present time there is no measure to quantify the effectiveness of a sunscreen’s ability to block UVA rays. It is well known that chemical sunscreen ingredients that block UVA rays are somewhat unstable when exposed to UV rays and oxygen (air). This is further complicated by the fact that we do not have the ability to measure the stability or effectiveness of chemical sunscreens that block UVA rays.”[19]
When you factor in that most of us don’t use as much sunscreen lotion as manufacturers recommend, the protection factors (for what they’re worth) will be lower again.
In other words, let the user beware. If you still think your sunscreen is truly a broad spectrum lotion protecting you from UVB and UVA radiation, you may be endangering yourself and your family. The effect of using a sunscreen that, at best, might only be shielding 25% of UVA radiation and 95% of UVB, is similar to being bombarded with UVA rays on a sunbed, which health officials are very vocal about, incidentally.
Further proof that natural tanners do better than sunblockers comes from a 2009 study by the US Food and Drug Administration’s Dianne Godar and others,[20] which found indoor office workers have higher melanoma rates than outdoor workers – a finding that supports Leeds University’s Julia Newton-Bishop’s conclusion that people who get outside in the sun at weekends are less likely to get melanoma than people who stay out of the sun.