Screening Sun Protection
A Look at the Recent Sunscreen Debates

Now that summer is gone and the snowsports season is in full swing, may think that the use of sunscreen and overall sun safety can be relegated to the back of their minds. For those in the sun protection industry, however, sunscreen has been the never-ending issue of the year, as recent controversies have risen concerning sunscreen's efficacy in the battle to reduce the risk of skin cancer. The most notable example is the recent release of a potentially misleading report that sunscreens may, in fact, increase the risk of cancer. This hot topic has been further fueled by the growth of alternative medicine, which inherently questions the use of any "chemicals" when inert or natural vehicles are available.

For most folks who fear the wrath of ultraviolet rays, avoiding the sun is always an option. For outdoor enthusiasts, the sun is simply unavoidable and any news concerning sunscreen is of great interest. Of course, cutting through the verbiage tossed about by combating dermatologists, epidemiologists, cancer groups and research scientists is not always easy, especially when the dialogue takes place in the thick language of medical journals, research papers and symposium synopses.

In an effort to answer the growing number of questions regarding sunscreen, we have combed over those reports and papers, and turned to cancer and skin experts for advice. Following is a quick summary of some of the core issues and recent developments in the sunscreen debate.

As a quick background, sunscreens are designed to protect against sunburn and prevent skin cancer. While the former is evident to anyone who has tried sunscreen, it is the latter that is currently being questioned.

Generally, sunscreens are available in two forms: chemical and physical. Chemical sunscreens contain one or more active ingredient from a long list of approved chemicals. These agents, with names like octyl methoxycinnamate and oxybenzone, prevent sunburn by absorbing ultraviolet rays. Physical sunscreens contain inert minerals such as titanium dioxide and zinc oxide and work by reflecting or scattering ultraviolet rays away from the skin, as opposed to absorbing the rays.

Much of the skepticism regarding sunscreens involves the chemical sunscreen agents. The controversies surrounding these agents began in the early 1990s, when researchers started to notice an increasing rate of new melanoma cases, the most deadly form of skin cancer.

On the forefront of this movement was Professor Johan Moan of the Norwegian Cancer Institute, who in 1991 determined that the yearly incident of melanoma in Norway had increased 350 percent for women and 440 percent for men between 1957 and 1984. Several studies followed and eventually it was suggested that the greatest rise in melanoma was occurring in countries where chemical sunscreens have been heavily promoted.

The generally accepted explanation for these unexpected increases was that consumers who used sunscreen simply overestimated its protection levels and either stayed in the sun longer than normal or failed to reapply properly.

Part of the problem is sunscreen works as advertised. When used properly, sunscreen prevents sunburn, which is nature's way of telling us to get out of the sun. Without this painful warning sign, sun lovers are forced to rely on their own good sense, which evidently isn't always so good.

"Unfortunately, some individuals feel that sunscreen should provide enough protection, and they may ignore other sun safety behaviors that could provide additional protection," said Mark Naylor of the University of Oklahoma Health Sciences Centers, while speaking at last October's Derm Update '98.

A big blow to sunscreen supporters came at last February's annual meeting of the American Association for the Advancement of Science, when Marianne Berwick, an epidemiologist from the Sloan-Kettering Cancer Center, announced evidence that sunscreens may not protect users from melanoma.

"We have found no relationship between sunscreen use at any age and the development of melanoma skin cancer," said Berwick.

According to Berwick, studies that linked sunburns to melanoma were invalid because the participants' reports on their sunburn histories were unreliable. After re-examining old data and conducting new control-case population-based studies, Berwick's team concluded that genetically determined characteristics, like the combination of skin, eye and hair color, were more a determinate of melanoma than a history of sun overexposure.

"The Academy views [Dr. Berwick's] report as misleading and confusing to the public," said the American Academy of Dermatology (AAD) in a released response, "and a potential setback to over 20 years of sun safety public education."

Setback or not, Berwick's report seemed to open a can of worms, as questions concerning sunscreens and other accepted procedures of sun safety have taken center stage. Some hot topics currently being researched include the connection between blocking the sun's rays and Vitamin D deficiencies, the possibility that a light suntan may actually provide some protection for the skin and the potential that certain UV-absorbing chemical sunscreens undergo adverse reactions when exposed to sunlight.

Of course, supporters of sunscreen are unshaken, armed with reports and data of their own. The AAD, one of sunscreen's most vocal supporters, is quick to point out that reports based on studies performed prior to the mid-80s are misleading, because broad-based sunscreens (ones that protect from both UVB and UVA rays) and higher SPF levels were not widely available until about 1984. Since there is a period of 10 to 20 years from sun exposure to clinical appearance of melanoma, sunscreens would have had little impact on those patient studies, says the AAD.

Many well-established and respected groups like the American Cancer Institute, the Center for Disease Control and Prevention, the National Cancer Institute, the EPA and FDA still consider sunscreen an integral part of total sun safety. These groups cite recent evidence linking UVB and UVA rays to skin cancer and premature aging, and since sunscreens block these rays, they are beneficial, if not necessary.

At present, just about every expert, agency and association involved in skin, sunscreens and cancer continue to recommend sunscreen as a necessary part of sun safety--in conjunction with avoiding peak sun hours and wearing protective clothing--and no one is recommending the elimination of its use. Experts agree that people with light-colored skin, eyes and hair should take extra precautions, and when choosing SPF levels, consumers should consider their pigmentation and previous experiences with sun exposure.

For outdoor enthusiasts who are wary of recent controversies, the best choice is the less-controversial physical sunscreens like zinc oxide or any of a growing number of natural alternatives.

One thing that is for sure, more research on how the sun affects human skin and the part sunscreen plays in protecting our epidermis needs to and will be done in the coming months, so stay tuned.

Sun Protection Survey

Only four in 10 Americans believe it is "very important" to protect themselves from the harmful effects of the sun, according to a survey commissioned by the American Academy of Dermatologists. The AAD believes the results of its survey on sun safety habits and beliefs can be cause for alarm, especially in light of a study published in the May issue of the Journal of Pathology that establishes a link between the sun's UVB rays and melanoma.

Conducted by TeleNation in April 1998, the survey questioned 1,000 adults, half men and half women. The margin of error is 3 percent. Following are some of the interesting highlights from the AAD survey.

HOW PEOPLE PROTECT THEMSELVES

When do people wear sunscreen?

The SPF level people usually choose when they buy a sunscreen for themselves:

The SPF people usually choose when buying sunscreen for their children:

Do people use sunscreen that protects them from UVA and/or UVB rays?

What else do people do to protect themselves from the sun?

WHAT PEOPLE BELIEVE ABOUT SUNSCREEN

Martin Vilaboy is the Editor-In-Chief of Outfitter Magazine, an outdoor industry trade publication for outdoor retailers.