"Sun exposure is the most important environmental factor involved in the development of skin cancer," according to background information in the article. Melanoma has had one of the greatest increases in incidence among solid tumors in the past three decades and accounts for the vast majority of skin cancer deaths. Although daily sunscreen use has been shown to prevent squamous cell skin carcinoma, several studies suggest that sunscreen use may be a risk factor instead of a protective one for melanoma. Some believe that higher protection by stronger sunscreens may encourage more time in the sun by delaying warning signs such as sunburn, giving one a false sense of safety.
Alain Dupuy, M.D., M.P.H., from the Hôpital Saint Louis, Paris, and colleagues, conducted a week-long, randomized, controlled trial during the summer of 2001 to determine the effect of sunscreen protection on sun-exposure behavior. Three hundred sixty-seven vacationers from four French seaside resorts were given one of three sunscreens: SPF 40 labeled as "high protection," SPF 40 labeled as "basic protection," and SPF 12 labeled as "basic protection." No mention of actual SPF was made on the labels. Participants were given an initial questionnaire about general sun-exposure behavior and completed self-administered questionnaires each evening, detailing their sun exposure and protection for every half-hour period during the day. Eighty percent of the participants were women, with an average age of 39 years.
The researchers found that neither SPF nor labeling was associated with significantly different durations of sunbathing during the week. Average weekly sun-exposure time was 14.2 hours in the high/SPF 40 group, 12.9 hours in the basic/40 group, and 14.6 hours in the basic/12 group. Ninety-six percent (343) of the vacationers said they'd used the sunscreen at least once, with 77 percent (276) saying they used it exclusively. The proportion of those who experienced sunburn during the week was higher in the low-SPF group (24 percent) than the high-SPF group with the same label (14 percent). In total, 63 participants experienced sunburn, with six of them having severe sunburn.
"In this population, our findings do not support the hypothesis that a higher SPF induces a higher exposure by delaying the alarm signs nor the hypothesis that mentioning 'high protection' on the label may induce longer exposure by giving an impression of safety," the authors write. "In addition, this study logically confirms that the use of higher-SPF sunscreens does reduce the number of sunburns in real life. Finally, our results suggest that people tend to self-regulate their sun protection with sunscreens, by inversely adapting the amount of sunscreen to the SPF, at least when sunscreens are freely delivered."
(Arch Dermtaol. 2005; 141; 950 – 956. Available pre-embargo by the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from Société Française de Dermatologie, Paris, and by Pierre Fabre Dermo-Cosmétique, Castanet-Tolosan, France, which provided sunscreens.
Editorial: Sunscreen, Sun Protection, and Our Many Failures
In an accompanying editorial, Mark Naylor, M.D., from the Oklahoma Medical Research Foundation, Oklahoma City, and June K. Robinson, M.D., editor Archives of Dermatology, discuss sun-exposure behavior and its risks.
"As long as the great majority of the population intentionally seeks UV exposure for purposes of tanning and 'sunning,' melanoma incidence will continue to rise as leisure time and average population age increase," the editorialists write. "Unfortunately, it seems likely that a significant percentage of the population will continue to ignore our recommendations for minimizing lifetime UV exposure and, worse, that a substantial number will continue to intentionally seek UV exposure for the purpose of cosmetic tanning."
"One of the most chilling findings of Dupuy et al was not the featured data concerning sunscreen use; rather, it was the self-reported intent of 96 percent of the participants to get a tan during their vacation week, and this while they were participating in a sunscreen study!" the editorialists write. "Clearly, this population views sunscreens more as tanning aids than as a means of limiting UV exposure. Unfortunately, it is very clear from these and other studies that measure sun-exposure behavior that we have a long way to go to get this situation headed in the right direction."
(Arch Dermtaol. 2005; 141; 1025 – 1027. Available pre-embargo by the media at www.jamamedia.org)
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email email mediarelations@jama-archives.org.
Media Advisory: To contact Alain Dupuy, M.D., M.P.H., email alain.dupuy@sls.aphp.fr. To contact editorialist Mark Naylor, M. D., call Adam Cohen at 405-271-7159.
Journal
Archives of Dermatology