Daniel Pendick

Advice you may not hear from your doctor: Don’t go out in the sun without protection

I’m a Long Island boy, so growing up often meant spending eight to 10 hours at a stretch playing in the sea surf with my four brothers at Jones Beach, fishing for flounder off the town docks, skin diving around stone jetties the Sound, or treading for clams in the mudflats at the mouth of the Nissequogue River.

In all those years, I don’t recall hearing the words “Put on sunscreen” pass from my mother’s lips. (I did often hear “Stop throwing shells at your brother” and “Be back here at 4 p.m. or I’m leaving without you.”)

How times have changed. Getting ready to frolic in the sun now reminds me of the kind of checklist astronauts on the International Space Station need when suiting up for a 6-hour spacewalk in the full blast of the sun’s radiation. Today, my mom might have taped a list like this to the door:

  • Put on sunscreen 20 to 30 minutes before you go out.
  • Use a broad-spectrum sunscreen that blocks ultraviolet A and B, with a sun protection factor (SPF) of at least 30.
  • Use a full ounce (enough to fill a shot glass) to cover every exposed surface.
  • Reapply every two to three hours, or if you frolic in the surf or sweat profusely while throwing shells at your brothers.
  • Wear a wide-brimmed hat.
  • Wear clothing with a tight weave or with chemical treatments to make them UV-resistant.
  • Apply lip balm containing sunscreen.

Roger that, Houston. It seems the only thing missing is the gold-plated spacesuit helmet and a T-shirt for mom that says “Radiation Safety Officer.”

It’s all for a good cause, says my go-to sun protection officer at Harvard Medical School, Dr. Daniela Kroshinsky. As a medical dermatologist at Massachusetts General Hospital, she sees the long-term outcomes of repeatedly frying yourself in the sun—skin cancer and skin aging.

Her bottom line, in an article in the August 2014 Harvard Men’s Health Watch, is this: “Melanoma is on the rise. We really advocate that people take sun-protective measures and notify their doctors of any concerning or changing spots on their bodies.”

We’ve been told countless times that regular use of sunscreen prevents melanoma skin cancer—the most dangerous kind of skin cancer because it can spread to distant sites in the body and lead to death. But according to a research review article this week in the Journal of the American Medical Association, not all doctors share Dr. Kroshinsky’s enthusiasm for the gospel of sun protection.

The article points to a recent study in JAMA Dermatology of 18 billion outpatient visits from 1989 to 2010. It found that doctors made a note that they mentioned sunscreen at just 0.07% of patient visits, or roughly 1 in 1,400 visits. Dermatologists did better, mentioning sunscreen 11.2% of the time during visits that were expressly related to skin cancer past or present.

If it sounds like doctors don’t care about sun protection, don’t jump to conclusions. The records scrutinized in the study show only mentions of sunscreen that physicians consciously noted in the official record. They may have mentioned it and not recorded it.

And besides, everyone knows that sunscreen prevents cancer—don’t they?

Does using sunscreen prevent cancer?

It may surprise you that public health experts debate the merits of doctors offering sun-protection advice to their patients. Why? The evidence is spotty that advice from doctors on prevents cancer, according to a 2012 recommendation by the U.S. Preventive Services Task Force (USPSTF). The USPSTF is a panel of experts who weigh the evidence for the kinds of things primary care doctors do—like giving out sun protection advice, or urging their patients to stop smoking and eat healthier.

The USPSTF found that the best evidence we have says that sun protection counseling for fair-skinned folks age 10 to 24 helps prevent skin cancer, and does not appear to have any downsides for health.

As for those age 25 and up, we simply don’t have enough good evidence to say that “doctor’s orders” regarding sun protection reduces skin cancer. I asked a confessed sunscreen proponent, Dr. C. Douglas Taylor, Chief of Hematology and Oncology at the Cambridge Health Alliance in Boston, what he thinks of the USPSTF’s partly cloudy sunscreen recommendation.

“In the end you come to conclusions and do interventions based on the best evidence and common sense,” says Dr. Taylor, who is also an instructor in medicine at Harvard Medical School. “I think it’s quite clear there is an impact of regular sunscreen use on skin cancer, including melanoma, and on skin aging.”

To be fair, Dr. Taylor does have a bit of a pro-sunscreen bias. If you were at the June 2014 Boston Dragon Boat Festival on the Charles River, you would have seen his colleagues toting around gallon-sized pump jugs of sunscreen. In fact, he’s a bit of a Pied Piper of sun protection.

“You could have a high potency sun blocker, SPF 30 and above, available at public venues, like at your backyard or neighborhood swimming pool, boat club, or rowing club,” Dr. Taylor says. “A gallon jug that would be instantly available for everyone and it would last a long time. I don’t know that they would make this available to letter carriers at the US Post Office, but they really ought to!”

Related Information: Skin Care and Repair

Comments:

  1. Claudia Wells

    I wonder do doctors assume that we should all know about the benefits of using sunscreen from advertising. I know my dermatologist has told me to make sure I use it. I grew up in Florida and had many burns as a child but so far, I have not had any real problem. But I think I have just been lucky.

  2. Sonia

    Thanks for sharing this posting. It’s hard to know the best advice to follow as they seem to come out with conflicting evidence for sunscreen weekly. My biggest problem is that I often fall asleep in the sun (kiddos make you that tired!) and miss the reapply window, putting myself at risk (depending on who you talk to).

  3. Kevin

    Dr.Umar at DermHair Clinic suggests to wear sunscreen even under light clothing to avoid sun damage

  4. Grayson Ryke

    You have you two thumbs up for this and fun article. A very interesting to read and inseparable.

    Thanks

  5. Vince Mioraglia

    A recent study … Int. J. Epidemiol. (2013) doi: 10.1093/ije/dyt168 “Skin cancer as a marker of sun exposure associates with myocardial infarction, hip fracture and death from any cause ” found that “‘….Conclusions In this nationwide study, having a diagnosis of skin cancer was associated with less myocardial infarction, less hip fracture in those below age 90 years and less death from any cause. Causal conclusions cannot be made from our data. A beneficial effect of sun exposure per se needs to be examined in other studies. ” …..now since no studies where ever conducted on the overall effect of sun avoidance and the evidence for the use of sunscreen is less than conclusive if there is a benefit to at least sensible sun exposure than what overall effect will a generation that has been raised to fear sun exposure experience . Is there a real epidemic of melanoma? Or is over diagnosis the problem

    .”Br J Dermatol. 2009 Sep;161(3):630-4. doi: 10.1111
    “Melanoma epidemic: a midsummer night’s dream?”
    RESULTS:

    There were 3971 melanomas in all, and their annual incidence increased from 9.39 to 13.91 cases per 100,000 per year during the period studied. This increased incidence was almost entirely due to minimal, stage 1 disease. There was no change in the combined incidence of the other stages of the disease, and the overall mortality only increased from 2.16 to 2.54 cases per 100,000 per year.
    CONCLUSIONS:

    We therefore conclude that the large increase in reported incidence is likely to be due to diagnostic drift which classifies benign lesions as stage 1 melanoma. ”

    Medicine and marketing

    • Joann Love

      I agree with you, there are rumblings since the 1960′s that melanoma is the result of increased artificial estrogen exposure combined with sun exposure, such as oral birth control or in older men who also are at increased risk, exogenous estrogen exposure such as in milk diary products and given to chickens and beef from water sources and plastic, canned goods.

  6. faizal

    thank you very much.

    I like this post.

  7. Joan

    Thank you for a good blogpost on this subject. I totally agree with the conclusion. There are a lot of good sunprotectors available so please don’t put yourself in unnecessary danger.

    Regards,
    Joan

  8. yudha

    Is this cancer disease occurs throughout the world, because in my country is very rarely the case. what often happens is the brain cancer, bone and breast cancer

  9. Dr. arvind a desai md.

    WOULD THIS APPLY TO ASIANS IN GENERAL AND INDIANS IN PARTICULAR. WE SIMPLY DO NOT SEE SKIN CANCER THE WAY YOU SEE IT . THE NUMBERS I MEAN.

    • Daniel Pendick

      Dr. Desai,

      It is true that skin tone affects skin cancer risk. According to the American Cancer Society: “Melanoma is more than 20 times more common in whites than in African Americans. Overall, the lifetime risk of getting melanoma is about 2% (1 in 50) for whites, 0.1% (1 in 1,000) for blacks, and 0.5% (1 in 200) for Hispanics.”

      The Skin Cancer Foundation cites the following statistics for Asians and skin cancer:
      —Skin cancer represents approximately two to four percent of all cancers in Asians.
      —Skin cancer comprises one to two percent of all cancers in African Americans and Asian Indians.
      —Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.

      If you go to the following website from the Skin Cancer Foundation, you can find more details as scientific sources: http://tinyurl.com/km8rraw

      DP

  10. Prof. Dr. Parimal A Parikh

    What do the studies say about the effects of metal or metal oxides nanoparticles on skin or other organs upon their absorption through the skin? Such nanoparticles are present in the sunscreen lotions.

    • Daniel Pendick

      Dr. Parikh:

      A recent review in Nanotoxicology stated that “there has been no comprehensive assessment of the impact on human health from exposure to the metal oxide
      nanoparticles destined for use in sunscreens, either in the workplace during the manufacturing process, in long-term use across a range of skin conditions, or
      upon release into the broader environment, either accidentally or consequent of
      normal sunscreen use.” [http://www.ncbi.nlm.nih.gov/pubmed/20795900]

      DP

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  12. John

    Interesting article.

    I was shocked (and somewhat grossed out) when I read this week about a sunscreen that you can drink! How nasty is that?! I mean, I love the smell and all, but c’mon people! lol I’ve never used too much sunscreen, as I rarely get burned. If I’m on vacation or something, I will obviously lather up, but for day to day life, I find its too big of an inconvenience to re-apply all the time.

    Great blog you have here.

    Regards,
    John from Hiring Simulation Assessment