Despite public education campaigns about avoiding sun exposure and tanning
salons, skin cancer incidence is climbing. There will be about 62,000
melanoma cases and 7,900 deaths this year, the American Cancer Society
estimates. There are more than 1 million annual cases of squamous and basal
skin cancers, and about 2,800 deaths.
Think slathering on the highest-number sunscreen at the beach or pool will
spare you skin cancer and premature wrinkles? Probably not, if you're in
the sun a lot. That's because you don't need a sunburn to suffer the
effects that can cause various types of skin cancer.
Sunscreens generally do a good job filtering out the ultraviolet rays that
cause sunburn _ UVB rays. But with sunburn protection, many people get a
false sense of security that keeps them under the harsh sun much longer.
That adds to the risk of eventual skin cancer _ both deadly melanoma and
the more common and less-threatening basal and squamous cell cancers.
And most sunscreens don't defend nearly as well against the UVA rays that
penetrate deep into the skin and are more likely to cause skin cancer and
wrinkles. That's true even for some products labeled "broad-spectrum
UVA/UVB protection."
Experts say the best protection against UVA is a sunscreen that includes
zinc oxide, titanium dioxide or avobenzone. Consumers should also look for
those that are water-resistant and have an SPF of 30 or better, indicating
strong protection against UVB rays, and apply liberally and often.
More important, limit time in the sun, particularly from 10 a.m. to 4 p.m.,
and cover up, including wearing a hat and sunglasses.
Often, product labels are confusing or bear misleading claims. For example,
the SPF, or sun protection factor, refers only to defense against the less
harmful UVB rays.
"I don't think people understand they're only getting protection from part
of the spectrum," said Dr. Sandra Read, a spokeswoman for the American
Academy of Dermatology. "You're accumulating this damage and you don't know
it."
Many sunscreens say little about when to reapply _ doctors say at least
every two hours and after swimming or sweating. Nor do they say much about
how much to use, roughly two tablespoons for an adult.
"Most people who use an SPF 15 get the protection equivalent to an SPF 5
because they put it on" too thinly, said Dr. Martin A. Weinstock, chairman
of the American Cancer Society's skin cancer advisory group and a Brown
University professor.
While a higher SPF number means more protection, the difference is small:
SPF 15 blocks about 93 percent of UVB rays and SPF 50, often more
expensive, blocks about 98 percent.
Most sunscreens work by reacting chemically with the skin, so they don't
start absorbing damaging rays right away and must be applied a half-hour
before going outside, something many labels fail to note.
And claims such as "waterproof" and "sunblock" are unsupported, according
to the Food and Drug Administration, which years ago proposed replacing
them with the more-accurate terms "water resistant" and "sunscreen."
Manufacturers, including Neutrogena Suncare maker Johnson & Johnson and
Coppertone maker Schering-Plough Corp., say they haven't complied because
the FDA still hasn't imposed those rules _ a delay that's spawned consumer
lawsuits and pressure on the FDA from Congress and the American Cancer
Society.
Still, doctors say people shouldn't abandon sunscreen: They probably should
use more.
"Sunscreens do protect against skin cancer," said Dr. Babar Rao, a
dermatologist at Robert Wood Johnson Medical School in New Jersey. "We
definitely still need sunscreen, even on a cloudy day."
Research has shown heavy sunscreen use lowers risk of squamous skin cell
cancer, which has a high cure rate if caught early. Another study found
heavy sunscreen use in children reduces the number of moles, which can turn
cancerous later, Weinstock noted.
In 1999, the FDA announced tougher rules for sunscreen testing and label
and ad claims, to take effect in 2001. But the agency put them on hold
indefinitely to do more tests, said Dr. Matthew Holman, senior scientist at
the FDA's drug evaluation center.
Last fall, Congress ordered the FDA to produce the new regulations within
six months through a provision added by Sen. Chris Dodd, D-Conn., in the
FDA appropriations bill.
"Twenty years is long enough for the FDA to ensure that all Americans have
equal access to clear, accurate and comprehensive sunscreen labeling as
their first line of defense against skin cancer," Dodd said, referring to
how long the agency has worked on new rules.
Holman said proposed rules could be announced this summer, but then there
will be lengthy hearings and revisions. "All we can say is really years"
until they take effect, he said.
This spring, a San Diego-based law firm got pending lawsuits against makers
of the top sunscreens _ Coppertone, Neutrogena, Playtex Products' Banana
Boat, Tanning Research Laboratories' Hawaiian Tropic and Chattem Inc.'s
Bullfrog _ consolidated into one case in Los Angeles.
Lead lawyer Samuel Rudman, who has called the makers "Fortune 500 snake oil
salesmen," said manufacturers are fraudulent in their label claims.
"Our lawsuit doesn't say, 'Don't use sunscreen.' It says, 'Tell the truth.'
If people knew, they would still use it," Rudman said.
The lawsuit, filed on behalf of 10 California residents, also seeks damages
for unspecified injuries and other restitution.
The manufacturers either declined to discuss the lawsuit or said it is
without merit.
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