Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Sunscreens: The balancing act between safety and cancer prevention

J. Leonard Lichtenfeld, MD
Conditions
September 12, 2020
56 Shares
Share
Tweet
Share

That’s the question that will be on the minds of many as the Food and Drug Administration releases a second study on the absorption of sunscreens. The reality is that answering the “safe” question is becoming more complicated—and more important as well, given the fact that so many of us use sunscreens as part of our own sun safety efforts, while others (me included) use sunscreen as part of our daily routine.

Despite the questions raised in this study, the FDA concludes: “These findings do not indicate that individuals should refrain from the use of sunscreen.”

It is a difficult balancing act pitting product safety up against the prevention of some very nasty cancers. It leaves many consumers and experts in the midst of a quandary of what to do and what to recommend.

Here is a factoid that many of you may not be aware of: We really don’t know as much as we need to know about the basic safety of most sunscreens.

Some are considered safe with a low risk of absorption. They are the mineral-based sunscreens that use zinc and titanium. However, those aren’t particularly cosmetically appealing, since they can leave a visible residue on the skin after application.

On the other hand, most sunscreens we use rely on a chemical base, and which do not usually leave whitish color on the skin. We apply them regularly, assuming that the ingredients have been tested to demonstrate that they do not cause harm. However, many of us have been surprised to find out that such testing—at least by modern techniques—has not been done. According to the FDA, we have a lot to learn about the safety of sunscreen, from the amount absorbed into our bodies to how long it stays in our bodies to whether there are other adverse consequences as claimed by some, such as affecting our endocrine and reproductive systems.

The current saga began last February when the FDA issued what is called a proposed rule, which was a bit of a shocker to people like me: they outlined a number of concerns about sunscreen absorption and safety. They basically said that if sunscreen absorption into the body was a very small amount that we didn’t need to be concerned.  However, if the amount was above a certain level (0.5 ng/ml), then we needed to know more detailed information about the safety of sunscreen. And, they said, we would have a final rule indicating what safety tests had to be done by November 2019.

There followed an article in the medical journal JAMA where the FDA reported research on four sunscreen ingredients, and guess what? They all were absorbed into the body and exceeded that minimal amount of absorption, adding fuel to the fire that perhaps we didn’t have as complete an understanding of sunscreens as we thought.

Now we have another study from the FDA, reporting on some of the same sunscreen ingredients, and adding a couple more. In addition, the researchers put the ingredients into several applications, including lotion, and various types of sprays (aerosol, non-aerosol, and pump). The researchers then did a careful examination in 48 volunteers of how much sunscreen was absorbed, how high the blood levels were, how long the sunscreen ingredient lasted in the blood, as well as how much stayed on the skin after application for how many days.

All the sunscreen ingredients exceeded that minimal threshold for absorption, some by quite a bit. In addition, some of the formulations left residue on the skin for quite a while, suggesting that absorption could continue into the body for a long time after sunscreen application was discontinued (up to 21 days for some of the ingredients in some of the formulations).

The conclusion:

In this study conducted in a clinical pharmacology unit and examining sunscreen application among health participants, all 6 of the tested active ingredients administered in 4 different sunscreen formulations were systemically absorbed and had plasma concentrations that surpassed the FDA threshold for potentially waiving some of the additional safety studies for sunscreens. These findings do not indicate that individuals should refrain from the use of sunscreen.

In an editorial that accompanied the research article, Drs. Adewole Adamson and Kanade Shinkai provided a balanced perspective on what is becoming a difficult question to answer:

“It is critical to recognize that these two studies conducted by the FDA do not provide any evidence that chemical sunscreens cause harm. However, the current study does provide important additional information documenting systemic absorption of commonly available chemical sunscreen filters and strengthens the need for current FDA efforts recommending safety testing for certain chemical sunscreen ingredients to confirm they are generally recognized as safe and effective.”

They go on to write:

Because good evidence indicates that UV exposure is a key modifiable cause of skin cancer and melanoma, sunscreen should continue to be an essential part of UV safety, which includes photoprotective clothing, eyewear, and avoidance of intense sun exposure. In the absence of clear data demonstrating harm, the use of chemical sunscreen may still be considered appropriate, the use of mineral-based sunscreen is a well-established safe alternative. Elevating the science of the benefits and harms of sunscreen should be a priority. The sunscreen industry must begin conducting these safety studies as recommended by the FDA. Until then, the harms of absorption of sunscreen filters will remain uncertain.

So, what do we do?

First, we need to realize there are alternatives: as noted, mineral sunscreens are considered safe and effective. They just don’t look too pretty. Second, we need to take the editorial’s advice to heart: There are other ways to stay safe in the sun. You can find recommendations on the American Cancer Society’s website, and don’t forget the message of Slip Slop Slap and Wrap: Slip on a sun-protective long sleeve shirt, slop on the sunscreen, slap on a wide-brimmed hat, and wrap on a pair of UV protective sunglasses—just like I do when I go to the beach. Avoid the sun at peak hours, seek shade, and of course, avoid artificial tanning beds.

We will work our way through this. We need solutions, and we need the FDA and the sunscreen industry to come together and give us the information we need. Uncertainty has huge risks, since some will inevitably take this indecision as an excuse to avoid sun-safe behaviors altogether.

However, don’t forget that the risk of skin cancer—especially melanoma—is very real. And not being safe in the sun is avoiding the reality that skin cancer can be a deadly disease.

J. Leonard Lichtenfeld is deputy chief medical officer, American Cancer Society. He blogs at Dr. Len’s Cancer Blog.

Image credit: Shutterstock.com 

Prev

COVID-19 reveals gaping holes in locum tenens contracts [PODCAST]

September 11, 2020 Kevin 0
…
Next

What is anti-racist medical education?

September 12, 2020 Kevin 4
…

Tagged as: Dermatology, Oncology/Hematology

Post navigation

< Previous Post
COVID-19 reveals gaping holes in locum tenens contracts [PODCAST]
Next Post >
What is anti-racist medical education?

More by J. Leonard Lichtenfeld, MD

  • Why won’t unproven COVID treatments go away?

    J. Leonard Lichtenfeld, MD
  • How can we improve the quality of medications?

    J. Leonard Lichtenfeld, MD
  • It’s time we get the technology working for the patients, and not make their lives more difficult

    J. Leonard Lichtenfeld, MD

Related Posts

  • Hormone replacement therapy is still linked to cancer

    Martha Rosenberg
  • We have a shot at preventing cervical cancer

    Lisa N. Abaid, MD, MPH
  • Obstruction of medical justice: How health care fails patients with cancer

    Miriam A. Knoll, MD
  • Despite progress in cancer care, cost and equity challenges still must be addressed

    David M. Aboulafia, MD
  • Balancing stewardship and entitlement in health care

    Hans Duvefelt, MD
  • Using the Avengers to explain how cancer treatments work

    Jennifer Lycette, MD

More in Conditions

  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • The teacher who changed my life through reading

    Raymond Abbott
  • Revaluating mental health assessments: It’s not just the patient you should consider

    Tomi Mitchell, MD
  • Breaking down barriers: How technology is improving diabetes management in underserved communities

    Anonymous
  • Yoga and self-care won’t cure my Crohn’s disease

    Kristen L. Cole
  • What causes fainting and how to prevent it during needle procedures

    Jean Paul Brutus, MD
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Lifestyle change: the forgotten solution in health care

      Tyler Petersen | Conditions
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • How medical student loan forgiveness can advance health equity [PODCAST]

      The Podcast by KevinMD | Podcast
    • The rise of generative AI in health care: Here’s what you need to know

      Anil Saldanha | Tech
    • Finding peace through surrender: a personal exploration

      Dympna Weil, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Unlocking the secret to successful weight loss: Curiosity is the key

      Franchell Hamilton, MD | Conditions
    • The teacher who changed my life through reading

      Raymond Abbott | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Nobody Wants This Job. Should Physicians Stick Around?
  • Early Postpartum IUD Placement Yields Low Complete Expulsion Rate
  • Hydrocortisone Reduced Mortality in Patients With Severe Pneumonia
  • Obesity Tied to Density of Food Stores Carrying Less Healthy Options, Report Finds
  • 4F-PCC No Help in Trauma Patients at Risk of Massive Transfusion

Meeting Coverage

  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • High Rates of Psoriasis Clearance With Investigational TYK2 Inhibitor
  • Rapid Improvement in Atopic Dermatitis With Topical PDE4 Inhibitor
  • New Approaches in the Bladder-Sparing Paradigm
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Lifestyle change: the forgotten solution in health care

      Tyler Petersen | Conditions
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • How medical student loan forgiveness can advance health equity [PODCAST]

      The Podcast by KevinMD | Podcast
    • The rise of generative AI in health care: Here’s what you need to know

      Anil Saldanha | Tech
    • Finding peace through surrender: a personal exploration

      Dympna Weil, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Unlocking the secret to successful weight loss: Curiosity is the key

      Franchell Hamilton, MD | Conditions
    • The teacher who changed my life through reading

      Raymond Abbott | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Sunscreens: The balancing act between safety and cancer prevention
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...