Is Sunscreen the New Margarine? (Our Expert Says No!)
You may have read Rowan Jacobsen's interesting (controversial?) piece in Outside Magazine where he questions current guidelines for sun exposure and suggests that they may be unhealthy, unscientific, and perhaps even racist. This consideration is based on the work of Dr. Richard Weller, a dermatologist at the University of Edinburgh. Read Rowan's provocative piece here.
Intrigued, I ran his article by my friend and world renowned melanoma expert (who you may have met during our annual TVD / Stanford Skin Screening events!) Dr. Susan Swetter, Professor of Dermatology at Stanford. She replied:
"As a melanoma/skin cancer expert for 25 years, I think the biggest problem with Dr. Weller's take on vitamin D and skin cancer risk is the near absolute disregard for the morbidity and mortality we see with melanoma – as well as other sun-related skin cancers. While nonmelanoma skin cancer type (i.e, basal cell and squamous cell carcinomas) don't generally result in death (though at least 2,500 deaths related to cutaneous squamous cell carcinoma occur annually in the US), the disfiguring surgery, downtime and patient/medical system cost of therapy is enormous given how common these skin cancers are – in the billions of dollars. With melanoma, sadly many patients die from disease – even with the more recent advances in treatment. In addition, the absolute number of deaths related to cutaneous squamous cell carcinoma is rising, with 2012 data estimating this number between 3,932 to 8,791 annually, the upper limit of which approaches annual melanoma-related deaths (over 10,000 per year).
A paper was published in 2015 by the CDC that showed that comprehensive primary prevention (including regular sun protection/sunscreen use) could prevent 230,000 cases of melanoma between 2020 and 2030 and save billions of dollars in first year treatment costs. There is no question that primary prevention practices are beneficial for skin cancer prevention, especially when started early in life and focused on higher risk individuals with greater sun sensitivity/lighter complexion, or other risk factors.
The causes of hypertension are so multifactorial, and no matter how much the association studies try to match for confounders, it's nearly impossible without a randomized controlled trial (i.e. more time in the sun generally means more exercise which lowers blood pressure in itself).
I can't imagine promoting the risk of potentially deadly/disfiguring skin cancer over the possible small contributing benefit of increased sun exposure for hypertension. That being said though, I believe Australia and England have a more rational approach for the consumer – namely, avoid tanning, tanning beds and sunburns; use sunscreen daily to high risk areas of the body for skin cancer (face, scalp, arms, hands); and get some sun in moderation, while maintaining a healthy lifestyle."
Thank you Susan, I couldn't agree more.
Dr. Eric Weiss