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% of UVB rays and SPF 50, often more expensive, blocks
about 98%.
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.
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.