Let's not forget that skin cancer prevention also includes, at an individual level, covering up with a shirt and/or broad-brimmed hat, and at a group level, provision of shade structures on playgrounds, playing fields, public beaches and similar locations.
Here in Texas one MUST protect from the sun. My personal "sun hacks;"
Broad brimmed hat - keeps you cool, too, by keeping the sun off your neck and shoulders
LONG SLEEVED reflective white shirt. My favorite is a specific brand that, shall we say, acts like armor underneath. (I am not getting paid!) Long sleeves made of reflective material keep you cooler by reflecting the infrared spectrum and keeping that heat energy off of your skin. The entire garment wicks away sweat, so you stay cool that way too. 105 degrees is not unusual here. You still get hot because the environmental temperature is well above your body temperature - so you have to dissipate body heat - but your ability to tolerate being in the sun will increase greatly with such a garment.
Sunscreen on what's exposed - hands, especially.
Stay in the shade - that's easy 'cause the sun is soooooo hot here in Tejas!
I have seen a flurry of internet “articles” about Korean sunscreens and how other countries (usually pointing to Korea and the EU) have better sunscreens that offer great protection while being more comfortable to wear. These “articles” say that sunscreen tech in the US hasn’t changed in decades due to FDA processes but outside the US there have been great innovations. I’d love to hear if you have any perspective on this — are there better sunscreen formulas outside the US, and if so, why the holdup in bringing them here?
Wow — I just checked out Dr. Wong’s website and found exactly what I was looking for on Korean sunscreen! I’d still be interested to know about why we don’t have these newer chemical filter options in the US, but here I am off to buy a bunch of sunscreen from Korea!
Also check out Evy (from somewhere in Scandinavia.). It’s amazing. Seems expensive, but if applied properly needs very little reapplication during the day. It’s easier to ship to the US than it was a year ago.
Keep in mind most Korean filters aren’t designed for hot days at the beach.
I used to love LaRoche Posay’s fluid (you can buy a product with the same packaging in the US but the chemical filters are different in the EU) — it doesn’t sting my eyes and works really well, but the last two bottles I’ve bought give me a very visible yellow cast to my cool-toned very pale complexion (and it stain linens yellow). So…it’s a good sunscreen under the right circumstances.
Dr Wong’s channel is the very best, but Dr Sam Ellis (medical and cosmetic dermatologist) also has some good sunscreen content. She practices in California and usually suppplies a link to a reputable source for ordering EU and Korean sunscreens.
I brought Bioré sunscreen back from Japan, but have also previously bought it from Amazon. I like it much better than smelly & thick zinc or titanium dioxide sunscreens available here. Link to NPR story discussed.
I agree with Scott. The perspective of danger is off here. Melanoma shows up where the sun doesn't shine also. Adequate Vitamin D levels are protective . Slathering your body every day with nanoparticles of chemicals is just not a go with me. Sunsceen in my blood is bad. Yet another chemical for my breasts to keep in and turn into another cancer? (Three timer) I have built up a good level of tolerance for the sun. When I have had enough, I cover up or get out of it.
While you are at it, you might consider a post about the kinds of heat illness and how to avoid them and manage them if they start to occur. And occupational safety regulations related to outdoor work. Which ought to apply to kids playing sports or doing marching band practice too, though they aren't always.
I am a retired epidemiologist with expertise in skin cancer prevention, so I read your most recent post with great interest.
First, let me congratulate you on going down the sunscreen rabbit hole! It's a complex topic and difficult to study epidemiologically as it relates to risk of melanoma because melanoma is so rare. Below are a few points I would like to add to your commentary.
1. Regarding proper use of sunscreen, we found in a case-control study we conducted (Cancer Epidemiol Biomarkers Prev. 2011 Dec;20(12):2583-93), that individuals do not use sunscreen properly. They do not apply sufficient amounts to obtain the benefit of the SPF, whether it's 30 or 50 and they do not reapply it as necessary. In our study, we found that use of sunscreen was either not associated or only weakly associated with melanoma risk, most likely, because improper use limits our ability to identify an association, if one exists. Furthermore, studies have shown that using even 50% of the recommended amount reduces the SPF protection, regardless of the factor, to very low levels of minimal benefit (Schneider, J. Arch Dermatol 2002;138:838-b-839-b). Inadequate application of sunscreen that leads to very low SPF is an important point to emphasize.
2. In our case-control study, the most consistently robust finding was for a decreased risk of melanoma if other sun protection methods were used, namely avoidance or covering up. Our results for methods other than sunscreen are consistent with the World Health Organization recommendations that place priority on these sun protection methods, and advise using sunscreen ONLY in conjunction with one of these other methods. The Australian Slip, Slap, Slop graphic you presented does not make this point clearly and I think our public health messaging for sun protection needs improvement, especially as in this country, studies have shown that most Americans associate sunscreen use with skin cancer prevention, even though the evidence is weak.
3. As for additional nuances, there is the concern that people use sunscreen to prolong their time in the sun. And if, as is likely, they are not using sunscreen properly, and are only using sunscreen and not one of the other methods, then they are very likely increasing their risk for skin cancer. Again, our public health messaging on sun protection is inadequate.
4. Lastly, you did not mention spray-on sunscreen. This application method should be discouraged as there is no way to know how much sunscreen is reaching the skin. I know it is a popular method with parents of young children due to its ease of application. However, parents need to know that spray-on sunscreen is not protecting their children,
Congratulations on your recent TIME recognition and the hard work of translating epidemiology for the public
I am so delighted to see Dr. Wong in a guest post! I’ve been a big fan for years.
Her YouTube channel (and blog) are a treasure trove of clearly explained beauty science, with a big focus on sunscreens. Her witty sense of humor is a bonus.
This feels like a case where the writer wants to be able to say sunscreen prevents cancer, so she glosses over the non-existent data to do so.
The fact is, we DO NOT have any evidence that using sunscreen prevents skin cancer.
It DOES prevent sunburn (and who wants sunburn?) and it MAY prevent unsightly skin damage (wrinkles), but don't rely on it to prevent cancer.
Indeed, there is no evidence that sun exposure causes skin cancer. UV radiation does, but genetics, age, and ones overall immune health play big roles, too. AND the kind on skin cancer matters, too. UV damages skin, which causes Basal cell carcinomas, not melanomas. Melanomas are the kind that kill. Basal cell carcinoma is easily removed and rarely turns into melanoma.
My mother's best friend died from melanoma. She loved gardening, and the black patch appeared on her left forearm, the part that faces the sun while working in the garden. Her doctors did eventually remove the black patch, but apparently they were too late.
and most common skin cancers are not very dangerous compared with the cancers avoided by sun exposure noted above -
"Survival for most non-melanoma skin cancers is excellent. The 5-year relative survival for BCC is 100%. This means that, on average, all of the people diagnosed with BCC are just as likely to live at least 5 years after their diagnosis as people in the general population. The 5-year relative survival for SCC is slightly less at 95%."
I understand the benefits of sunscreen, I just hate the way it feels. I've tried every brand available. So I mostly stay out of the sun, and slop it on during the handful of days a year that I'm out for awhile.
I understand the five icons for sun protection (clothing cover, sunscreen, hat, shade, and sunglasses), but how do the words "slap" and "slide" serve as mnemonics for "hat" and "sunglasses"?
I added “it on” in my mom brain, as if running out the door and telling Kid 1 or Kid 2 —“slap on a hat!” and “slide on your sunglasses!” Hey, whatever works! I especially like “slop on some
Originally it was three words: Slip, Slap, Slop. Very easy to remember, and the three words were more similar to each other..... When you see Australian schoolkids on the playground or on a school trip, every one of them has a hat (though they aren't all wearing them optimally, being kids....)
I've encountered this in Australia. I think it was a sun protection campaign when I was there. Slip, Slop, Slap. Slip on a shirt, Slop on the sunscreen, Slap on a hat. I love the addition of Slide on some sunglasses and Seek shade. Too bad there isn't a Sl word for shade! Slither to shade?? haha!
Thank you everyone for your responses to my questions. As it happens, our daughter now lives in Australia (Canberra in ACT) with her Australian spouse. I have sent your responses to the two of them to see if either remembers this ad campaign. The icons would work best if tied to a campaign that fleshed out the ideas. Sounds like that was what happened. Great community here.
It’s from a very successful public safety campaign in Australia. I think the full ad campaign tied the words to specific actions in a way that really clicked.
I'm wondering about amount of sunscreen. I read on the Skin Cancer Foundation's website that people need to apply a full ounce of sunscreen to their entire body to get full broad spectrum protection. Now, at home, I certainly could measure one ounce and do this, but I have not, and doing it out and about is... prohibitive. We don't get burned or even tan, really, with the amount of sunscreen I apply. Is not getting burned/tan the measure of success here?
Also, one ounce on me, a 6ft tall person is a lot different than one ounce on the kid at 3'7".
Maybe you could email Dr Wong to ask where exactly you look for the documentation of each company’s assumptions for amount of product per square inch? Each company definitely has that information and I think it’s filed with the government in a way the public can access. (Clearly, I’m fuzzy on the details.)
In a few places on Dr Wong’s YouTube channel, she discusses how spf calculations are made, and sometimes she shows the documentation lists a company’s assumptions for how much product per square centimeter. I have just never paused the video to note the section headings on the paperwork.
[In one particularly funny video, she carefully calculates the surface area of her own face, then applies the product in the amount the company says is necessary to achieve the listed spf — except the product in that video is a powder sunscreen where it’s impossible to get the spf listed unless you are willing to look -insane-. Also I think you have to powder so heavily that it would actually fall off your face. It was a funny video but also a powerful lesson. She’s a great science educator.]
I don’t think she’s done a how-to for finding each company’s documents for amount of product, but maybe she’ll consider doing a video on that topic.
My legs are so white, they've been spotted by the Space Station during the summer. I put on sunscreen even indoors. The thing I'm bad about is remembering to reapply every two hours.
Same here. I recently bought some leggings from Solbari that can be worn for swimming (ocean and chlorinated water). I get easily overheated, but find them very cool and easy to wear even for jogging in full sun. When your clothing has a guaranteed UPF rating you don’t need to worry about reapplying!
PS: because I am so pale, if I’m going to be out on a boat all day near the equator (once or twice a year), I will meticulously apply Evy to my skin and let it dry down to its protective film before putting on UPF clothing. Even UPF 30 or 50 clothing lets in some UV, and if there’s zero shade, I want that extra protection.
Dream team collab.! Thanks for the great information, Ph.D ladies!! Love it when science communicators broaden their reach, together! Sending to both my homeschool kids with notes—great lessons here in science, misinformation, infographic communication, and more.
I am a bit disappointed that this post seems to treat chemical and mineral sunscreens as if they are equally recommended. As you note, many of the chemical sunscreens on the market have not been shown to be safe and effective. Recommending mineral sunscreens, and (better yet) hats and sun-protective clothing, is a much better public health message.
One other point--the Environmental Working Group (ewg.org) reviews a comprehensive list of sunscreens with pros and cons for each brand. They also have a good summary of the state of the science on sunscreen.
The Environmental Working Group is not a good source - they profit from fearmongering (they pushed the vaccine/autism link until the mid 2010s), and their sunscreen content ignores the fundamental principles of toxicology and optical science, and don't reflect the consensus of relevant experts. I spoke about this on a recent episode of Conspirituality, along with Dr Andrea Love who covered their Dirty Dozen food misinfo.
Let's not forget that skin cancer prevention also includes, at an individual level, covering up with a shirt and/or broad-brimmed hat, and at a group level, provision of shade structures on playgrounds, playing fields, public beaches and similar locations.
Very timely an thorough, Dr. Jetelina!
Here in Texas one MUST protect from the sun. My personal "sun hacks;"
Broad brimmed hat - keeps you cool, too, by keeping the sun off your neck and shoulders
LONG SLEEVED reflective white shirt. My favorite is a specific brand that, shall we say, acts like armor underneath. (I am not getting paid!) Long sleeves made of reflective material keep you cooler by reflecting the infrared spectrum and keeping that heat energy off of your skin. The entire garment wicks away sweat, so you stay cool that way too. 105 degrees is not unusual here. You still get hot because the environmental temperature is well above your body temperature - so you have to dissipate body heat - but your ability to tolerate being in the sun will increase greatly with such a garment.
Sunscreen on what's exposed - hands, especially.
Stay in the shade - that's easy 'cause the sun is soooooo hot here in Tejas!
I have seen a flurry of internet “articles” about Korean sunscreens and how other countries (usually pointing to Korea and the EU) have better sunscreens that offer great protection while being more comfortable to wear. These “articles” say that sunscreen tech in the US hasn’t changed in decades due to FDA processes but outside the US there have been great innovations. I’d love to hear if you have any perspective on this — are there better sunscreen formulas outside the US, and if so, why the holdup in bringing them here?
Wow — I just checked out Dr. Wong’s website and found exactly what I was looking for on Korean sunscreen! I’d still be interested to know about why we don’t have these newer chemical filter options in the US, but here I am off to buy a bunch of sunscreen from Korea!
Also check out Evy (from somewhere in Scandinavia.). It’s amazing. Seems expensive, but if applied properly needs very little reapplication during the day. It’s easier to ship to the US than it was a year ago.
Keep in mind most Korean filters aren’t designed for hot days at the beach.
I used to love LaRoche Posay’s fluid (you can buy a product with the same packaging in the US but the chemical filters are different in the EU) — it doesn’t sting my eyes and works really well, but the last two bottles I’ve bought give me a very visible yellow cast to my cool-toned very pale complexion (and it stain linens yellow). So…it’s a good sunscreen under the right circumstances.
Dr Wong’s channel is the very best, but Dr Sam Ellis (medical and cosmetic dermatologist) also has some good sunscreen content. She practices in California and usually suppplies a link to a reputable source for ordering EU and Korean sunscreens.
I brought Bioré sunscreen back from Japan, but have also previously bought it from Amazon. I like it much better than smelly & thick zinc or titanium dioxide sunscreens available here. Link to NPR story discussed.
https://www.npr.org/sections/health-shots/2024/05/18/1251919831/sunscreen-effective-better-ingredients-fda#:~:text=At%20issue%20is%20not%20just,those%20used%20in%20the%20U.S.
I agree with Scott. The perspective of danger is off here. Melanoma shows up where the sun doesn't shine also. Adequate Vitamin D levels are protective . Slathering your body every day with nanoparticles of chemicals is just not a go with me. Sunsceen in my blood is bad. Yet another chemical for my breasts to keep in and turn into another cancer? (Three timer) I have built up a good level of tolerance for the sun. When I have had enough, I cover up or get out of it.
While you are at it, you might consider a post about the kinds of heat illness and how to avoid them and manage them if they start to occur. And occupational safety regulations related to outdoor work. Which ought to apply to kids playing sports or doing marching band practice too, though they aren't always.
Second that request !
I am a retired epidemiologist with expertise in skin cancer prevention, so I read your most recent post with great interest.
First, let me congratulate you on going down the sunscreen rabbit hole! It's a complex topic and difficult to study epidemiologically as it relates to risk of melanoma because melanoma is so rare. Below are a few points I would like to add to your commentary.
1. Regarding proper use of sunscreen, we found in a case-control study we conducted (Cancer Epidemiol Biomarkers Prev. 2011 Dec;20(12):2583-93), that individuals do not use sunscreen properly. They do not apply sufficient amounts to obtain the benefit of the SPF, whether it's 30 or 50 and they do not reapply it as necessary. In our study, we found that use of sunscreen was either not associated or only weakly associated with melanoma risk, most likely, because improper use limits our ability to identify an association, if one exists. Furthermore, studies have shown that using even 50% of the recommended amount reduces the SPF protection, regardless of the factor, to very low levels of minimal benefit (Schneider, J. Arch Dermatol 2002;138:838-b-839-b). Inadequate application of sunscreen that leads to very low SPF is an important point to emphasize.
2. In our case-control study, the most consistently robust finding was for a decreased risk of melanoma if other sun protection methods were used, namely avoidance or covering up. Our results for methods other than sunscreen are consistent with the World Health Organization recommendations that place priority on these sun protection methods, and advise using sunscreen ONLY in conjunction with one of these other methods. The Australian Slip, Slap, Slop graphic you presented does not make this point clearly and I think our public health messaging for sun protection needs improvement, especially as in this country, studies have shown that most Americans associate sunscreen use with skin cancer prevention, even though the evidence is weak.
3. As for additional nuances, there is the concern that people use sunscreen to prolong their time in the sun. And if, as is likely, they are not using sunscreen properly, and are only using sunscreen and not one of the other methods, then they are very likely increasing their risk for skin cancer. Again, our public health messaging on sun protection is inadequate.
4. Lastly, you did not mention spray-on sunscreen. This application method should be discouraged as there is no way to know how much sunscreen is reaching the skin. I know it is a popular method with parents of young children due to its ease of application. However, parents need to know that spray-on sunscreen is not protecting their children,
Congratulations on your recent TIME recognition and the hard work of translating epidemiology for the public
DeAnn Lazovich, Ph.D.
Associate Professor Emerita
Division of Epidemiology and Community Health
School of Public Health
University of Minnesota
I am so delighted to see Dr. Wong in a guest post! I’ve been a big fan for years.
Her YouTube channel (and blog) are a treasure trove of clearly explained beauty science, with a big focus on sunscreens. Her witty sense of humor is a bonus.
Everyone should flock to her channel asap!
This feels like a case where the writer wants to be able to say sunscreen prevents cancer, so she glosses over the non-existent data to do so.
The fact is, we DO NOT have any evidence that using sunscreen prevents skin cancer.
It DOES prevent sunburn (and who wants sunburn?) and it MAY prevent unsightly skin damage (wrinkles), but don't rely on it to prevent cancer.
Indeed, there is no evidence that sun exposure causes skin cancer. UV radiation does, but genetics, age, and ones overall immune health play big roles, too. AND the kind on skin cancer matters, too. UV damages skin, which causes Basal cell carcinomas, not melanomas. Melanomas are the kind that kill. Basal cell carcinoma is easily removed and rarely turns into melanoma.
I'd expect better from this source!
I've seen some pretty destructive basal cells.
My mother's best friend died from melanoma. She loved gardening, and the black patch appeared on her left forearm, the part that faces the sun while working in the garden. Her doctors did eventually remove the black patch, but apparently they were too late.
Lets keep in mind that sun exposure is extremally health promoting. All cause mortality declines with increased sun exposure - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129901/
and most common skin cancers are not very dangerous compared with the cancers avoided by sun exposure noted above -
"Survival for most non-melanoma skin cancers is excellent. The 5-year relative survival for BCC is 100%. This means that, on average, all of the people diagnosed with BCC are just as likely to live at least 5 years after their diagnosis as people in the general population. The 5-year relative survival for SCC is slightly less at 95%."
(Canadian Cancer Society) https://cancer.ca/en/cancer-information/cancer-types/skin-non-melanoma/prognosis-and-survival/survival-statistics#:~:text=Relative%20survival&text=Survival%20for%20most%20non%2Dmelanoma,people%20in%20the%20general%20population.
I understand the benefits of sunscreen, I just hate the way it feels. I've tried every brand available. So I mostly stay out of the sun, and slop it on during the handful of days a year that I'm out for awhile.
I understand the five icons for sun protection (clothing cover, sunscreen, hat, shade, and sunglasses), but how do the words "slap" and "slide" serve as mnemonics for "hat" and "sunglasses"?
I added “it on” in my mom brain, as if running out the door and telling Kid 1 or Kid 2 —“slap on a hat!” and “slide on your sunglasses!” Hey, whatever works! I especially like “slop on some
sunscreen!” Extra goopy sounding for kids :)
I think it's "slap on" a hat and "slide on" some shades. This originated in Australia. I remember hearing about it many years ago.
Originally it was three words: Slip, Slap, Slop. Very easy to remember, and the three words were more similar to each other..... When you see Australian schoolkids on the playground or on a school trip, every one of them has a hat (though they aren't all wearing them optimally, being kids....)
I've encountered this in Australia. I think it was a sun protection campaign when I was there. Slip, Slop, Slap. Slip on a shirt, Slop on the sunscreen, Slap on a hat. I love the addition of Slide on some sunglasses and Seek shade. Too bad there isn't a Sl word for shade! Slither to shade?? haha!
Slap on a hat. Slide on your sunglasses. :)
Thank you everyone for your responses to my questions. As it happens, our daughter now lives in Australia (Canberra in ACT) with her Australian spouse. I have sent your responses to the two of them to see if either remembers this ad campaign. The icons would work best if tied to a campaign that fleshed out the ideas. Sounds like that was what happened. Great community here.
It’s from a very successful public safety campaign in Australia. I think the full ad campaign tied the words to specific actions in a way that really clicked.
I'm wondering about amount of sunscreen. I read on the Skin Cancer Foundation's website that people need to apply a full ounce of sunscreen to their entire body to get full broad spectrum protection. Now, at home, I certainly could measure one ounce and do this, but I have not, and doing it out and about is... prohibitive. We don't get burned or even tan, really, with the amount of sunscreen I apply. Is not getting burned/tan the measure of success here?
Also, one ounce on me, a 6ft tall person is a lot different than one ounce on the kid at 3'7".
Maybe you could email Dr Wong to ask where exactly you look for the documentation of each company’s assumptions for amount of product per square inch? Each company definitely has that information and I think it’s filed with the government in a way the public can access. (Clearly, I’m fuzzy on the details.)
In a few places on Dr Wong’s YouTube channel, she discusses how spf calculations are made, and sometimes she shows the documentation lists a company’s assumptions for how much product per square centimeter. I have just never paused the video to note the section headings on the paperwork.
[In one particularly funny video, she carefully calculates the surface area of her own face, then applies the product in the amount the company says is necessary to achieve the listed spf — except the product in that video is a powder sunscreen where it’s impossible to get the spf listed unless you are willing to look -insane-. Also I think you have to powder so heavily that it would actually fall off your face. It was a funny video but also a powerful lesson. She’s a great science educator.]
I don’t think she’s done a how-to for finding each company’s documents for amount of product, but maybe she’ll consider doing a video on that topic.
My legs are so white, they've been spotted by the Space Station during the summer. I put on sunscreen even indoors. The thing I'm bad about is remembering to reapply every two hours.
Same here. I recently bought some leggings from Solbari that can be worn for swimming (ocean and chlorinated water). I get easily overheated, but find them very cool and easy to wear even for jogging in full sun. When your clothing has a guaranteed UPF rating you don’t need to worry about reapplying!
PS: because I am so pale, if I’m going to be out on a boat all day near the equator (once or twice a year), I will meticulously apply Evy to my skin and let it dry down to its protective film before putting on UPF clothing. Even UPF 30 or 50 clothing lets in some UV, and if there’s zero shade, I want that extra protection.
Dream team collab.! Thanks for the great information, Ph.D ladies!! Love it when science communicators broaden their reach, together! Sending to both my homeschool kids with notes—great lessons here in science, misinformation, infographic communication, and more.
I am a bit disappointed that this post seems to treat chemical and mineral sunscreens as if they are equally recommended. As you note, many of the chemical sunscreens on the market have not been shown to be safe and effective. Recommending mineral sunscreens, and (better yet) hats and sun-protective clothing, is a much better public health message.
One other point--the Environmental Working Group (ewg.org) reviews a comprehensive list of sunscreens with pros and cons for each brand. They also have a good summary of the state of the science on sunscreen.
The Environmental Working Group is not a good source - they profit from fearmongering (they pushed the vaccine/autism link until the mid 2010s), and their sunscreen content ignores the fundamental principles of toxicology and optical science, and don't reflect the consensus of relevant experts. I spoke about this on a recent episode of Conspirituality, along with Dr Andrea Love who covered their Dirty Dozen food misinfo.