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Risk Reduction for Nonmelanoma Skin Cancer With Childhood Sunscreen Use

Risk Reduction for Nonmelanoma Skin Cancer With Childhood Sunscreen Use Abstract • Exposure to ultraviolet radiation is the principle cause of basal and squamous cell carcinomas of the skin, which are the most frequent tumors occurring in white residents of the United States. Using a mathematical model based on epidemiologic data, we quantified the potential benefits of using a sunscreen with a sun protective factor of 15 and estimate that regular use of such a sunscreen during the first 18 years of life would reduce the lifetime incidence of these tumors by 78%. Additional benefits of sunscreen use during childhood include reduced risk of sunburn, retarding the pace of skin aging, and possible reduction in melanoma risk. We recommend that pediatricians encourage sunscreen use and sun avoidance as a regular part of pediatric preventive health care. (Arch Dermatol 1986;122:537-545) References 1. Causes and Effects of Stratospheric Ozone Reduction: An Update . A report prepared by the Committee on Chemistry and Physics of Ozone Depletion and the Committee on Biological Effects of Increased Solar Ultraviolet Radiation. Washington, DC, National Academy Press, 1982. 2. Fears TR, Scotto J: Estimating increases in skin cancer morbidity due to increases in ultraviolet radiation exposure . Cancer Invest 1983;1:119-126.Crossref 3. De Gruijl FR, Van Der Meer JB, Van Der Leun JC: Dose-time dependency of tumor formation by chronic UV exposure . Photochem Photobiol 1983;37:53-62.Crossref 4. Forbes PD, Davies RE, Urbach F: Experimental ultraviolet photocarcinogenesis: Wavelength interactions and time-dose relationships . NCI Monogr 1978;50:31-38. 5. Setlow RB: The wavelengths in sunlight effective in producing skin cancer: A theoretical analysis . Proc Natl Acad Sci USA 1974;71:3363-3366.Crossref 6. Nachtwey DS, Rundel RD: A photobiological evaluation of tanning booths . Science 1981;211:405-407.Crossref 7. Pathak MA: Sunscreens: Topical and systemic approaches for protection of human skin against harmful effects of solar radiation . J Am Acad Dermatol 1982;7:285-312.Crossref 8. Cripps DJ, Hegedus S: Protection factor of sunscreens to monochromatic radiation . Arch Dermatol 1974;109:202-204. 9. Wulf HC, Poulsen T, Brodthagen H, et al: Sunscreens for delay of ultraviolet induction of skin tumors . J Am Acad Dermatol 1982;7:194-202. 10. Kligman LH, Akin FJ, Kligman AM: Sunscreens prevent ultraviolet photocarcinogenesis . Am Acad Dermatol 1980;3:30-35. 11. Plastow SR, Lovell CR, Young AR: UV-B induced collagen changes in hairless albino mouse skin, abstracted . Photochem Photobiol 1985;41( (suppl) ):75S. 12. Kligman LH, Akin FJ, Kligman AM: Prevention of ultraviolet damage to the dermis of hairless mice by sunscreens . J Invest Dermatol 1982;78:181-189. 13. Kligman LH, Akin FJ, Kligman AM: Sunscreens promote repair of ultraviolet radiation-induced dermal damage . J Invest Dermatol 1983;81:98-102. 14. Vogel HG, Alpermann HG, Futterer E: Prevention of changes after UV-irradiation by sunscreen products in skin of hairless mice . Arch Dermatol Res 1981;270:421-428. 15. Gurish MF, Roberts LK, Krueger GG, et al: The effect of various sunscreen agents on skin damage and the induction of tumor susceptibility in mice subjected to ultraviolet irradiation . J Invest Dermatol 1981;76:246-251. 16. Guidelines for Health Supervision . Elk Grove Village, Ill, American Academy of Pediatrics, 1985. 17. Doubilet P, Weinstein MC, McNeil J: Use and misuse of the term 'cost-effective' in medicine . N Engl J Med 1986;314:253-255. 18. Scotto J, Fears TR, Fraumeni JF: Incidence of Nonmelanoma Skin Cancer in the United States . US Dept of Health and Human Services publication (NIH) 83-2433, 1983. 19. Suzuki F, Han A, Lankas GR, et al: Spectral dependencies of killing, mutation, and transformation in mammalian cells and their relevance to hazards caused by solar ultraviolet radiation . Cancer Res 1981;41:4916-4924. 20. Doniger J, Jacobson ED, Krell K, et al: Ultraviolet light action spectra for neoplastic transformation and lethality of Syrian hamster embryo cells correlate with spectra for pyrimidine dimer formation in cellular DNA . Proc Natl Acad Sci USA 1981;78:2378-2382. 21. Scotto J, Fears TR, Gori GB: Measurements of Ultraviolet Radiation in the United States and Comparisons With Skin Cancer Data . US Dept Health and Human Services, (November) , 1975. 22. De Gruijl FR, Van Der Leun JC: A dose-response model for skin cancer induction by chronic UV exposure of a human population . J Theor Biol 1980;83:487-504. 23. Vitaliano PP: The use of logistic regression for modeling risk factors: With application to nonmelanoma skin cancer . Am J Epidemiol 1978;108:402-414. 24. Green AES: Ultraviolet exposure and skin cancer response . Am J Epidemiol 1978;107:277-280. 25. Green AES, Hedinger RA: Models relating ultraviolet light and nonmelanoma skin cancer incidence . Photochem Photobiol 1978;28:283-291.Crossref 26. Fears TR, Scotto J, Schneiderman MA: Mathematical models of age and ultraviolet effects on the incidence of skin cancer among whites in the United States . Am J Epidemiol 1977;105:420-427. 27. Rundel RD: Promotional effects of ultraviolet radiation on human basal and squamous cell carcinoma . Photochem Photobiol 1983;38:569-575.Crossref 28. Armitage P, Doll R: Stochastic models for carcinogenesis . Fourth Berkeley Symposium on Mathematical Statistics and Probability 1961;4:19-38. 29. Day NE, Brown CC: Multistage models and primary prevention of cancer . JNCI 1980;64:977-989. 30. Ebbesen P, Kripke ML: Influences of age and anatomical site on ultraviolet carcinogenesis in BALB/c mice . JNCI 1982;68:691-694. 31. Forbes PD, Davies RE, Urbach F: Aging, environmental influences, and photocarcinogenesis . J Invest Dermatol 1979;73:131-134.Crossref 32. Gerstl SAW, Zardecki A, Wiser HL: UV-B Handbook . Los Alamos, NM, Los Alamos National Laboratory, 1983, vol 1. 33. Weinstein MC, Stason WB: Foundations of cost-effectiveness analysis for health and medical practices . N Engl J Med 1977;296:716-721.Crossref 34. Warner KE, Luce BR: Cost-Benefit and Cost-Effectiveness Analysis in Health Care . Ann Arbor, Mich, Health Administration Press, 1982. 35. Kopf AW, Kripke ML, Stern RS: Sun and malignant melanoma . J Am Acad Dermatol 1984;11:674-684.Crossref 36. Lew RA, Sober AJ, Cook N, et al: Sun exposure habits in patients with cutaneous melanoma: A case control study . J Dermatol Surg Oncol 1983;9:981-986.Crossref 37. Holman CD, Armstrong BK: Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: An analysis separating histogenetic types . JNCI 1984;73:75-82. 38. Eaton GJ, Custer RP, Crane AR: Effects of ultraviolet light on nude mice: Cutaneous carcinogenesis and possible leukemogenesis . Cancer 1978;41:182-188.Crossref 39. Bergstresser PR, Streilein JW: Ultraviolet radiation produces selective immune incompetence . J Invest Dermatol 1983;81:85-86.Crossref 40. Blank IH, Cohen JH, Anderson RR, et al: Observations on the mechanism of the protective action of sunscreens . J Invest Dermatol 1982;78:381-385.Crossref 41. Fisher AA: Sunscreen dermatitis due to glyceryl PABA: Significance of cross-reactions to this PABA ester . Curr Contact News 1976;18:495-500. 42. Kaidbey KH, Kligman AM: Sunburn protection by longwave ultraviolet radiation-induced pigmentation . Arch Dermatol 1978;114:46-48.Crossref 43. Pathak MA, Fanselow DL: Photobiology of melanin pigmentation: Dose/response of skin to sunlight and its contents . J Am Acad Dermatol 1983;9:724-733.Crossref 44. Langner A, Kligman AM: Tanning without sunburn with aminobenzoic acid-type sunscreen . Arch Dermatol 1972;106:338-343.Crossref 45. Sayre RM, Desrochers DL, Wilson CJ, et al: Skin type, minimal erythema dose (MED), and sunlight acclimatization . J Am Acad Dermatol 1981;5:439-443.Crossref 46. Forbes PD: UV-A and photocarcinogenesis, abstracted . Photochem Photobiol 1985;41( (suppl) ):7S. 47. Van Weelden H, Van Der Leun JC: Carcinogenesis by UV-A in pigmented and albino hairless mice, abstracted . Photochem Photobiol 1985;41( (suppl) ):109S. 48. Sayre RM: UV-A sunscreens, sunlight, and responses of normal individuals, abstracted . Photochem Photobiol 1985; 41( (suppl) ):10S. 49. Kligman LH, Kligman AM: The effect of UV-A on dermal connective tissue of hairless mice, abstracted . Photochem Photobiol 1985;41( (suppl) ):4S. 50. Stern RS, Momtaz K: Skin typing for assessment of skin cancer risk and acute response to UV-B and oral methoxsalen photochemotherapy . Arch Dermatol 1984;120:869-873.Crossref 51. Silverstone H, Searle JHA: The epidemiology of skin cancer in Queensland: The influence of phenotype and environment . Br J Cancer 1970;24:235-252.Crossref 52. Holman CDJ, Evans PR, Lumsden GJ, et al: The determinants of actinic skin damage: Problems of confounding among enviromental and constitutional variables . Am J Epidemiol 1984;120:414-422. 53. Wilson PD, Kaidbey KH, Kligman AM: Ultraviolet light sensitivity and prolonged UV-R-erythema . J Invest Dermatol 1981;77:434-436.Crossref 54. Vitaliano PP, Urbach F: The relative importance of risk factors in nonmelanoma carcinoma . Arch Dermatol 1980;116:454-456.Crossref 55. Johnson EY, Lookingbill DP: Sunscreen use and sun exposure: Trends in a white population . Arch Dermatol 1984;120:727-731.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Risk Reduction for Nonmelanoma Skin Cancer With Childhood Sunscreen Use

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1986.01660170067022
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Abstract

Abstract • Exposure to ultraviolet radiation is the principle cause of basal and squamous cell carcinomas of the skin, which are the most frequent tumors occurring in white residents of the United States. Using a mathematical model based on epidemiologic data, we quantified the potential benefits of using a sunscreen with a sun protective factor of 15 and estimate that regular use of such a sunscreen during the first 18 years of life would reduce the lifetime incidence of these tumors by 78%. Additional benefits of sunscreen use during childhood include reduced risk of sunburn, retarding the pace of skin aging, and possible reduction in melanoma risk. We recommend that pediatricians encourage sunscreen use and sun avoidance as a regular part of pediatric preventive health care. (Arch Dermatol 1986;122:537-545) References 1. Causes and Effects of Stratospheric Ozone Reduction: An Update . A report prepared by the Committee on Chemistry and Physics of Ozone Depletion and the Committee on Biological Effects of Increased Solar Ultraviolet Radiation. Washington, DC, National Academy Press, 1982. 2. Fears TR, Scotto J: Estimating increases in skin cancer morbidity due to increases in ultraviolet radiation exposure . Cancer Invest 1983;1:119-126.Crossref 3. De Gruijl FR, Van Der Meer JB, Van Der Leun JC: Dose-time dependency of tumor formation by chronic UV exposure . Photochem Photobiol 1983;37:53-62.Crossref 4. Forbes PD, Davies RE, Urbach F: Experimental ultraviolet photocarcinogenesis: Wavelength interactions and time-dose relationships . NCI Monogr 1978;50:31-38. 5. Setlow RB: The wavelengths in sunlight effective in producing skin cancer: A theoretical analysis . Proc Natl Acad Sci USA 1974;71:3363-3366.Crossref 6. Nachtwey DS, Rundel RD: A photobiological evaluation of tanning booths . Science 1981;211:405-407.Crossref 7. Pathak MA: Sunscreens: Topical and systemic approaches for protection of human skin against harmful effects of solar radiation . J Am Acad Dermatol 1982;7:285-312.Crossref 8. Cripps DJ, Hegedus S: Protection factor of sunscreens to monochromatic radiation . Arch Dermatol 1974;109:202-204. 9. Wulf HC, Poulsen T, Brodthagen H, et al: Sunscreens for delay of ultraviolet induction of skin tumors . J Am Acad Dermatol 1982;7:194-202. 10. Kligman LH, Akin FJ, Kligman AM: Sunscreens prevent ultraviolet photocarcinogenesis . Am Acad Dermatol 1980;3:30-35. 11. Plastow SR, Lovell CR, Young AR: UV-B induced collagen changes in hairless albino mouse skin, abstracted . Photochem Photobiol 1985;41( (suppl) ):75S. 12. Kligman LH, Akin FJ, Kligman AM: Prevention of ultraviolet damage to the dermis of hairless mice by sunscreens . J Invest Dermatol 1982;78:181-189. 13. Kligman LH, Akin FJ, Kligman AM: Sunscreens promote repair of ultraviolet radiation-induced dermal damage . J Invest Dermatol 1983;81:98-102. 14. Vogel HG, Alpermann HG, Futterer E: Prevention of changes after UV-irradiation by sunscreen products in skin of hairless mice . Arch Dermatol Res 1981;270:421-428. 15. Gurish MF, Roberts LK, Krueger GG, et al: The effect of various sunscreen agents on skin damage and the induction of tumor susceptibility in mice subjected to ultraviolet irradiation . J Invest Dermatol 1981;76:246-251. 16. Guidelines for Health Supervision . Elk Grove Village, Ill, American Academy of Pediatrics, 1985. 17. Doubilet P, Weinstein MC, McNeil J: Use and misuse of the term 'cost-effective' in medicine . N Engl J Med 1986;314:253-255. 18. Scotto J, Fears TR, Fraumeni JF: Incidence of Nonmelanoma Skin Cancer in the United States . US Dept of Health and Human Services publication (NIH) 83-2433, 1983. 19. Suzuki F, Han A, Lankas GR, et al: Spectral dependencies of killing, mutation, and transformation in mammalian cells and their relevance to hazards caused by solar ultraviolet radiation . Cancer Res 1981;41:4916-4924. 20. Doniger J, Jacobson ED, Krell K, et al: Ultraviolet light action spectra for neoplastic transformation and lethality of Syrian hamster embryo cells correlate with spectra for pyrimidine dimer formation in cellular DNA . Proc Natl Acad Sci USA 1981;78:2378-2382. 21. Scotto J, Fears TR, Gori GB: Measurements of Ultraviolet Radiation in the United States and Comparisons With Skin Cancer Data . US Dept Health and Human Services, (November) , 1975. 22. De Gruijl FR, Van Der Leun JC: A dose-response model for skin cancer induction by chronic UV exposure of a human population . J Theor Biol 1980;83:487-504. 23. Vitaliano PP: The use of logistic regression for modeling risk factors: With application to nonmelanoma skin cancer . Am J Epidemiol 1978;108:402-414. 24. Green AES: Ultraviolet exposure and skin cancer response . Am J Epidemiol 1978;107:277-280. 25. Green AES, Hedinger RA: Models relating ultraviolet light and nonmelanoma skin cancer incidence . Photochem Photobiol 1978;28:283-291.Crossref 26. Fears TR, Scotto J, Schneiderman MA: Mathematical models of age and ultraviolet effects on the incidence of skin cancer among whites in the United States . Am J Epidemiol 1977;105:420-427. 27. Rundel RD: Promotional effects of ultraviolet radiation on human basal and squamous cell carcinoma . Photochem Photobiol 1983;38:569-575.Crossref 28. Armitage P, Doll R: Stochastic models for carcinogenesis . Fourth Berkeley Symposium on Mathematical Statistics and Probability 1961;4:19-38. 29. Day NE, Brown CC: Multistage models and primary prevention of cancer . JNCI 1980;64:977-989. 30. Ebbesen P, Kripke ML: Influences of age and anatomical site on ultraviolet carcinogenesis in BALB/c mice . JNCI 1982;68:691-694. 31. Forbes PD, Davies RE, Urbach F: Aging, environmental influences, and photocarcinogenesis . J Invest Dermatol 1979;73:131-134.Crossref 32. Gerstl SAW, Zardecki A, Wiser HL: UV-B Handbook . Los Alamos, NM, Los Alamos National Laboratory, 1983, vol 1. 33. Weinstein MC, Stason WB: Foundations of cost-effectiveness analysis for health and medical practices . N Engl J Med 1977;296:716-721.Crossref 34. Warner KE, Luce BR: Cost-Benefit and Cost-Effectiveness Analysis in Health Care . Ann Arbor, Mich, Health Administration Press, 1982. 35. Kopf AW, Kripke ML, Stern RS: Sun and malignant melanoma . J Am Acad Dermatol 1984;11:674-684.Crossref 36. Lew RA, Sober AJ, Cook N, et al: Sun exposure habits in patients with cutaneous melanoma: A case control study . J Dermatol Surg Oncol 1983;9:981-986.Crossref 37. Holman CD, Armstrong BK: Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: An analysis separating histogenetic types . JNCI 1984;73:75-82. 38. Eaton GJ, Custer RP, Crane AR: Effects of ultraviolet light on nude mice: Cutaneous carcinogenesis and possible leukemogenesis . Cancer 1978;41:182-188.Crossref 39. Bergstresser PR, Streilein JW: Ultraviolet radiation produces selective immune incompetence . J Invest Dermatol 1983;81:85-86.Crossref 40. Blank IH, Cohen JH, Anderson RR, et al: Observations on the mechanism of the protective action of sunscreens . J Invest Dermatol 1982;78:381-385.Crossref 41. Fisher AA: Sunscreen dermatitis due to glyceryl PABA: Significance of cross-reactions to this PABA ester . Curr Contact News 1976;18:495-500. 42. Kaidbey KH, Kligman AM: Sunburn protection by longwave ultraviolet radiation-induced pigmentation . Arch Dermatol 1978;114:46-48.Crossref 43. Pathak MA, Fanselow DL: Photobiology of melanin pigmentation: Dose/response of skin to sunlight and its contents . J Am Acad Dermatol 1983;9:724-733.Crossref 44. Langner A, Kligman AM: Tanning without sunburn with aminobenzoic acid-type sunscreen . Arch Dermatol 1972;106:338-343.Crossref 45. Sayre RM, Desrochers DL, Wilson CJ, et al: Skin type, minimal erythema dose (MED), and sunlight acclimatization . J Am Acad Dermatol 1981;5:439-443.Crossref 46. Forbes PD: UV-A and photocarcinogenesis, abstracted . Photochem Photobiol 1985;41( (suppl) ):7S. 47. Van Weelden H, Van Der Leun JC: Carcinogenesis by UV-A in pigmented and albino hairless mice, abstracted . Photochem Photobiol 1985;41( (suppl) ):109S. 48. Sayre RM: UV-A sunscreens, sunlight, and responses of normal individuals, abstracted . Photochem Photobiol 1985; 41( (suppl) ):10S. 49. Kligman LH, Kligman AM: The effect of UV-A on dermal connective tissue of hairless mice, abstracted . Photochem Photobiol 1985;41( (suppl) ):4S. 50. Stern RS, Momtaz K: Skin typing for assessment of skin cancer risk and acute response to UV-B and oral methoxsalen photochemotherapy . Arch Dermatol 1984;120:869-873.Crossref 51. Silverstone H, Searle JHA: The epidemiology of skin cancer in Queensland: The influence of phenotype and environment . Br J Cancer 1970;24:235-252.Crossref 52. Holman CDJ, Evans PR, Lumsden GJ, et al: The determinants of actinic skin damage: Problems of confounding among enviromental and constitutional variables . Am J Epidemiol 1984;120:414-422. 53. Wilson PD, Kaidbey KH, Kligman AM: Ultraviolet light sensitivity and prolonged UV-R-erythema . J Invest Dermatol 1981;77:434-436.Crossref 54. Vitaliano PP, Urbach F: The relative importance of risk factors in nonmelanoma carcinoma . Arch Dermatol 1980;116:454-456.Crossref 55. Johnson EY, Lookingbill DP: Sunscreen use and sun exposure: Trends in a white population . Arch Dermatol 1984;120:727-731.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: May 1, 1986

References