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Sunscreens and Melanoma - Don't Drink the Cool Aid!

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As summer approaches the airways are about to be bombarded with reports on every TV station and on the front pages of newspapers concerning the need to stay out of the sun or wear sunscreen cream - the reason is to avoid the very dangerous form of skin cancer - malignant melanoma.

The problem is that for decades the media has been spreading misinformation.

The truth is that until the past year or so sunscreens blocked UV-B radiation, the same UV frequencies which are blocked by common window glass.

Most sunscreens don't block UV-A radiation.

The reason this matters is because UV-A frequencies cause cancer while UV-B radiation generates Vitamin-D in human skin and studies show that Vitamin-D not only fights cancer, it is the best available treatment for malignant melanoma. Even worse, UV-A radiation destroys Vitamin D in the skin.

Let me repeat that because it is not what you have been told by most reporters.

UV-A IS NOT blocked by glass or most sunscreens.
UV-B IS blocked by glass and sunscreens.

UV-A causes cancer; UV-B fights cancer.

What is the evidence?

Unfortunately the evidence is scientific and requires reading and thinking about some fairly complex medical reports and studies - this is obviously not something which would be done in a 30-second spot on the local TV news which may be why reporters continue to just repeat what they get from press releases.

If you are willing to read and re-read this article carefully you will come to understand just how dangerous it can be to get medical information from 30-second TV spots.

"Sunscreen use has been shown to not be effective in reducing the risk of either basal cell carcinoma or CMM [cutaneous malignant melanoma ]. The fact that CMM mortality rates nearly doubled from the 1950-1969 period to the 1970-1994 period, whereas those for NMSC fell approximately 50% (27), suggests that altered solar UV irradiance behavior and/or sunscreen use have likely played an important role."

Photochemistry and Photobiology: Vol. 81, No. 6, pp. 1276-1286.

"Comparisons of Estimated Economic Burdens due to Insufficient Solar Ultraviolet Irradiance and Vitamin D and Excess Solar UV Irradiance for the United States"

ABSTRACT

" Vitamin D sufficiency is required for optimal health, and solar ultraviolet B (UVB) irradiance is an important source of vitamin D. UVB and/or vitamin D have been found in observational studies to be associated with reduced risk for over a dozen forms of cancer, multiple sclerosis, osteoporotic fractures, and several other diseases. On the other hand, excess UV irradiance is associated with adverse health outcomes such as cataracts, melanoma, and nonmelanoma skin cancer. Ecologic analyses are used to estimate the fraction of cancer mortality, multiple sclerosis prevalence, and cataract formation that can be prevented or delayed. Estimates from the literature are used for other diseases attributed to excess UV irradiation, additional cancer estimates, and osteoporotic fractures.

These results are used to estimate the economic burdens of insufficient UVB irradiation and vitamin D insufficiency as well as excess UV irradiation in the United States for these diseases and conditions. We estimate that 50000-63000 individuals in the United States and 19000-25000 in the UK die prematurely from cancer annually due to insufficient vitamin D. The U.S. economic burden due to vitamin D insufficiency from inadequate exposure to solar UVB irradiance, diet, and supplements was estimated at $40-56 billion in 2004, whereas the economic burden for excess UV irradiance was estimated at $6-7 billion.

These results suggest that increased vitamin D through UVB irradiance, fortification of food, and supplementation could reduce the health care burden in the United States, UK, and elsewhere. Further research is required to confirm these estimates."

So, why have some studies failed to show that Vitamin-D fights cancer? There has been a lot of confusion over the question of whether Vitamin D can help prevent or cure cancer and unfortunately most is based on a dumb mistake. Even researchers make dumb mistakes.

In this case, there are many studies which showed no benefit to cancer patients who took vitamin D supplements over the years. Unfortunately, they mostly calculated Vitamin-D intake based on fortified milk consumption and taking multivitamin pills. What the studies missed is that the kind of vitamin D in most over-the-counter pills, or used to fortify milk, bread, and other foods, or found naturally in foods, isn't the kind that helps prevent and cure cancer.

ONLY vitamin D3 (1,25-dihydroxyvitamin D3), which is usually obtained by prescription or from exposure to sunlight (only UVB which is blocked by window glass and other things, UV-A, which passes through glass actually destroys D3), has been shown or claimed to protect cells from cancer or reduce cancer mortality.

In other words, most of those studies are junk. Meaningless.

But there ARE studies showing that high levels of D3 in the bloodstream cuts the death rate from melanoma by 50%, and other studies which show that indoor workers have a higher death rate from melanoma than outdoor workers, and studies which show anti-cancer action in the laboratory for D3.

http://www.cfsan.fda.gov/~frf/forum05/H-PO-36.htm

A Melanoma Hypothesis: The Paradox of Outdoor and Indoor Solar UV Exposures. D. E. Godar1 , J. C. Dowdy2 , S. G. Coelho3 , R. J. Landry3 , R. M. Sayre2 , J. C. Van der Leun4 , 1OSEL, CDRH, FDA, Silver Spring, MD, 2Rapid Precision Testing Laboratories, Cordova, TN, 3OSEL, CDRH, FDA, Rockville, MD, 4ECOFYS, Utrecht, The Netherlands

"Melanoma has been increasing at a steady logarithmic rate in fair-skinned, indoor workers since the mid 1930's. A paradox exists between indoor and outdoor workers because indoor workers get three to nine times less solar UV (290-400 nm) than outdoor workers, yet have a higher incidence of melanoma."

AND

JNCI Journal of the National Cancer Institute 2005 97(3):195-199; doi:10.1093/jnci/dji019 "Sun Exposure and Mortality From Melanoma" (Author affiliations include Sloan-Kettering) "Results: Sunburn, high intermittent sun exposure, skin awareness histories, and solar elastosis were statistically significantly INVERSELY associated with death from melanoma. Melanoma thickness, mitoses, ulceration, and anatomic location on the head and neck were statistically significantly positively associated with melanoma death.

http://jnci.oxfordjournals.org/cgi/content/abstract/97/3/195?ijkey=ff2a6d07a0b0cebddb6083e6268e8b47c4a69b8c&keytype2=tf_ipsecsha

AND

Two Studies Find Evidence That Sunlight May Have Beneficial Influence on Cancer
Sarah L. Zielinski
http://jnci.oxfordjournals.org/cgi/content/extract/97/3/157-b

In English that means that high sun exposure was not related to high death rates from MM.

These and other studies indicate that while excessive unfiltered sun exposure may cause more skin cancer, it also makes it less deadly.

That is the proposed explanation for the strange data which shows deaths from MM are higher in northern areas (where there is less sunlight) and higher in indoor workers than in outdoor workers in the same area.

To repeat - there may be more cases of MM in outdoor workers but it is less life-threatening. That makes perfect sense if you know farmers and construction workers - I've never seen one use sunscreen so they get both UV-A and UV-B radiation - hence they have high blood levels of the critical form of vitamin D (1,25-dihydroxyvitamin D3).

So, why not avoid sunlight entirely - even that coming through windows? That would almost certainly greatly reduce the incidence of all forms of skin cancer, but if you do that you need to take Vitamin-D supplements because of another major study which shows that most people have a deficiency of Vitamin D and that they can die from that lack.

Importance of Vitamin-D

"We estimate that 50 000-63 000 individuals in the United States and 19 000-25 000 in the UK die prematurely from cancer annually due to insufficient vitamin D. The U.S. economic burden due to vitamin D insufficiency from inadequate exposure to solar UVB irradiance, diet, and supplements was estimated at $40-56 billion in 2004, whereas the economic burden for excess UV irradiance was estimated at $6-7 billion."

American Society for Photobiology Journal 81:1276-1286 (2005)
doi: 10.1562/2005-01-24-RA-424
Photochemistry and Photobiology: Vol. 81, No. 6, pp. 1276-1286.
"Comparisons of Estimated Economic Burdens due to Insufficient Solar Ultraviolet Irradiance and Vitamin D and Excess Solar UV Irradiance for the United States"
William B. Grant,1, * Cedric F. Garland,2 and Michael F. Holick3

FULL ABSTRACT

"Vitamin D sufficiency is required for optimal health, and solar ultraviolet B (UVB) irradiance is an important source of vitamin D. UVB and/or vitamin D have been found in observational studies to be associated with reduced risk for over a dozen forms of cancer, multiple sclerosis, osteoporotic fractures, and several other diseases. On the other hand, excess UV irradiance is associated with adverse health outcomes such as cataracts, melanoma, and nonmelanoma skin cancer.

Ecologic analyses are used to estimate the fraction of cancer mortality, multiple sclerosis prevalence, and cataract formation that can be prevented or delayed. Estimates from the literature are used for other diseases attributed to excess UV irradiation, additional cancer estimates, and osteoporotic fractures. These results are used to estimate the economic burdens of insufficient UVB irradiation and vitamin D insufficiency as well as excess UV irradiation in the United States for these diseases and conditions. We estimate that 50 000-63 000 individuals in the United States and 19 000-25 000 in the UK die prematurely from cancer annually due to insufficient vitamin D.

The U.S. economic burden due to vitamin D insufficiency from inadequate exposure to solar UVB irradiance, diet, and supplements was estimated at $40-56 billion in 2004, whereas the economic burden for excess UV irradiance was estimated at $6-7 billion. These results suggest that increased vitamin D through UVB irradiance, fortification of food, and supplementation could reduce the health care burden in the United States, UK, and elsewhere. Further research is required to confirm these estimates."

Another quote from the ASPJ article:

"Risk of hip fracture in elderly cut by 50% with Vitamin D supplementation (low 25(OH)D serum levels."

And Finally

Unfortunately malignant melanoma is extremely dangerous and despite a lot of research there is little treatment available except for surgical removal of the cancer - once it spreads there is simply no good chemotherapy available.

But consider this report:

Journal of the National Cancer Institute, Vol. 97, No. 3, 161-163, February 2, 2005
DOI: 10.1093/jnci/dji047

http://jnci.oxfordjournals.org/cgi/content/full/97/3/161

"In this issue of the Journal, two independent epidemiologic studies suggest that sunlight may reduce the risk of non-Hodgkin lymphoma (NHL) and may be associated with increased survival rates in patients with early-stage melanoma. In a large population-based case-control study of more than 3700 patients with incident lymphoma and nearly 3200 control subjects in Sweden and Denmark, Smedby et al. reported a 20% to 40% reduction in the risk of this cancer. The reduction in risk was dose-related with increasing indices of prior sun exposure."

"In a follow-up study of more than 500 melanoma patients who participated in a U.S. case-control study in the 1990s, Berwick et al. (3) noted that subsequent mortality from melanoma was approximately one-half as high among those with signs of solar elastosis assessed by means of a standardized physical examination as among those without solar elastosis. The association of this biomarker of sun exposure and melanoma mortality persisted after adjustment for potential confounding factors, including thickness of the lesion and other established melanoma prognostic factors. The association was not confounded by early detection or various screening behaviors, including skin awareness, and skin self- or physician examination, or by social class."

Translated into English, eliminating the influence of early detection or cancer screening, or socio-economic status, the subsequent mortality (death rate) for those with high levels of solar exposure (as measured by blood test levels of Vitamin-D) was only half as high.

For updates and more information on this and other related stories see HON-certified www.newmedicineonline.com

Unfortunately most of the hotlinks to these articles expire after a few months but the articles are available in medical libraries and through medical information subscription services. They were active when originally posted.

But a number of these links are still active as are the links to further citations at sites such as http://jnci.oxfordjournals.org.

This information is not intended to provide medical advice. Please check with your physician or dermatologist before taking any action based on this information and share with your doctor the information along with the citations from medical journals presented here.

Some things are simply too complicated to explain (or fully understand) in 30 seconds but that that doesn't make them less important - it makes them MORE important.

Some medical researchers dispute the importance of Vitamin D.

While you should be skeptical, it is also important to consider whether Vitamin D is dangerous and therefore whether it is a good decision to ignore the evidence provided in this article while waiting for a final consensus by all researchers - remembering that such consensus normally takes decades.

Further reading

"High Blood Levels Of Vitamin D Protect Women From Breast Cancer, Study Suggests

....The result of the study involving 1,394 breast cancer patients and an equal number of healthy women after menopause was surprisingly clear: Women with a very low blood level of 25(OH)D have a considerably increased breast cancer risk."

(Helmholtz Association of German Research Centres (2008, April 22). High Blood Levels Of Vitamin D Protect Women From Breast Cancer, Study Suggests. ScienceDaily. Retrieved May 14, 2009, from http://www.sciencedaily.com­ /releases/2008/04/080418094101.htm)

"Possible Therapeutic Role of Vitamin D3 in Aggressive Fibromatosis"
"Desmoids, also known as aggressive fibromatoses, are locally invasive tumors that are intermediate in their biological behavior that lies between benign fibrous proliferations and low-grade fibrosarcomas. In this report, we present a case of a young female patient with a huge tumoral mass located in the right shoulder region that recurred after total resection and was resistant to radio-chemo-hormonal therapy. Eventually, she responded to 1,25-(OH)2-vitamin D3 treatment."
http://jjco.oxfordjournals.org/cgi/content/full/34/8/472

And, there is an indication of increased melanoma risk in individuals with a genetic varient of the Vitamin D receptor (which could make them less able to achieve cancer protection from Vitamin D.)

Simone Mocellin and Donato Nitti. Vitamin D Receptor Polymorphisms and the Risk of Cutaneous Melanoma: A Systematic Review and Meta-Analysis. Cancer, Online: September 22, 2008; Print Issue Date: November 1, 2008 DOI: 10.1002/cncr.23867

"A growing body of evidence suggests that vitamin D -- specifically 1,25-dihydroxycholecaliciferol (1,25[OH]2D3) -- has significant protective effects against cancer.

Much of the interest in vitamin D's anticancer potential centers on its role as a transcription factor involved in regulating cell growth, differentiation, and apoptosis, the authors said.

Epidemiologic evidence has suggested an inverse association between sun exposure, serum levels of 1,25[OH]2D3, and vitamin D intake and the risk of developing or surviving cancer, they continued."
http://www.medpagetoday.com/Dermatology/SkinCancer/10993

John McCormick is a reporter, /science/medical columnist and finance and social commentator, with 17,000+ bylined stories.

Contact John through NewsBlaze.

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