Got skin cancer? Blame the FDA

Americans are getting skin cancer – and sometimes dying from it – at an alarming rate, while the U.S. Food and Drug Administration irresponsibly refuses to approve state-of-the-art sunscreens that could do a much better job protecting us from the sun’s cancer-causing rays.

The rest of the world has not been out snoozing in the sun. Since the 1990s, advanced new sunscreens have been widely sold in Europe, Latin America, Asia and Australia.

But Americans have access only to older generations of sunscreen that prevent sunburn – not the deeper damage that can cause skin cancer. That’s because the FDA stubbornly refuses to approve the sale of superior new sunscreens that can safeguard our health.

The delay in approving sunscreens that could prevent many skin cancers and save lives has to do with the complex and outmoded way the FDA approves new over-the-counter drugs, the category of medical products that includes sunscreens. It is long past time for the FDA to modernize and speed up its approval process.

What can be done if the FDA refuses? In a 2015 editorial, the Wall Street Journal posited that the only way to end the FDA’s “willful culture of control and delay” is to strip “the sunscreen police of all powers over the stuff.”  That would cause the bureaucrats to do a slow burn, so we like that idea.

Sun damage to skin is an extremely serious health problem. Skin cancer will strike one in five Americans over the course of their lives, and the rates of all types of skin cancer – including melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma) – are increasing.

Melanomas are often deadly. Approximately 160,000 people in the United States are diagnosed with them annually, and one American dies every hour of every day – amounting to about 10,000 per year. In 2014, the U.S. surgeon general declared skin cancer a public health emergency – yet, even four years later, the FDA is not responding as if it were dealing with an emergency.

And unfortunately, skin cancer rates and deaths continue to rise – while mortality from almost every other cancer has been declining.

It is long past time for the FDA to modernize and speed up its approval process.

About 65 percent of melanomas and 90 percent of keratinocyte cancers worldwide are attributable to sun exposure, so prevention through avoidance of excessive ultraviolet radiation exposure is critical. But in an extraordinary exhibition of nonfeasance, the FDA’s irresponsible unwillingness to approve state-of-the-art sunscreens is condemning many Americans to get skin cancers they could otherwise avoid. 

The U.S. lags badly on sunscreen availability, with access only to outdated, ineffective products that perform poorly at protecting us. Astonishingly, the last time a new sunscreen ingredient was introduced in the United States was in 2002 – when smartphones didn’t exist and Donald Trump was a Democrat.

A little background is necessary to understand sun damage to skin and its prevention. There are two major wavelengths of ultraviolet light beaming down on us from the sun that are believed to damage the skin and lead to skin cancer as well as premature skin aging – types A and B, commonly referred to as UVA and UVB.

Most U.S. sunscreens are fairly effective against UVB light, which is what causes immediate sunburn. And a sunburn, of course, is noticeable after a short period of time. It’s a signal your body gives you to get out of the sun before your burn worsens.

UVA light penetrates deeper into the skin and is in many ways more damaging – and this is the light that can cause cancer. And unlike UVB that causes sunburn, the more serious damage that can be caused by UVA is not something we notice. It can take many years – even decades – of exposure to UVA light to cause skin cancer.

U.S. sunscreens fail to provide adequate protection against cancer-causing UVA light. Americans are therefore being hit with a double whammy. Because sunscreens offer protection from sunburn caused by UVB light, many people stay in the sun longer, understandably thinking they are safe. As a result, they are exposed for a longer period of time to more harmful UVA light.

Most Americans mistakenly believe that they are getting state-of the-art skin protection from sunscreen. However, a sunscreen with SPF 50 bought in the United States allows three times as much ultraviolet light to enter the skin as sunscreens with the same SPF available abroad.

Inadequate sunscreen is not only killing Americans – it is also costing us a bundle in health care expenditures. In the era of rising health care costs, prevention is critical.

Allowing access to highly effective sunscreens would be much cheaper than paying for repeated costly and sometimes disfiguring removal of precancerous and cancerous lesions.

In a large, randomized prospective trial conducted in Australia – where state-of-the-art sunscreen is available – regular use of this advanced sunscreen significantly reduced the number of precancerous lesions, as well as non-melanoma and melanoma skin cancers that people suffered. In other words, the lack of cutting-edge sunscreen leads to more cutting of the skin by doctors treating people for skin cancer.

Another wrinkle in this story is that Americans are spending unprecedented amounts on products and procedures to inhibit or reverse skin aging, which is accelerated by sun damage. Skin aging and wrinkling are drastically reduced by the regular use of newer-generation sunscreens.

In fact, there is recent evidence that using the new and more effective sunscreens can even reverse some skin aging.

Measures to protect the skin from sun damage should also include avoidance of tanning, whether outdoors or in tanning facilities; reducing peak sunlight exposure – between 10 a.m. and 4 p.m. – when possible; and wearing protective clothing and hats.

While the sun is 93 million miles from Earth, its rays have an impact on everything we do and make life possible on our planet. It’s important that we respect the power of this star to do us harm and that we protect ourselves from its harmful ultraviolet light with the best sunscreens that have been developed. The Food and Drug Administration should let us get that protection.

Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University's Hoover Institution.

Renata H. Mullen is a dermatologist in Palo Alto, California.