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Only one intervention trial found a modest reduction in naevus development confined to children with freckles, whereas several studies found a positive association between naevus numbers and the use of sunscreens.4 It was suggested that sunscreen use could encourage longer stays in the sun without protecting completely against cancer-causing radiation.3 And indeed, a more recent review showed that sunscreen use leads to longer duration of sun exposure when sun exposure is intentional, but not when it is nonintentional.5 We agree with Lautenschlager and colleagues that sunscreens are to be used as an adjunct on body areas that remain uncovered and should not be used to increase time in the sun.
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In their Review of photoprotection (Aug 11, p 528),1 Stephan Lautenschlager and colleagues note that behavioural solutions such as shadeseeking and use of sun-protective clothes are often deemed to be unacceptable, and suggest that, since sunscreens could become the predominant mode of sun protection, the population has to be advised as how to make the best use of sunscreens.
The initial justification for the recommendation of sunscreen use in the prevention of skin cancers rested "not so much on hard 'evidence of efficacy' as on a line of 'evidence-based reasoning' leading to a highly plausible basis for action'? But, although sunscreens prevent sunburn, actinic keratoses, and to some extent squamous-cell carcinoma of the skin, they do not show preventive activity against basal-cell carcinoma and cutaneous melanoma.3 Nine cross-sectional studies and two intervention trials have used naevus development in children as a surrogate endpoint to assess the possibility that sunscreens could prevent melanoma. Only one intervention trial found a modest reduction in naevus development confined to children with freckles, whereas several studies found a positive association between naevus numbers and the use of sunscreens.4 It was suggested that sunscreen use could encourage longer stays in the sun without protecting completely against cancer-causing radiation.3 And indeed, a more recent review showed that sunscreen use leads to longer duration of sun exposure when sun exposure is intentional, but not when it is nonintentional.5
We agree with Lautenschlager and colleagues that sunscreens are to be used as an adjunct on body areas that remain uncovered and should not be used to increase time in the sun. However, young people tend to use sunscreensto increase sun exposure and acquire a "safe tan" without sunburn, and this behaviour is unfortunately being backed-up by commercial advertising promoting "safe sun".
1 Lautenschlager S, Wulf HC, Pittelkow MR. Photoprotection. Lancet 2007; 370:528-37.
2 Hill D. Efficacy of sunscreens in protection against skin cancer. Lancet 1999; 354:699-700.
3 International Agency for Research on Cancer. Handbooks of cancer prevention, vol 5: sunscreens. Lyon; IARC Press, 2001.
4 Doré JF, Boniol M, Chignol MC. Autier P. The usefulness of sunscreens. In; Ringborg U, Brandberg Y, Breitbart E, Greinert R, eds. Skin cancer prevention. New York/London: Informa Healthcare, 2007: 241-78.
5 Autier P, Boniol M, Doré JF. Sunscreen use and increased duration of intentional sun exposure: still a burning issue, Int J Cancer 2007; 121:2755-59.
JFD has received lecture fees from I & E Consultants for Beiersdorf and is a member of the Afssaps working group on photoprotection.
* Mathieu Boniol, Philippe Autier, Jean-François Doré
International Agency for Research on Cancer, 69372 Lyon, France (MB, PA); and INSERM U590, Centre Léon Berard, Lyon, France (JFD)
Copyright Elsevier Limited Oct 27-Nov 2, 2007