Prevention of <scp>DNA</scp> damage in human skin by topical sunscreens

Olsen, Catherine M.; Wilson, Louise F.; Green, Adèle C.; Biswas, Neela; Loyalka, J; Whiteman, David C.

doi:10.1111/phpp.12298

Cited by 47 publications

(34 citation statements)

References 37 publications

(54 reference statements)

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“…We therefore advocate for studies examining intermediate (biological) endpoints to be used in high‐quality RCTs. The effectiveness of sunscreen to reduce UV radiation to the skin has been proven after acute exposure in human studies and in experimental studies . In our review, this translated into a reduced melanoma risk in the long‐term for only some studies and we attribute this to residual confounding of observational studies and the misuse of sunscreen to increase rather than decrease sun exposure in some high latitude populations.…”

Section: Resultsmentioning

confidence: 95%

“…19 However, future RCTs could examine intermediate endpoints (biomarkers, genetic mutations) to improve the evidence-base for sunscreen use. 19 Because of the imprecise definition of evervs. never-use of sunscreen and highly variable assessment of sunscreen use across studies, we compared the studies reporting at least three-levels and different patterns of sunscreen use.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…The RCT was performed in an Australian population with high year‐round sun exposure and skin cancer awareness . There is therefore a need for additional high‐quality, large RCTs in countries of higher latitude, but these are highly unlikely to be conducted because of ethical constraints (vulnerable study participants cannot be denied regular use of sunscreen) and the need to enrol extremely large numbers of participants in order to prospectively assess the rare outcome of melanoma . However, future RCTs could examine intermediate endpoints (biomarkers, genetic mutations) to improve the evidence‐base for sunscreen use …”

Section: Discussionmentioning

confidence: 99%

“…10,13 Use of sunscreen is generally regarded as a major primary prevention measure alongside seeking shade, wearing protective clothes, and avoiding sunbeds, [14][15][16][17] and is a popular method of sun protection. 18 However effectiveness of sunscreen to reduce UV-induced damage to the skin has been proven only in experimental studies, 19 and evidence of its effectiveness in preventing melanoma in humans is inconclusive. Only one randomised controlled trial (RCT) of daily sunscreen application to prevent skin cancer has been performed, showing a reduced risk of melanoma (hazard ratio = 0.50, p value = 0.051) in those randomly assigned to daily compared to discretionary sunscreen use.…”

Section: Introductionmentioning

confidence: 99%

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Challenges in assessing the sunscreen‐melanoma association

Rueegg

Stenehjem

Egger

et al. 2019

Intl Journal of Cancer

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Whether sunscreen use affects melanoma risk has been widely studied with contradictory results. To answer this question we performed a systematic review of all published studies, accounting for sources of heterogeneity and bias. We searched for original articles investigating the sunscreen‐melanoma association in humans to February 28, 2018. We then used random‐effects meta‐analysis to combine estimates of the association, stratified by study design. Stratified meta‐analysis and meta‐regression were used to identify sources of heterogeneity. We included 21,069 melanoma cases from 28 studies published 1979–2018: 23 case–control (11 hospital‐based, 12 population‐based), 1 ecological, 3 cohort and 1 randomised controlled trial (RCT). There was marked heterogeneity across study designs and among case–control studies but adjustment for confounding by sun exposure, sunburns and phenotype systematically moved estimates toward decreased melanoma risk among sunscreen users. Ever‐ vs . never‐use of sunscreen was inversely associated with melanoma in hospital‐based case–control studies (adjusted odds ratio (OR) = 0.57, 95%confidence interval (CI) 0.37–0.87, p heterogeneity < 0.001), the ecological study (rate ratio = 0.48, 95%CI 0.35–0.66), and the RCT (hazard ratio (HR) = 0.49, 95%CI 0.24–1.01). It was not associated in population‐based case–control studies (OR = 1.17, 95%CI 0.90–1.51, p heterogeneity < 0.001) and was positively associated in the cohort studies (HR = 1.27, 95%CI 1.07–1.51, p heterogeneity = 0.236). The association differed by latitude ( p interaction = 0.042), region ( p interaction = 0.008), adjustment for naevi/freckling ( p interaction = 0.035), and proportion of never‐sunscreen‐users ( p interaction = 0·012). Evidence from observational studies on sunscreen use and melanoma risk was weak and heterogeneous, consistent with the challenges of controlling for innate confounding by indication. The only RCT showed a protective effect of sunscreen.

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Section: Resultsmentioning

confidence: 95%

Section: Interpretation Of Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Challenges in assessing the sunscreen‐melanoma association

Rueegg

Stenehjem

Egger

et al. 2019

Intl Journal of Cancer

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“…Skin cancer is mainly caused by UVB‐induced DNA photodamage that, if unrepaired, leads to mutations in critical genes. The action spectra for sunburn (erythema) and photodamage overlap, and there is consistent and compelling experimental evidence that sunscreens designed to prevent erythema also prevent DNA damage when applied to human skin before UVB exposure 15 …”

Section: Evidence Base Regarding Use and Effects Of Sunscreenmentioning

confidence: 98%

When to apply sunscreen: a consensus statement for Australia and New Zealand

Whiteman

Aitken

Gordon

et al. 2019

Australian and New Zealand Journal of Public Health

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Introduction: Cancers of the skin are the most common cancers in humans, with Australia and New Zealand having the world’s highest incidence. Primary prevention campaigns advise people to apply sunscreen to exposed body sites when outdoors. However, despite growing evidence that cumulative sub‐erythemal exposures cause mutational damage, and trial data demonstrating benefit from daily sunscreen use, current policies do not consider the hazards of incidental (everyday) sun exposure. Thus, a Sunscreen Summit was convened to review the evidence and update the policies for people living in Australia and New Zealand. Results: After reviewing the benefits and risks of sunscreen application, the policy group concluded that people living in Australia and New Zealand should be advised to apply sunscreen to the face/head/neck and all parts of the body not covered by clothing on all days when the ultraviolet index is forecast to reach three or greater, irrespective of their anticipated activities. For planned outdoors activities, sunscreen should be used alongside other sun protection measures. Conclusions: People living in Australia and New Zealand are now advised to apply sunscreen every day when the UV index is predicted to reach 3 or above. Implications for public health: Increased use of sunscreen as part of the daily routine to reduce incidental sun exposure will lead to decreased incidence of skin cancer in the future.

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Roles of UVA radiation and DNA damage responses in melanoma pathogenesis

Khan

Travers

Kemp

2018

Environ and Mol Mutagen

112

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The growing incidence of melanoma is a serious public health issue that merits a thorough understanding of potential causative risk factors, which includes exposure to ultraviolet radiation (UVR). Though UVR has been classified as a complete carcinogen and has long been recognized for its ability to damage genomic DNA through both direct and indirect means, the precise mechanisms by which the UVA and UVB components of UVR contribute to the pathogenesis of melanoma have not been clearly defined. In this review, we therefore highlight recent studies that have addressed roles for UVA radiation in the generation of DNA damage and in modulating the subsequent cellular responses to DNA damage in melanocytes, which are the cell type that gives rise to melanoma. Recent research suggests that UVA not only contributes to the direct formation of DNA lesions but also impairs the removal of UV photoproducts from genomic DNA through oxidation and damage to DNA repair proteins. Moreover, the melanocyte microenvironment within the epidermis of the skin is also expected to impact melanomagenesis, and we therefore discuss several paracrine signaling pathways that have been shown to impact the DNA damage response in UV-irradiated melanocytes. Lastly, we examine how alterations to the immune microenvironment by UVA-associated DNA damage responses may contribute to melanoma development. Thus, there appear to be multiple avenues by which UVA may elevate the risk of melanoma. Protective strategies against excess exposure to UVA wavelengths of light therefore have the potential to decrease the incidence of melanoma. Environ. Mol. Mutagen. 59:438-460, 2018. © 2018 Wiley Periodicals, Inc.

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Prevention of DNA damage in human skin by topical sunscreens

Abstract: Our review of the experimental evidence supports a protective effect of topical sunscreens in preventing UVR-induced DNA damage in human skin cells in vivo.

Cited by 47 publications

References 37 publications

Challenges in assessing the sunscreen‐melanoma association

Challenges in assessing the sunscreen‐melanoma association

When to apply sunscreen: a consensus statement for Australia and New Zealand

Roles of UVA radiation and DNA damage responses in melanoma pathogenesis

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