It may be that you flinched when you saw this headline. Presumably, this sentence describes the total opposite of what the media, influencers and the skincare industry have been communicating to you.

That said, I know this is a hugely controversial post. But, it is important that someone questions the consensus that has been accepted by the Western world since the mid-20th century.

In this post, I won't go into the evolution of skin and why you shouldn't always use sunscreen overall. If you want to learn more about this, you can read this post that I wrote a while ago - https://www.1753skincare.com/blogs/news/felet-med-solskydd-och-varfor-det-inte-finns-olika-manniskoraser

This post is largely an extension of the above blog post. I therefore recommend that you first read the above post before continuing to read this text.

This post will provide answers to four different questions. Then, I will share a conclusion based on the answers to these questions.

The questions are as follows:

1. How has the number of skin cancer cases evolved over the last 60-80 years?
2. What has been the development of sun protection?
3. What is our average daily life in Western society today and historically?
4. What is the average development phase of most skin cancers?

Skin cancer over time

Skin cancer is a major societal problem today and one of the most common types of cancer in the Western world. One of the most comprehensive studies (*1) on the development of skin cancer was conducted in Sweden and is based on the development of melanoma from the 1960s until today.

In this study, patients with skin melanoma were followed for up to 10 years to see if they developed new melanomas. Patients were divided according to the decade in which they were first diagnosed: 1960s, 1970s, 1980s, 1990s and 2000s. The frequency of new melanomas was calculated and the results showed that the rate of new melanomas increased steadily over these decades.

In the 1960s, less than 1% of patients had a new melanoma, but by the 2000s this had increased to 6.4% for women and 7.9% for men. This increase was independent of age, gender, the severity of the melanoma or its location on the body. The proportion of patients with more than two melanomas also increased, from 0% in the 1960s to 18% in the 2000s.

We therefore know that the number of melanoma cases has increased significantly from the 1960s until today.

What has been the evolution of sun protection (2*)?

1946: Swiss chemist Franz Greiter develops and commercializes the first modern sunscreen, known as "Gletscher Crème" or Glacier Cream. He names his brand Piz Buin in honor of the mountain he climbed. The brand still exists today with more effective variants of Glacier Cream.

1962: Greiter is credited with the invention of sun protection factor (SPF); the original Gletscher Crème had an SPF of 2.

1967: Formulators begin developing water-resistant sunscreens.

1978: The US Food and Drug Administration (FDA) begins regulating the rapidly growing sunscreen market. UV tanning beds also start to appear in the US.

1980s: Australia, followed by other countries, accepts the definition of SPF as "the ratio of UV energy needed to produce a minimum erythema dose on protected versus unprotected skin." SPF becomes the standard for testing sunscreen formulations. Sunscreens with PABA and its derivatives are also abandoned during this period due to its sensitizing potential and content of nitrosamines.

1990s: Most sunscreen products on the market have SPF between 15 and 30; avobenzone (with the addition of octyl triazone to increase photostability) is the most common ingredient for UVA protection, while octyl methoxycinnamate is the most common ingredient for UVB protection.

2007: The International Agency for Research on Cancer publishes a groundbreaking study confirming the link between sunbeds and melanoma.

2008: Danovaro and colleagues publish the first study describing the potential role of sunscreen ingredients in causing coral bleaching in areas with high human recreational use.

2018: Following Downs and colleagues' article raising concerns about the potential harm of two sunscreen ingredients - oxybenzone and octinoxate - on coral bleaching and underwater ecosystems, Hawaii becomes the first state to pass a law banning the sale of sunscreens containing oxybenzone and octinoxate, active ingredients found in most major sunscreen brands.

We now know that the first 'real' sunscreen product appeared in the late 1940s and was officially accepted in the early 1960s. Since then, the development of sunscreen has been very fast. Today, we see a variety of skincare brands ranging from SPF 30 to SPF 50.

How does our average day-to-day life in Western society look today compared to the last 70 years?

The average Westerner today spends an average of 90% of their waking hours indoors. This is a marked increase from the 1950s. This change is due to a number of factors that have influenced our lifestyles and societies. Some of the main factors surrounding this change are:

Working life: Many jobs used to require physical work outdoors, such as farming, construction work and factory work. Industrialization was in full swing, but many factories were not as automated as today, which meant that people needed to do work that required their presence on site.

Leisure: Children and young people spent more time outdoors, playing and participating in physical activities. Sports and other outdoor activities were common features of everyday life.

Transportation: Fewer households had access to cars, which meant that people often walked or cycled to their destinations. Public transport was also more widespread and frequently used.

Technology: Technology was not as integrated into people's lives. The TV existed, but it didn't dominate the social center of the home the way digital devices do today.

Instead, what we see today is what we might call an 'indoor-oriented society'. What we have moved to include the following:

Working life: There has been a massive shift from physical jobs to office jobs. With the advance of technology, many jobs have moved into digital spaces. With the advent of teleworking and flexible working hours, many people spend most of their working day in front of a computer, often at home.

Leisure: Digital devices such as smartphones, tablets and computers have changed the way we spend our free time. Streaming services, social media and video games mean that many people choose to stay indoors.

Transportation: The increased use of cars and other convenient means of transport has reduced the need to be outdoors to get around.

Technology: The development of technology has not only changed the world of work but also how we manage everyday tasks. Online shopping, food delivery services and digital communication reduce the need to leave home.

In practice, this means that we spend a vastly greater proportion of our waking hours indoors than we did before.

What is the average stage of most skin cancers?

The two most common skin cancers are basal cell carcinoma (BCC ) and melanoma. The latter is usually referred to as "the most serious type of skin cancer" as it tries to spread to other parts of the body.

Both of these cancers have a relatively long development period. This means that it can take quite a long time from the time the cell damage occurs until the cancer develops. In many cases, this lead time can be several years.

Summing up and challenging the consensus

So, what do we know? We know that UVA and UVB are largely responsible for skin cancer. We also know that there has been a massive increase in skin cancer cases since the 1950s, while the first sunscreen product (with SPF 2) appeared in the mid-50s.

We know that the average person in the Western world today spends a significantly greater amount of time indoors than the average person did in the 1950s. We also know that the general recommendation from skin therapists, dermatologists and other people in the "beauty industry" is to always use sunscreen to reduce the risk of "UV-related damage".

Here, therefore, is an extremely relevant question - How is it that the number of skin cancer cases has exploded despite the fact that we have never spent as much time indoors as we do today, while at the same time using unprecedented amounts of sunscreen?

Before I give my explanation, I thought I would go through the explanations that I have received when I have talked to a plethora of skin therapists, dermatologists and "professionals" in the skin care industry in recent years. The two most common explanations are the following:

1. We have started traveling a lot more and therefore expose our skin to a much higher amount of UV than we used to. As a result, the number of skin cancer cases is increasing.
   
   
2. The lead time for skin cancer is very long. It is only in the last 30 years that we have really started using sunscreen and therefore the number of skin cancer cases should soon decrease.

Here are my objections to these two statements:

1. It is certainly true that we have started traveling more. However, skin cancer is increasing in the entire population, not just in those who frequently travel and are in UV environments that they evolutionarily should not be in. In addition, in recent years, people generally use a large amount of sunscreen when they are abroad in warmer climates.
   
   
2. It is certainly true that the development time for skin cancer is quite long. However, this should mean that adults in their 50s and 60s (who grew up in their 20s and 30s) should have had a higher number of skin cancers than we have today. This is because people in the 20s and 30s were outdoors to a much greater extent than we are today.

So the questions remain. "Why is the number of skin cancer cases increasing to the extent that it is today?" and "why is this information not being communicated?"

Even though more research is needed, vitamin D is a hormone that has been shown to prevent cancer in laboratory experiments. According to the latest statement from an international conference on vitamin D, it is likely that vitamin D levels below 50 nmol/L may be harmful to health, affecting about a quarter of the world's population.

What is needed is balance. Too much UV is harmful to the skin. But, too little UV is also harmful. We need to expose our skin to UV in the 'right amount'.

So why is this information not communicated?

The answer is simple... There is very little incentive to disseminate information recommending that people use a smaller amount of sunscreen.

All stakeholders in beauty and skin health (skincare suppliers, the pharmaceutical industry, beauty editors and skincare influencers) make money from the flourishing of the skincare industry (including the sunscreen industry). Therefore, there is no incentive for these groups to spread the word about the risks of underexposing your skin to UV.

No one makes money by NOT using sunscreen.

So what should we do about UV exposure?

It's really quite simple... If you are in a UV environment that your skin is not evolutionarily built for, use a physical sunscreen.

Are you in Thailand on vacation during winter? Use sunscreen

Are you indoors in an industry or office for much of the year and then lying on the beach all July? Wear sunscreen.

Going for a walk one day in November? Absolutely DO NOT use sunscreen.

Do you have any questions, concerns or objections? Do not hesitate to contact me. You can reach me at christopher@1753skincare.com

Thank you for taking the time to read this text.

*1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936055/

*2 The first real sunscreen appeared in the 1950s https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682817/

We spend more and more time indoors - https://www.tutorchase.com/answers/ib/geography/how-has-leisure-time-changed-in-the-last-fifty-years

https://ec.europa.eu/commission/presscorner/detail/en/IP_03_1278

It often only takes 4-5 years for cancer to develop - https://www.cancerresearchuk.org/about-cancer/skin-cancer/about-skin-cancer

https://www.aad.org/public/diseases/skin-cancer/types/common

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8709188/