From SPF to skin color, sunscreen’s effectiveness is complicated

0:00I'm Aisha Roscoe and this is a Sunday story from up first. It's summer's last hurrah. Summer isn't over yet. So in these final days of summer we've got summer maybe winding down but we still have a few last hurrah to enjoy. Like this long Labor Day weekend and as you're packing up for the beach or a hike don't forget the sunscreen. This mainstay of skincare is in the spotlight right now as questions swirl about changing ingredients, misleading some protection factors and long standing public health advice. This week on the Sunday story a simple lotion that turns out to be anything but stay with us. This message comes from Sotva. Have a big day coming up? Remember tomorrow starts tonight with the restorative sleep you need to perform at your

1:00best. The kind every Sotva mattress is designed for. So whether it's the first day of school, a new job or an important presentation. Sotva helps you be the best version of you. And now save up to $625 on $1000 or more at Sotva.com slash NPR. That's S-W-A-T-V-A.com slash NPR. This message comes from BetterHelp. Imagine carrying a backpack every day. Inside it, every conversation, every mistake, every expectation. It is easy not to notice how heavy it is until someone asks if you want to put it down. Sometimes feeling better starts exactly like that. Better isn't one size fits all. Better is personal. It's therapy tailored to the individual to help lighten what you carry. Such with a therapist who truly understands, visit BetterHelp.com slash NPR. We're back with a Sunday story and an episode about the changing world of sunscreen. Joining me is Justine Paradis of New Hampshire Public Radio.

2:04She recently reported an episode on sunscreen for outside in a show where curiosity and the natural world collide. Justine, welcome to the Sunday story. I'm thrilled to be here. Thanks for having me. Justine, what I know about sunscreen is I imagine what most people know and it's this message that's been pounded into us and shouted. That's just where it. Just where sunscreen because you got to be protected from sun. Right. It's the mantra. I just slather it on. Sunscreen, this reporting has shown me that it's actually this really impressive product. It's kind of this advanced, very technical material. Now, when I think of sunscreen, I don't think technical. So that is interesting. Tell me more. Well, let's just break down what we look for in a sunscreen. Ayesha, what do you look for in a sunscreen for yourself? I don't want to get letters about this, but I'm going to be honest because this is

3:04an honest, a safe space I hope. I don't really think about it that much. If I'm going to the beach or something, I do get sunscreen from me and the kids and I just look at what's on the shelf and it's cheap and it's, say it's sunscreen. That's all I look for. I don't want to greasy. I don't want it to show. No, no, you don't. You want it to last a while. Maybe even you want it to be water resistant. There are all these assumptions built in and the biggest one is probably you want it to protect from sunburn and ultimately from cancer. Right. That's the main thing. I don't want the cancer. I don't want the cancer or the sunburn. Definitely don't want the cancer. Yes. I know. And on top of that, you also want it to be pretty cheap. And I learned that these can be competing things on a chemistry level to be non-toxic and not oily and water resistant and be protective. Like this is a lot to ask from a lotion that you also want to look invisible. Yeah, it turns out it's super high tech.

4:06It's like someone said, hey, make me a cake. That's vegan and not free and dairy free. And it still works somehow and it's great. This is Anna Wang. She is an associate professor of chemistry at the University of New South Wales in Sydney, Australia. And she calls herself a soft matter scientist. She told me this means she likes dealing with everything squishy, which I really love. I really appreciate it as that high tech material. And as a chemist and physicist, it gives you so much to work with from both those angles. Well, you know, I'm curious. What is the origin story of modern sunscreen? So the first commercial product for sunscreen was developed just after World War II. During the war, airmen were supplied with this product called Red Veterinary Petroleum or Red Vet Pet. It was this dark, thick jelly. And after the war, one of those airmen, who was a pharmacist, adapted the product into what eventually became Coppertown. Coppertown is taking the wraps off some.

5:06Now Coppertown is this iconic sun tan cream that was immortalized in mid-20th century billboard and TV jingles, like ads showing a child with that gorgeous tan line and no burn. Coppertown's for you and you and you too, whoever you are, wherever you are, you get a beautiful tan in bed. So that's a commercial from 1978. I mean, they used to have real jingles back then. We've been deprived. But I would think not only do we not have jingles like that now, I would think that a lot else has changed since then, right? Oh, definitely. I mean, Coppertown was originally marketed as a sun tan cream. So big emphasis on the tan. But over the years, the idea of sunscreen has morphed into more of a product to protect from the sun. And on that note, there is actually big news in sunscreen in the United States. Breaking sunscreen news. What is the breaking news on sunscreen? A new sunscreen ingredient. The Food and Drug Administration approved the chemical compound, BEMO trizinal, and sunscreen

6:11sold in the U.S. It's a big deal. The first new active sunscreen ingredient has been approved in the United States in more than 25 years. It's called BEMO trizinal or BEMT. BEMO trizinal. BEMO trizinal. BEMO trizinal. And this has been decades in the making. Is it BEMO trizinal? What is it? Honestly, I've heard it many different ways. I'm going with BEMO trizinal, but... Okay. So BEMO trizinal. And so how is that different from what is already available here in the U.S.? Yeah, in a few ways. So the way sunscreen works is that one way or another, it basically absorbs the light from the sun, those UV rays which are harmful and can damage our DNA. BEMO trizinal has broader UV protection than what's currently on the market in the U.S. It also lasts longer, and it's a bigger molecule, so it doesn't absorb into the skin as easily as other molecules.

7:13And it's been available for decades in Europe, parts of Asia, Australia. It's better. It's advanced. This is a day where lay Adamson, he goes by a day. He is a dermatologist and associate professor and internal medicine at the Dell Medical School at the University of Texas, Austin. This is why you go online and you have influencers talking about sunscreens from other parts of the world. They all have this stuff, and so this is now our opportunity to be able to catch up with the rest of the world as it comes to modern sunscreens. Well, I guess I didn't realize we were behind the rest of the world when it comes to sunscreens. I think there was a thought that maybe we were on par with the rest of the world because we have those mineral sunscreens, right? Like, what about those? Totally. So in mineral sunscreen, the UV filters are zinc oxide and titanium oxide. And the perennial issue with them is the white paint effect. Some are better than others on this point, but as a day put it, BEMO trizinal could be described as more, quote, cosmetically elegant.

8:15OK. People want to protect themselves from the sun, but they don't want to look like a ghost. So if BEMO trizinal is so much better and it's available in Europe and other parts of Asia, why did it take so long to be available here in the United States? That's a good question. It is confusing. Since it's intended to prevent skin cancer, the US regulates sunscreen exclusively as an over-the-counter drug. That is different from how it's regulated in many other regions, including the EU, where sunscreen is regulated as a cosmetic. And what this means is we have an extremely high bar here. I spoke with Alexa Friedman, senior scientist with a consumer watchdog called the Environmental Working Group, or EWG. This is a group which has also been lobbying the FDA to consider more sunscreen ingredients. So I asked her, this sounds like based on like the US's higher standards, that sounds like we would have better sunscreens. It does.

9:17The issue is that in the United States, because of this lengthy process, we haven't had access to the same filters that are in international markets. So when Alexa says lengthy process, BEMO trizinal was first proposed to the FDA in 2005. So if it gets to the market this fall, which is what's expected, that means it took more than 20 years. It's a long time. And I would imagine that was tough from a business standpoint. The sunscreen market's been sort of stuck. So for more than one reason, innovation in the sunscreen market has been challenging. But so far at least, it's a bipartisan issue. It's a priority listed in the Make America Healthy Again or Mahaw Strategy Report, and also elevated by representative Alexandria Ocasio-Cortez, like here she is in a social media video from 2023. West sunscreens are far behind the rest of the world. I was in South Korea earlier this year, and it is so clear how far advanced the rest of

10:19the world is on sunscreen. And we deserve better here. There was another attempt to change the situation a few years ago, but at least for BEMO trizinal, things didn't change much until 2020, when Congress passed the CARES Act. Do you remember that? I've tried to block a lot of that out of my head, but I think yes, this was the big coronavirus relief package, and people got those COVID relief checks. Yeah, I remember that too. But also, the CARES Act changed the way many over-the-counter drugs are regulated in the United States, including sunscreens. It basically helped streamline the application process, and now BEMO trizinal is finally about to hit the US market. And it is a win. It is an achievement for public health that we have this new filter. But at the end of the day, the US still lags behind other countries, like the EU, when it comes to options. When we come back, another aspect of sunscreen and public health, the conversation on skin color and SPF. It was all white people in the Australian study.

11:20We'll be right back. This message comes from Midi Health, a virtual care platform for women in paramanopause and menopause. Chief Medical Officer Dr. Kathleen Jordan shares the wide range of symptoms they work to address for women in midlife. There's dry eyes, dry hair, dry skin, there's dry mouth, trouble sleeping, panic and anxiety attacks. When we ask patients about common symptoms, on average, they report six. Midi Health, committed to helping women in midlife with paramanopause and menopause care. Accessible via telehealth visits. Add join m-i-d-i dot com. This message comes from Granger. This is the story of the one. As a maintenance supervisor at a manufacturing facility, he knows keeping the line up and running is a top priority. That's why he chooses Granger. Because when a drive belt gets damaged, Granger makes it easy to find the exact specs for the replacement product he needs. And next day delivery helps ensure he'll have everything in place and running like clockwork.

12:24Call 1-800-GRanger. Click Granger.com or just stop by. Granger for the ones who get it done. We're back with a Sunday story. I'm with Justine Paradis of New Hampshire Public Radio. She recently reported a deep dive on sunscreen. Are you sure I remember how earlier I said that sunscreen may seem ordinary, but it's actually kind of high tech and awesome. Yes, I remember that. Well it's also imperfect. And to explain this, let's look at one of the most basic pieces of information on the bottle. SPF. Do you know what SPF stands for? I do not. I'll be honest about that as well. Something about the sun, I would think. Absolutely. Yeah, it stands for sun protection factor. So if you got an SPF of 30, in theory, it's saying that it offers you 30 times the amount of time until you get a sunburn as opposed to if you were wearing nothing. Does that make sense?

13:25That does make sense. I did not think it meant that. I thought it meant like the amount of rays blocked. From the sun or something about the UV rays, but this also makes sense. It's confusing, but SPF is a super imperfect measurement. And to explain why, let's journey to the shores of Australia, fall 2025, where an Australian consumer watchdog group called Choice decided to test the SPF claims of sunscreen in the country. Twenty widely available products from brands like Nutrugina, La Roche Pose, Cancer Council, Banana Boat. And 16 of those 20 products fell short of what they advertised. 16 out of 20. I mean, that sounds like a lot of misinformation. These were all sunscreen's advertised to be SPF 50 or above, but they came in all over the place, like in the 40s, 30s, 20s and lower, like one even tested at an SPF of four. Like, how could that happen?

14:27Like, that's not even close to what they advertise. I know. And I think that there are a few reasons that might have contributed. One of them is how SPF is tested in the first place. So the SPF of a sunscreen is determined by the In-Vivo test. So that's on human skin in a lab. They put sunscreen on one part of someone's body and no sunscreen on another. They expose both parts to UV radiation and then they see how long it takes their skin to burn. And then they roughly measure redness. So it's a very subjective measure. This again is Alexa Friedman from EWG, a consumer watchdog. We know from various different studies and reports that there's like this issue of inconsistent testing even the same formulation. So you could measure an SPF 50 at one lab and an SPF 30 at another. That's really surprising. You think it would be a consistent measurement. I know. Yeah, the discrepancies are notable. And away the soft matter squishy scientist said there is an alternative SPF International

15:31Standards test, which uses plastic instead of skin to evaluate sunscreen. But she says this isn't necessarily a more accurate method because skin is actually a really tricky material to try and emulate. It's like see through to some wavelengths and not to other wavelengths. It's a mixture of like proteins and lipids, but there's also water inside and it's also rough and it has hairs and the fact that it absorbs some of the ingredients that is not going to be emulated by pieces of plastic. Even though the discrepancies in SPF may seem dramatic, the fact is that the difference between an SPF 30 for instance and an SPF 50 really isn't that much. Like without getting too much into the math, it's the difference between blocking 97% of the sun's UVB rays versus 98%. The reality is sunscreen is really just a thin film on your skin and it gets rubbed off. So whether it's an SPF 50 or an SPF 30, either way it's typically not going to last more than a couple hours. I'm also going to compromise the sunscreen in that time by sweating, by moving around,

16:34by being in the wind, by being on sand. It's much better just to reapply. And one thing that almost any skincare pro will tell you is that no one actually ever uses enough sunscreen and you should reapply every couple hours anyway. It definitely sounds like a PSA to me. That's information I can use because growing up, you know, and even now, I mean, usually we put on that sunscreen once at the beach and we don't put it all in no mode. You know, like, you really don't have to spend all day out there. But it makes sense and it is important because it's protecting us from skin cancer. Yeah, it does. But the way we know that is also an interesting story. It turns out the strongest evidence comes basically from a longitudinal study, one done over a number of years. And really, there's only been one fully powered, randomized trial looking at sunscreen as an exposure and skin cancer as an outcome.

17:34This is David Whiteman, a medical epidemiologist at QIMR, Berghoff for a Medical Research Institute in Brisbane, Australia. That was done in a little town north of Brisbane here, little sugar cane town called Nambo. It's called the Namboer trial. The kind of research that takes a huge amount of resources and people and money and time, it started in the 1990s. And the investigator there, Adele Green, recruited more than 1600 people in the town to participate. And then they were randomly assigned to one half, were given free sunscreen and very strict instructions how to use it and constant badgering to get them to use it. The other half of the town were not given sunscreen. They could use sunscreen if they wish to, just do what you normally do. Both groups got free skin checks for up to a decade, checking out every little spot, looking for three types of cancers. They had teams of dermatologists pouring over the town. For one common type of skin cancer, basil cell carcinoma, they found the strict sunscreen

18:36use and skin checks didn't make a difference. For another, squamous cell carcinoma, it did. That rate dropped by almost 40%. But then there's melanoma, the rarer but scarier, more aggressive kind. That's the kind that kills people, right? Right, it's the deadliest one. But because melanoma is rarer, they didn't necessarily expect to see a significant difference with sunscreen and skin checks, but they did. Which was interesting and surprising. So sunscreen use did reduce melanoma? Yes. This isn't the only evidence to support this conclusion, but it is the only evidence at this level, which David described as, quote, the gold standard in clinical medicine. And it's probably the only evidence of that level that we're ever going to get, because it's unlikely that anyone in the future will ever be able to repeat a study like that. So love it or love it.

19:36That's the evidence that we have. And that the entire kind of foundation upon which we promote sunscreen for prevention of melanoma rests on that single study. This again is dermatologist, a day Adam Sin. And a day pointed out that as solid as this study is, it's not perfect. It was all white people in the Australian study, essentially. Well, all but four out of more than 1600 participants. Okay. What does this mean for people of color? If the advice for white people is where sunscreen every day, is that true for people of color to should black people wear sunscreen? Well, this is the question. First of all, my source has told me there's just not enough research on people of color, sunscreen and UV exposure period. But here's what we know. Skin cancer is a serious risk for people with lighter skin, people of Northern European descent, typically.

20:36But for black people, the risk is way, way lower. Now right up top, I do want to acknowledge here that people of color or even black people, these terms are too broad. Obviously skin tone varies widely within these descriptions. And I'll talk more about that in a minute. But in the United States, government data shows that melanoma is in the ballpark of 30 times more prevalent in white people than in black people. Death from any cancer is all, all is terrible, all of is bad. I'm not saying let people just die, okay? But if you're thinking about the problems, the things to think about as a black person, that you could potentially die from or that is dangerous, skin cancer is the bottom of the list. People do get melanoma and when they do, it's proportionally deadlier. But usually it occurs in places typically not exposed to the sun, like the palms of the hand or the soles of the feet. Famously Bob Marley died from a melanoma under his toenail. So UV radiation may not be a major risk factor for melanoma in skin of color.

21:41So for folks with skin of color, there's actually no data to support. The use of sunscreen for a cancer prevention, right? They just as I'm in shown. Both epidemiologists David Whiteman and Adele Green, the investigator behind the Nambor trial, they agreed the results of the Nambor trial can't necessarily be extrapolated to people of color. Not only that, but there is what David called very good data about the protective effects of melanin. Like you pointed to this study out of England where researchers simulated a solar radiation on a variety of skin types to measure how melanin protected against DNA damage in the skin. And in this study, they found the comparative fair European origin skin types, the melanin content of the darkest skin tone demonstrated 60 times the protection against DNA damage in one of the deeper layers of skin. And the melanin pigment just absorbs. It's like a shield of armor above the DNA absorbs that ultraviolet radiation.

22:44And so there's almost no DNA damage when you give skin of color quite high levels of UV. Certainly that would in a European ancestry person would cause unbelievable DNA damage. So back to that public health advice offered by major groups like the CDC, the American Cancer Society, the American Academy of Dermatology, they all say some version of everyone needs to wear sunscreen every day. And that message, I think it is deeply flawed. But I understand why certain authorities and officials like to just give blanket recommendations because it's easier. Now a day's opinion is that blanket recommendations are not supported by evidence. And that perhaps public health authorities should offer different specific advice for people of color. And that's actually happening now in Australia. Really? I mean, what are they doing there? So Australia has one of the highest rates of skin cancer in the world. And now many public health authorities have endorsed new messaging, which does include

23:49different advice for different skin types. Epidemiologist David Whiteman has been part of crafting that messaging. And it hasn't been easy. How do you get a public health strategy that is effective but targeted. And that's new territory for all of us. And so we're trying to work out how you do that in a modern society. It's proving to be a challenge. What they've done is create three skin type categories and the advice is different for each. So people with the fairest skin types, so skin that burns easily and rarely if ever tans. Sunscreen should be a part of the morning routine whenever the UV forecast is three or above, which as a point of reference is an average early spring day in New England. Meanwhile, the people with the darkest skin types, so deep brown or black skin, which rarely if ever burns, quote, routine sunscreen application is not needed. And quote, sun protection may be needed if outdoors for extended periods when the UV

24:51is three or above. That sounds like there's some measured language in there. So what about in the US? Honestly, the debate seems pretty unsettled in the US. You could ask basically, what's the harm in being cautious and just giving that blanket advice? I think you can't go wrong with that. That's Susan Taylor, professor of dermatology at the University of Pennsylvania and founder of the Skin of Color Society. She stands behind the blanket sunscreen advice for people of color, arguing that sunscreen still protects against issues like hyperpigmentation and sunburn. And she also argues it protects against other non melanoma types of cancer. Though other experts did tell me that association remains unclear in skin of color. We've had conversations in the skin of color society. We've had advisory groups, right? And where we've landed is that people of color should still use sunscreen. But dermatologist Aday Adamson, he chafes at what he calls a maximalist approach. I think that people need honesty.

25:56I think that there needs to be voices out there that are just telling the facts as it is and allowing people to interpret those facts. Honestly, it feels like these questions go way beyond sunscreen. Yeah, absolutely. So what do we take from this? It does seem a bit unsatisfying. Yeah, I agree. I think that for me, this reporting has left me both more impressed with sunscreen as this technical material and an understanding that sunscreen is imperfect. It has limitations and that is why in public health in Australia and in the US, the message is often something like this. Sunscreen is one component of a sun protection strategy. It's never our first line of defense. It's always the last line of defense. Before you even get to the sunscreen, there are lots of other things people should do first to minimize risk, like avoiding peak hours of the day when the UV is at its most

26:58intense, wearing hats, staying in the shade. So bust out that parasol. Totally. If you want to get stylish with it. And wherever the science ends up heading in the coming years, I'm not sure that basic advice will change. So justine, thank you so much for coming on and breaking down the science of sunscreen. It's my pleasure. Thank you for having me. It's been really fun. That was Justine Paradis, a producer with outside in from New Hampshire Public Radio. You can find more from that show wherever you get your podcasts. This episode was produced by Ben Rappaport and edited by Jenny Schmidt. It was fact-checked by Greta Pittinger. The engineer was Robert Rodriguez. The rest of the Sunday story team includes Sharon Machihi and Andrew Mamba. Our supervising senior producer is Leana Simstrom and our executive producer is Irene Neguchi.

28:00I'm Aisha Roscoe. Up first we'll be back tomorrow with all the news you need to start your week. Until then, have a great rest of your weekend. This message comes from an PR sponsor, Charles Schwab, with its original podcast, Schwab Market Update. Join host Keith Lansford for this information-packed daily market preview delivered in 10 minutes or less, including projected stock updates, monetary policy decisions, and key results and statistics that may impact your trading. Don't mood the latest episode and subscribe at Schwab.com slash Market Update Podcast or wherever you get your podcasts. This message comes from Rosetta Stone, offering an alternative approach to language learning. The app guides users to intuitively think in a second language using images and contextual audio, mimicking how people acquire speech as children. The platform also includes advanced speech recognition technology that compares a learner's

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