Brianna Starr (left) and Alicia Starr would spend hours in the sun perfecting their tans.
CNN —
Brianna Starr, 29, and her sister, Alicia, 26, never worried much about sunscreen. While growing up in Kansas, they focused on getting a gorgeous tan, like many of their friends and the influencers they followed on social media.
“It was a social thing,” Brianna said. “So many times we’d go over to my friend’s pool, and we would just lay there for two hours without any sunscreen. We used tanning beds before prom to get color. Having the appearance of being tanned was our priority.”
When Alicia was diagnosed with melanoma at age 19, however, that view changed.
“When Alicia found out she started googling and thought she would be dead in five years,” Brianna said. “Luckily, the doctors did a wide, local excision and got it all out.
“I started seeing a dermatologist every six months and actually flagged two separate moles, one on my neck and one on my shoulder, that were worrisome and could have developed into melanoma,” Brianna added.
Brianna Starr applies sunscreen every day after her doctor found two precancerous moles during a routine skin check.
Despite near constant warnings about the dangers of skin cancer and early aging, nearly a third (32%) of American adults under 35 believe a golden tan makes people look healthier, according to a survey released Wednesday by theOrlando Health Cancer Institute.
In fact, nearly a quarter (23%) of younger adults in the survey said drinking water and staying hydrated prevents a sunburn, and 1 in 7 (14%) of those under 35 said daily sunscreen use is more harmful to the skin than direct sun exposure, the survey found.
“I think a lot of people get their information from TikTok, Instagram, Twitter, that might not be actually legit,” said Brianna, who now lives in Orlando, Florida.
There is no such thing as a healthy tan, and no scientific data exists that says drinking water provides any level of protection from the sun, said Dr Rajesh Nair, an oncology surgeon at the Orlando Health Cancer Institute who led the research.
“As for sunscreens, the protective benefits far outweigh any known risks, but if you’re concerned about chemicals or ingredients in a sunscreen, mineral sunscreens like zinc oxide that offer a physical barrier to the sun are proven to be safe,” Nair said in a statement.
2024 Guide to Sunscreens
Enter the Environmental Working Group’s 2024 Guide to Sunscreens, also released Wednesday, which analyzed the ingredients in 1,700 chemical and mineral sunscreens and found only 1 in 4 met their standards for safety.
The annual report provides a database of products by brand and type, while also breaking them down into the top recreational sunscreens, the best daily SPF (sun protection factor) and the safest sunscreens for babies and children.
Many of the safest choices will be mineral-based instead of chemical-based sunscreens, said EmilySpilman, EWG’s healthy living science program manager.
“The mineral sunscreens zinc oxide and titanium dioxide are not absorbed by the skin, and they don’t appear to harm the environment,” Spilman said.
Mineral sunscreens work by physically deflecting and blocking the sun’s rays, as opposed to sunscreens with chemicals that absorb UV rays and release heat as they break down.
The report also offers an expanded list of EWG-verified products. To be in this category, sunscreen labels must not use marketing claims banned by the FDA, such as “sunblock,” “sweatproof” or “waterproof” and cannot be in an aerosol or powder form due to the risk of inhalation. The product must also have an SPF between 15 and 50 and must agree to provide results on UVA performance from an independent laboratory.
Growing use of illegal imported sunscreens
One of the key changes in 2024 is the growth of US purchases of imported sunscreens from Japan and Europe where newer, safer types of sunscreen ingredients have been in use for years. Some products, sold on Amazon, Temu and other online marketplaces, boast sales of over 20,000 units each month, the report said.
“This shows that US consumers are aware that US sunscreen products don’t have the same safety, efficacy and protection compared to products available in the rest of the world,” Spilman said.
There’s one big problem, however: It’s currently illegal to buy or sell these products in the US because they contain ingredients that have not yet been approved by the US Food and Drug Administration.
“It’s still not legal to bring (international sunscreens) into the US,” Spilman said. “If you’re buying them on vacation and bringing them in through customs on your way home, there is a chance that they may be confiscated.”
Still waiting on regulatory action
The FDA has been working on updating sunscreen standards for decades. The agency’s efforts began in thelate 1990s, “when Bill Clinton was president and people worried that computer systems would fail due to the Y2K bug,” the report said.
In 2021, the FDA proposed an update of sunscreen safety standards that would accelerate sunscreen safety by improving protection against ultraviolet A (UVA) rays; by mandating more transparent labels, so that it would be easier to see ingredients; and by limiting sunscreen to below 60 SPF, a level experts say provides no additional sun protection and offers false hope to consumers.
The FDA also called for additional tests for aerosol products, considered by EWG and other experts to be harmful to airways as well as not as effective as sunscreen lotions.
The new regulations required sunscreen manufacturers to provide more safety data on a dozen frequently used chemicals with safety concerns or take them off the market, the report said.
“The public record does not currently contain sufficient data to support positive GRASE determinations for cinoxate, dioxybenzone, ensulizole, hom*osalate, meradimate, octinoxate, octisalate, octocrylene, padimate O, sulisobenzone, oxybenzone, or avobenzone,” theFDA stated in 2021.GRASE means “generally recognized as safe and effective.”
However, deadlines given by the FDA to industry to provide that scientific information in 2022, 2023 and 2024 have come and gone with no action yet taken, said Homer Swei, EWG’s senior vice president of healthy living science.
“The FDA has reached out many times and have been very clear on the data they require, and the deadline for the industry,” Swei said. “The FDA is going to have to make some very hard decisions on what to do here.”
Industry says sunscreens are safe
The Personal Care Products Council, a trade group representing the cosmetics and personal care products industry, challenged the EWG’s sunscreen guide in a written statement, saying that the report “misleads consumers into assuming sunscreen products are unsafe, thereby jeopardizing public health.”
The council and its member companies “continue to work with the U.S. Food and Drug Administration (FDA) to provide additional safety data on several ultraviolet (UV) filters in order to ensure consumer confidence in the safety and effectiveness of these critical products.”
The council also noted that “globally approved filters used in Europe and other regions are not available in the U.S., greatly limiting options for American consumers.”
Don’t stop using sunscreen
Some small changes have occurred: Manufacturer use of the ultraviolet ray blocker oxybenzone, which has been linked to human health harms anddestruction of coral reefs,has been in decline over the last five years, the report found.
In 2019, oxybenzone was an ingredient in60% of all sunscreen products tested by EWG, dropping to 30% in 2022. By 2023 and again in 2024, the chemical was used in only 6% of tested products, which included sunscreens and daily moisturizers and lip balms with sunscreen protection.
“Last year was really the first year we identified that big drop, which indicated that manufacturers and formulators were starting to move away from the ingredient, even without FDA intervention,” Spilman said.
“No new products are coming onto the market with oxybenzone in the formulation in 2024, but what we’re seeing instead is a substitution with chemicals that can all be absorbed into the skin and may be disruptive to the body’s endocrine (hormonal) system.”
Despite these concerns, the use of sunscreen is critical to skin health, experts say, and consumers should continue to use sunscreen every day, even on cloudy days. Besides, consumers should always rely on safe sun practices first, then apply sunscreen, according to Dr. Len Lichtenfeld, former interim chief medical and scientific officer and deputy chief medical officer for the American Cancer Society.
We have a phrase we’ve used for a long time that actually came out of Australia:Slip, slop, slap and wrap,” Lichtenfeld told CNN in a prior interview.
“Slip on a long-sleeve shirt, slap on a wide-brimmed hat, slop on the sunscreen, and use UV-protective sunglasses that wrap around the eyes when out in the sun,” Lichtenfeld said. “There are a number of sun safety strategies that are effective. Sunscreens are one of those strategies, but they should not be the primary strategy.”
