Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial
Abstract
Background The use of sunscreens on the skin can prevent sunburn but whether long-term use can prevent skin cancer is not known. Also, there is evidence that oral betacarotene supplementation lowers skin-cancer rates in animals, but there is limited evidence of its effect in human beings. Methods In a community-based randomised trial with a 2 by 2 factorial design, individuals were assigned to four treatment groups: daily application of a sun protection factor 15-plus sunscreen to the head, neck, arms, and hands, and betacarotene supplementation (30 mg per day); sunscreen plus placebo tablets; betacarotene only; or placebo only. Participants were 1621 residents of Nambour in southeast Queensland, Australia. The endpoints after 4.5 years of follow-up were the incidence of basal-cell and squamous-cell carcinomas both in terms of people treated for newly diagnosed disease and in terms of the numbers of tumours that occurred. Analysis of the effect of sunscreen was based only on skin cancers that developed on sites of daily application. All analyses were by intention to treat. Findings 1383 participants underwent full skin examination by a dermatologist in the follow-up period. 250 of them developed 758 new skin cancers during the follow-up period. There were no significant differences in the incidence of first new skin cancers between groups randomly assigned daily sunscreen and no daily sunscreen (basal-cell carcinoma 2588 vs 2509 per 100,000; rate ratio 1.03 [95% CI 0.73-1.46]; squamous-cell carcinoma 876 vs 996 per 100,000; rate ratio 0.88 [0.50-1.56]). Similarly, there was no significant difference between the betacarotene and placebo groups in incidence of either cancer (basal-cell carcinoma 3954 vs 3806 per 100,000; 1.04 [0.73-1.27]; squamous-cell carcinoma 1508 vs 1146 per 100,000; 1.35 [0.84-2.19]). In terms of the number of tumours, there was no effect on incidence of basal-cell carcinoma by sunscreen use or by betacarotene but the incidence of squamous-cell carcinoma was significantly lower in the sunscreen group than in the no daily sunscreen group (1115 vs 1832 per 100,000; 0.61 [0.46-0.81]). Interpretation There was no harmful effect of daily use of sunscreen in this medium-term study. Cutaneous squamous-cell carcinoma, but not basal-cell carcinoma seems to be amenable to prevention through the routine use of sunscreen by adults for 4.5 years. There was no beneficial or harmful effect on the rates of either type of skin cancer, as a result of betacarotene supplementation.
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Sunscreen is effective in decreasing the number of squamous cell cancers (SCCs).
“and squamous cell cancers (SCCs) (47).”
From Photoprotection: a Review of the Current and Future Technologies (2010) · cites this paper as [47]
A statistically significant reduction of BCCs with routine use of sunscreens has not been demonstrated.
“A statistically significant reduction of BCCs with routine use of sunscreens has not been demonstrated.”
From Photoprotection: a Review of the Current and Future Technologies (2010) · cites this paper as [47]
Routine use of sunscreens reduces skin cancers.
“Nevertheless, routine use has been shown to reduce skin cancers and slow the photoaging process.”
From Photoprotection: a Review of the Current and Future Technologies (2010) · cites this paper as [47]
There is an overall trend showing a decreased incidence of BCCs with routine sunscreen use.
“However, there is an overall trend showing a decreased incidence of BCCs (47,48).”
From Photoprotection: a Review of the Current and Future Technologies (2010) · cites this paper as [47]
The protective benefit of sunscreens for basal cell carcinomas (BCCs) is not conclusive.
“As for basal cell carcinomas (BCCs), the protective benefit is not conclusive.”
From Photoprotection: a Review of the Current and Future Technologies (2010) · cites this paper as [47]
Cites
A Clinical Trial of Beta Carotene to Prevent Basal-Cell and Squamous-Cell Cancers of the Skin
Greenberg, E. R., Baron, J. A., Stukel, T. A., Stevens, M. M., Mandel, J. S., Spencer, S. K., Elias, P. M., Lowe, N., Nierenberg, D. W., Bayrd, G., et al. (1990) · New England Journal of Medicine · doi:10.1056/nejm199009203231204 · Cited by 482 · see citing works
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Cited by
Sorted by citations
Bjelakovic, G., Nikolova, D., Gluud, L. L., Simonetti, R. G., & Gluud, C. (2007) · JAMA · doi:10.1001/jama.297.8.842 · Cited by 2,275 · see citing works
Regression to the mean: what it is and how to deal with it
Barnett, A. G. (2004) · International Journal of Epidemiology · doi:10.1093/ije/dyh299 · Cited by 1,988 · see citing works
Melanocyte biology and skin pigmentation
Lin, J. Y., & Fisher, D. E. (2007) · Nature · doi:10.1038/nature05660 · Cited by 1,379 · see citing works
Vivekananthan, D. P., Penn, M. S., Sapp, S. K., Hsu, A., & Topol, E. J. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13637-9 · Cited by 1,083 · see citing works
Bjelakovic, G., Nikolova, D., Gluud, L. L., Simonetti, R. G., & Gluud, C. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007176.pub2 · Cited by 924 · see citing works
Inorganic and organic UV filters: Their role and efficacy in sunscreens and suncare products
Serpone, N., Dondi, D., & Albini, A. (2007) · Inorganica Chimica Acta · doi:10.1016/j.ica.2005.12.057 · Cited by 711 · see citing works
A Phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention
Chen, A. C., Martin, A. J., Choy, B., Fernández-Peñas, P., Dalziell, R. A., McKenzie, C. A., Scolyer, R. A., Dhillon, H. M., Vardy, J. L., Kricker, A., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1506197 · Cited by 648 · see citing works
Guidelines of care for the management of basal cell carcinoma
Bichakjian, C., Armstrong, A., Baum, C., Bordeaux, J. S., Brown, M., Busam, K. J., Eisen, D. B., Iyengar, V., Lober, C., Margolis, D. J., et al. (2018) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2017.10.006 · Cited by 499 · see citing works
Myung, S.-K., Ju, W., Cho, B., Oh, S.-W., Park, S. M., Koo, B.-K., Park, B.-J., & for the Korean Meta-Analysis (KORMA) Study Group (2013) · BMJ · doi:10.1136/bmj.f10 · Cited by 467 · see citing works
Krause, M., Klit, A., Blomberg Jensen, M., Søeborg, T., Frederiksen, H., Schlumpf, M., Lichtensteiger, W., Skakkebaek, N. E., & Drzewiecki, K. T. (2012) · International Journal of Andrology · doi:10.1111/j.1365-2605.2012.01280.x · Cited by 461 · see citing works
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Cadet, J., & Douki, T. (2018) · Photochemical & Photobiological Sciences · doi:10.1039/c7pp00395a · Cited by 435 · see citing works
Fortmann, S. P., Burda, B. U., Senger, C. A., Lin, J. S., & Whitlock, E. P. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-12-201312170-00729 · Cited by 442 · see citing works
Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection
Young, A. R., Claveau, J., & Rossi, A. B. (2017) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2016.09.038 · Cited by 339 · see citing works
Kullavanijaya, P., & Lim, H. W. (2005) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2004.07.063 · Cited by 356 · see citing works
Neurotoxic effect of active ingredients in sunscreen products, a contemporary review
Ruszkiewicz, J. A., Pinkas, A., Ferrer, B., Peres, T. V., Tsatsakis, A., & Aschner, M. (2017) · Toxicology Reports · doi:10.1016/j.toxrep.2017.05.006 · Cited by 323 · see citing works
Nutritional protection against skin damage from sunlight
Sies, H., & Stahl, W. (2004) · Annual Review of Nutrition · doi:10.1146/annurev.nutr.24.012003.132320 · Cited by 307 · see citing works
Selenium supplementation and secondary prevention of nonmelanoma skin cancer in a randomized trial
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Photoprotection: a Review of the Current and Future Technologies
Wang, S. Q., Balagula, Y., & Osterwalder, U. (2010) · Dermatologic Therapy · doi:10.1111/j.1529-8019.2009.01289.x · Cited by 294 · see citing works
Druesne‐Pecollo, N., Latino‐Martel, P., Norat, T., Barrandon, E., Bertrais, S., Galan, P., & Hercberg, S. (2010) · International Journal of Cancer · doi:10.1002/ijc.25008 · Cited by 283 · see citing works
Ultraviolet radiation accelerates BRAF-driven melanomagenesis by targeting TP53
Viros, A., Sanchez-Laorden, B., Pedersen, M., Furney, S. J., Rae, J., Hogan, K., Ejiama, S., Girotti, M. R., Cook, M., Dhomen, N., et al. (2014) · Nature · doi:10.1038/nature13298 · Cited by 249 · see citing works
Sunscreen use and increased duration of intentional sun exposure: Still a burning issue
Autier, P., Boniol, M., & Doré, J. (2007) · International Journal of Cancer · doi:10.1002/ijc.22745 · Cited by 226 · see citing works
Passeron, T., Lim, H. W., Goh, C. ‐., Kang, H. Y., Ly, F., Morita, A., Ocampo Candiani, J., Puig, S., Schalka, S., Wei, L., et al. (2021) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.17242 · Cited by 221 · see citing works
Sunscreen photoprotection and vitamin D status
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Self-citationSunscreen and Prevention of Skin Aging: A Randomized Trial
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Self-citationBjelakovic, G., Nikolova, D., & Gluud, C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0074558 · Cited by 183 · see citing works
Does chronic sunscreen use reduce vitamin D production to insufficient levels?
Norval, M., & Wulf, H. C. (2009) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2009.09332.x · Cited by 169 · see citing works
Schwingshackl, L., Boeing, H., Stelmach-Mardas, M., Gottschald, M., Dietrich, S., Hoffmann, G., & Chaimani, A. (2017) · Advances in Nutrition · doi:10.3945/an.116.013516 · Cited by 165 · see citing works
Role of UV Light in Photodamage, Skin Aging, and Skin Cancer: Importance of Photoprotection
Gonzaga, E. R. (2009) · American Journal of Clinical Dermatology · doi:10.2165/0128071-200910001-00004 · Cited by 156 · see citing works
O’Connor, E. A., Evans, C. V., Ivlev, I., Rushkin, M. C., Thomas, R. G., Martin, A., & Lin, J. S. (2022) · JAMA · doi:10.1001/jama.2021.15650 · Cited by 151 · see citing works
Cellular effects of long wavelength UV light (UVA) in mammalian cells
McMillan, T. J., Leatherman, E., Ridley, A., Shorrocks, J., Tobi, S. E., & Whiteside, J. R. (2008) · Journal of Pharmacy and Pharmacology · doi:10.1211/jpp.60.8.0004 · Cited by 146 · see citing works
Human safety and efficacy of ultraviolet filters and sunscreen products
Nash, J. (2006) · Dermatologic Clinics · doi:10.1016/j.det.2005.09.006 · Cited by 126 · see citing works
Effects of sunscreen on skin cancer and photoaging
Iannacone, M. R., Hughes, M. C. B., & Green, A. C. (2014) · Photodermatology, Photoimmunology & Photomedicine · doi:10.1111/phpp.12109 · Cited by 118 · see citing works
Self-citationSies, H., & Stahl, W. (2004) · Photochemical & Photobiological Sciences · doi:10.1039/b316082c · Cited by 113 · see citing works
Photostability of commercial sunscreens upon sun exposure and irradiation by ultraviolet lamps
Gonzalez, H., Tarras-Wahlberg, N., Strömdahl, B., Juzeniene, A., Moan, J., Larkö, O., Rosén, A., & Wennberg, A.-M. (2007) · BMC Dermatology · doi:10.1186/1471-5945-7-1 · Cited by 107 · see citing works
Linos, E., Keiser, E., Fu, T., Colditz, G., Chen, S., & Tang, J. Y. (2011) · Cancer Causes & Control · doi:10.1007/s10552-011-9780-1 · Cited by 97 · see citing works
Modern approaches to photoprotection
DeBuys, H. V., Levy, S. B., Murray, J. C., Madey, D. L., & Pinnell, S. R. (2000) · Dermatologic Clinics · doi:10.1016/s0733-8635(05)70208-4 · Cited by 80 · see citing works
Sunscreen use and failures — on site observations on a sun-holiday
Petersen, B., Datta, P., Philipsen, P. A., & Wulf, H. C. (2012) · Photochemical & Photobiological Sciences · doi:10.1039/c2pp25127b · Cited by 77 · see citing works
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Heinen, M. M., Hughes, M. C., Ibiebele, T. I., Marks, G. C., Green, A. C., & van der Pols, J. C. (2007) · European Journal of Cancer · doi:10.1016/j.ejca.2007.09.005 · Cited by 68 · see citing works
Self-citationWang, S. Q., Xu, H., Stanfield, J. W., Osterwalder, U., & Herzog, B. (2017) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2017.01.017 · Cited by 63 · see citing works
Point: Sunscreen Use Is a Safe and Effective Approach to Skin Cancer Prevention
Green, A. C., & Williams, G. M. (2007) · Cancer Epidemiology, Biomarkers & Prevention · doi:10.1158/1055-9965.epi-07-0477 · Cited by 62 · see citing works
Self-citationSerum antioxidants and skin cancer risk: An 8-year community-based follow-up study
van der Pols, J. C., Heinen, M. M., Hughes, M. C., Ibiebele, T. I., Marks, G. C., & Green, A. C. (2009) · Cancer Epidemiology, Biomarkers & Prevention · doi:10.1158/1055-9965.epi-08-1211 · Cited by 43 · see citing works
Self-citationSkin cancer prevention: a review of current topical options complementary to sunscreens
Rosenthal, A., Stoddard, M., Chipps, L., & Herrmann, J. (2019) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.15522 · Cited by 28 · see citing works
Photoprotection by sunscreen depends on time spent on application
Heerfordt, I. M., Torsnes, L. R., Philipsen, P. A., & Wulf, H. C. (2018) · Photodermatology, Photoimmunology & Photomedicine · doi:10.1111/phpp.12373 · Cited by 20 · see citing works
Molina-García, M., Malvehy, J., Granger, C., Garre, A., Trullàs, C., & Puig, S. (2022) · Dermatology and Therapy · doi:10.1007/s13555-021-00644-3 · Cited by 15 · see citing works
Sun Care Advertising in Popular U.S. Magazines
Lee, E. T., O'Riordan, D., Swetter, S. M., Demierre, M.-F., Brooks, K., & Geller, A. C. (2006) · American Journal of Health Promotion · doi:10.4278/0890-1171-20.5.349 · Cited by 14 · see citing works
The effects of UVB irradiance on vitiligo phototherapy and UVB‐induced photocarcinogenesis
Yang, T., Chiu, S., & Lan, C. E. (2020) · Photodermatology, Photoimmunology & Photomedicine · doi:10.1111/phpp.12536 · Cited by 8 · see citing works
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Rajan, R. (2024) · Sunscreens for Skin of Color · doi:10.1007/978-981-97-3195-4_2 · Cited by 2 · see citing works
Bennett, M. F., & Cooper, K. D. (2009) · Light-Based Therapies for Skin of Color · doi:10.1007/978-1-84882-328-0_2 · Cited by 2 · see citing works
- Authors
- Green, A., Williams, G., Nèale, R., Hart, V., Leslie, D., Parsons, P., Marks, G. C., Gaffney, P., Battistutta, D., Frost, C., Lang, C., & Russell, A.
- Affiliations
- The University of Queensland (AU)
- Griffith University (AU)
- QIMR Berghofer Medical Research Institute (AU)
- Corresponding author
- Green, Adèle
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1999-08
- Volume
- 354
- Issue
- 9180
- Pages
- 723-729
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2135825792
- Cited by
- 976
- References
- 1
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 32 · 2023: 32 · 2022: 24 · 2021: 33 · 2020: 29 · 2019: 39 · 2018: 33 · 2017: 30 · 2016: 42 · 2015: 43 · 2014: 49 · 2013: 32 · 2012: 51
- FWCI
- 38.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Dermatology › Skin Protection and Aging
- Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Keywords
- sunscreen, basal cell carcinoma, squamous cell carcinoma, skin cancer prevention, sun protection, sun protection factor, vitamin A, sunburn, skin cancer incidence, tumor burden, skin cancer screening, sun protection behavior
- MeSH terms
- Adult, Aged, Carcinoma, Basal Cell, Basal Cell Carcinoma, Carcinoma, Squamous Cell, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Radiation-Induced, Queensland, Skin Neoplasms, Sunscreening Agents, beta Carotene
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