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.
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.
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]).
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.