A Systematic Risk-Benefit Assessment of Sunscreen Use in the Norwegian Population in Reply to Mixed Messages in Risk Communication

Norway is among the countries with the highest incidence and mortality of skin cancer worldwide, yet consumer organizations pay less attention to cancer protection and more to unverified health and environmental hazards. This unnuanced communication may potentially lead to insecurity among consumers about sunscreen protection. Therefore, VKM performed an assessment of 1) the hazard of and dermal exposure to the six most frequently used ultraviolet (UV) filters in sunscreens in Norway: bis-ethyl-hexyloxyphenol methoxyphenyl triazine; butyl methoxydibenzoyl methane; 2-ethylhexyl salicylate; ethylhexyl triazone; octocrylene; and titanium dioxide in nanoform, 2) the hazard of sunscreen use, and 3) the protection of sunscreen against UV-induced adverse effects. Scientific publications and reports up to 2022 were retrieved in two searches to assess adverse and protective effects of sunscreen. Toxicological data of UV filters also came from a chemical agency's dossiers. Specific searches were made for data on concentrations and dermal absorption of UV filters and user amounts of sunscreens. We developed a systematic quality evaluation of the UV filter analysis methods. Probabilistic methods were used to estimate exposure to each UV filter. Health outcome studies were assessed for risk of bias and weight of evidence across outcomes was evaluated. The internal exposure to the individual UV filters were below the derived no-effect level. Thus, the risk of exposure to them was considered negligible. Hazards and risk conclusions associated with sunscreen use was precluded by insufficient evidence. The benefit conclusion was that sunscreens are presumed to protect against certain skin cancers and polymorphic light eruption. VKM concluded that for the general Norwegian population, sunscreen use is beneficial. This message should be communicated to the public by all relevant authorities.

Keywords: Sun protection, Malignant melanoma, Non-melanoma skin cancer, Vitamin D synthesis, Probabilistic exposure assessment, Internal validity, Confidence in evidence, Uncertainty factor, Consumer organization.