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Pages 163-183

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From page 163...
... Skin Cancer Causes and Risk Factors Skin cancer risk is strongly associated with UVR resulting from sun exposure and other sources of UV light, including tanning beds, with clear molecular pathways of UV-induced genetic mutations that can lead to cancer (Ciążyńska et al., 2021; Savoye et al., 2018; Wu et al.
From page 164...
... have a lower incidence attributed, in part, to the inherent sun protection provided by melanin (NCI, 2016) However, race and ethnicity are a poor proxy for skin cancer risk.
From page 165...
... . Certain patients, such as organ transplant recipients who require anti-rejection immunosuppressive medications, have extremely high rates of skin cancer (between 2 and 80 times depending on the cancer type, the level of systemic immunosuppression, and race and ethnicity of the patient)
From page 166...
... . Modeled estimates indicate that regular use of sunscreen under the age of 18 can reduce skin cancer risks by 50 to 80 percent (Stern et al., 1986)
From page 167...
... . The critique concluded that, while sunscreen use alone should not be considered the only strategy for reducing skin cancer, the evidence is strong enough that clinicians, cancer prevention agencies and public health experts should recommend regular use and reapplication of sunscreen for primary prevention in fair-skinned people when they are outdoors (Gimotty and Glanz, 2011)
From page 168...
... Systematic reviews have synthesized information regarding the safety of UV filters for human health, covering both organic UV filters (Ghazipura et al., 2017; Huang et al., 2021; Ruszkiewicz et al., 2017; Suh et al., 2020)
From page 169...
... However, the authors all recognize substantial data gaps, including that benefits of UV filters may differ in distinct human populations (individuals with darker skin types who have lower skin cancer risk, and conversely, people with photosensitive conditions)
From page 170...
... and other outdoor activities is associated with exposure to ultraviolet radiation, often during peak daytime sunlight hours and often for prolonged periods of time. Water-related activities are of particular interest in the context of the committee's task because they are most likely to be a source of UV filters and other ingredients that go directly into aquatic environments.
From page 171...
... The provision of shade structures and organization of outdoor activities with attention to shade can reduce UV radiation exposure and may ultimately decrease skin cancer risk (Buller et al., 2017; Fiessler et al., 2018; Gage et al., 2019; Holman et al., 2018b; Parisi and Turnbull, 2014)
From page 172...
... is an independent, nonfederal, unpaid panel of public health and prevention experts who identify effective public health interventions based on rigorous systematic reviews of peer-reviewed literature. The CPSTF conducted an initial evidence review of interventions to prevent skin cancer by reducing exposure to ultraviolet radiation that was published in 2003–2004 that found sufficient evidence to recommend education and policy approaches to increase sun-protective behaviors determined to be effective when implemented in recreational and tourism settings and in primary schools (Saraiya et al., 2004)
From page 173...
... . Currently, there are 21 research-tested intervention programs designed to reduce the risk for UV damage and skin cancers in a range of settings, including school, workplace, clinical, and home settings.
From page 174...
... . Also, a recent longitudinal analysis in Australia found that, over time, sunscreen has been increasing in its role as the "most favored" form of sun protection among adolescents and adults, compared to use of protective clothing and shade (Koch et al., 2017)
From page 175...
... . Attitudes and Knowledge About Sunscreen and Environmental Impacts There are only a few empirical publications that report on attitudes and knowledge about sunscreen and potential effects on aquatic environments including coral reefs.
From page 176...
... For each scenario about possible changes in sunscreen choice and use, this section describes what the resulting human health outcomes may be expected to be. A restriction on certain UV filters may have negative impacts on the use of sunscreen to prevent skin cancer and photoaging if it leads to reduced sunscreen usage (Cassel and Glanz, 2018)
From page 177...
... SUNSCREEN, PREVENTIVE HEALTH BEHAVIORS, AND IMPLICATIONS OF CHANGES IN SUNSCREEN USE 177 TABLE 7.1  Regulations and Policies to Limit UV Filters Used in Sunscreen Location UV Filters Prohibitions Status Citation U.S. Locations Hawaii Oxybenzone, octinoxate Ban of sale within the state of Passed May 2018; in effect Hawaii SB 2571 Hawaii without a prescription.
From page 178...
... However, some outdoor activities and employments do not lend themselves to use of these alternatives or there is insufficient uptake in these practices. Even among those at highest risk for skin cancer, use of alternatives is suboptimal.
From page 179...
... Based on limited intensity and reach of past skin cancer prevention campaigns, such as the "Choose Your Cover" campaign by CDC, an additional campaign may have some but still limited impact. Some beaches have provided sunscreen to promote use but this has not been widespread.
From page 180...
... In addition, risk prediction modeling studies (e.g., Rigotti and Wallace, 2015; Stern et al., 1986; van Dijk et al., 2013) could be designed to address these potential incidence, morbidity, and mortality outcomes related to skin cancers, given potential changes in sunscreen, effectiveness, availability, and use.
From page 181...
... These decisions regarding UV filters will be informed by further analysis of the available data along with collection of any additional data deemed necessary to conduct ecological risk assessments (ERAs)
From page 182...
... The most information is available for the inorganic UV filters, zinc oxide and titanium dioxide, though there are still gaps in knowledge, especially for marine species. The amount and quality of information available varies among the organic UV filters, with the benzophenones, particularly oxybenzone having received the most attention, and others having almost no data available to review beyond assessments based on their physico-chemical properties (aminobenzoic acid, cinoxate, meradimate, trolamine salicylate)
From page 183...
... UV filters also enter aquatic systems through treated or untreated wastewater. Treatment can degrade and/ or differentially remove a portion of the UV filters present in influents (most likely to be removed are homosalate, meradimate, octocrylene, octinoxate, octisalate, padimate O, titanium dioxide, and zinc oxide based on Kow and laboratory testing)


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