No safe tan: Why Canada’s sunburn problem keeps getting worse

Scroll through social media and you will encounter a strange vocabulary for an old impulse: “tanmaxxing,” “UV chasing” and “SPF shunning.” In some corners of the internet, sunscreen is described as toxic, while a “natural” tan is portrayed as protective.

As a dermatologist and skin-cancer researcher, and a medical student, we find the misinformation troubling. But after years studying Canadian sun behaviour, our team has concluded that correcting myths alone will not solve the problem.

TikTok may have invented the term “tanmaxxing,” but it didn’t invent the desire to be tanned.

Fighting biology and beauty standards

Ultraviolet radiation stimulates beta-endorphin production in skin, engaging our endogenous opioid system. It feels good to be in the sun after a long winter, and most of us can relate to that. Experimental research suggests UV exposure can reinforce sun-seeking behaviour.

Tanning also carries social rewards. In our focus-group research on beauty standards, participants described a “sun-kissed” appearance as healthy, attractive and even affluent.

That makes it harder for public-health advice to persuade people to limit their sun exposure and avoid tanning. Cancer-prevention messages have to compete with the body’s response to sunlight, as well as the beauty standards and sense of belonging that can come with looking tanned.

The sunscreen paradox

In our recent national study published in JAMA Network Open, we analyzed more than 7,000 Canadian adolescents, representing 2.3 million youths. More than 40 per cent reported a sunburn last year. About 62 per cent rarely or never used body sunscreen, 73 per cent rarely or never wore a hat and 75 per cent rarely or never wore long clothing.

Nor does the problem disappear at 18. In our adult national study, roughly one in three reported a sunburn in the previous year, while sunscreen use declined and time outdoors increased.

But our adolescent data revealed an interesting point: groups reporting greater sunscreen use, including girls and higher-income adolescents, were also more likely to report sunburn.

We have seen this before. In 22 focus groups across Atlantic Canada, residents of Nova Scotia and Prince Edward Island knew about sun safety and frequently relied on sunscreen. Yet in our survey of nearly 8,000 Canadians, residents there reported roughly twice as many sunburns as those in provinces with lower melanoma incidence. We called this apparent contradiction the “sunscreen paradox.”

However, sunscreen does not cause sunburn, melanoma or skin cancer. Scientific precision is important, and the apparent paradox is an observational finding that needs scrutiny. For example, people at greatest risk may use more sunscreen. Others may apply too little, fail to reapply or spend longer outdoors.

Behavioural compensation is also plausible because SPF/sunscreen may make someone feel safe enough to stay outside longer.

I often counsel patients that shade does not wear off. A shirt cannot be applied too thinly. Sunscreen remains important, but works best with clothing, hats, sunglasses and shade.

The protective “base tan” is another persistent myth in my practice. In our Manitoba survey, more than 40 per cent believed a base tan provides protection. Dermatology guidance describes that protection as minimal, roughly SPF 2 to 4 (dermatologists recommend SPF 50+). Also, the logic is backward: you expose your skin to UV to acquire the tan you hope will protect you from UV.

A tan is not proof that your skin handled the sun safely; it is proof that your skin was damaged by it.

Photoaging can be prevented

Perhaps dermatologists have made a tactical mistake. We tell a 16-year-old that UV exposure increases cancer risk decades later. That’s true, but adolescents are not known for making decisions based on what might affect their health at 55.

If appearance helps drive tanning, appearance may help prevention. UV accelerates photoaging, which can include premature wrinkles, coarse texture, brown marks often called “sun spots,” mottled pigmentation and visible blood vessels.

Severe photodamage can produce deep neck furrows, cysts around the eyes and precancerous actinic keratoses.

This is not about shaming aging. Aging is normal; photoaging is not, and can be prevented. The contradiction is that people tan to look better, while accelerating changes that many people later pay to prevent or reverse.

The goal: No tan, no burn

In our first national melanoma analysis, we identified more than 72,000 cases in Canada from 1992 through 2010. A follow-up analysis identified nearly 40,000 from 2011 through 2017, with incidence reaching roughly 21 cases per 100,000 people annually. One mortality analysis estimated 20.4 years of potential life lost for a person dying from melanoma.

Globally, melanoma accounted for roughly 1.6 million disability-adjusted life years in 2015. In Canada, skin cancer cost an estimated $532 million in 2004. Of this, 83.4 per cent — about $444 million — was attributable to melanoma. The annual burden was projected to reach $922 million by 2031.

We have mapped associations between melanoma and geography, temperature, summer UV and vegetation. We’ve identified distinct patterns among LGBTQ+ Canadians and studied sun-protection experiences among Inuit communities in the North.

Our policy comparison shows how Australia and New Zealand reinforce education with structural measures, including tanning-bed restrictions, shade and workplace or school policies.

Our message should not simply be “use sunscreen.” It should be “no tan, no burn.” That does not mean hiding indoors. Enjoy our short Canadian summers by layering sun protection: shade, clothing, a hat, sunglasses and sunscreen generously applied to exposed skin and reapplied appropriately.

There is no healthy UV-induced tan. There is healthy time outdoors, without the tan and without the burn.