The study, “Associations Between Perceived Costs and Rewards of Sun Protection and Sun Safety Practices Among High School Students,” published April 21 in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, and simultaneously presented at the 2026 AACR Annual Meeting, collected epidemiologic survey data from more than 2,100 students enrolled in Utah high schools as part of the Sun-safe Habits Intervention and Education (SHINE) trial conducted between 2021 and 2023.

Researchers found that students who viewed sun protection, such as wearing sunscreen or protective clothing, as inconvenient or uncomfortable were significantly less likely to engage in sun-safe behaviors. Similarly, teens who perceived tanning as enhancing appearance or social appeal were less likely to protect themselves from ultraviolet radiation (UVR), a leading cause of skin cancer.

Even after adjusting for demographics and skin cancer knowledge, higher perceived costs of sun protection and greater perceived rewards of tanning were associated with lower engagement in UVR-protective behaviors.

“These data remind us that knowing about the risks of overexposure to the sun isn’t enough to change teens’ behavior,” said the study’s senior author Kenneth P. Tercyak, PhD, professor of oncology, pediatrics, and psychiatry and co-leader of the Cancer Prevention and Control Program at Georgetown University’s Lombardi Comprehensive Cancer Center. “To do that, we have to understand what they think about the pros and cons of staying safe, and help shift that perspective.”

The authors suggest that school-based skin cancer prevention programs should move beyond risk messaging to incorporate appearance-focused and tailored strategies, such as UV photography or photoaging feedback, to reduce motivational barriers and promote lasting behavior change.

“This study drives home the importance of reaching people early in life with more effective skin cancer prevention strategies that resonate, and working with communities to help lower the cancer burden,” said first author, Omar U. Anwar, a biology student at Georgetown University.

He recently earned his PhD in medical science at Lund University and is a senior consultant at the dermatology clinic in Landskrona, Sweden. In one of the studies included in his dissertation, he investigated the links between common blood pressure medications and cases of basal cell carcinoma, a form of skin cancer. This cancer type is very common, with 70,000 newly discovered cases per year in Sweden. It often appears on skin that has been exposed to intense sun.

“Basal cell carcinoma is a rather mild form of cancer, with a low risk of spreading and low mortality. Treatment usually involves surgically removing the tumour, but it’s often also possible to freeze or scrape it away,” says Johan Kappelin.

Previous studies, both Swedish and international, have shown a likely increased risk of various skin cancers in connection with antihypertensive medications. When focusing specifically on basal cell carcinoma, Johan Kappelin used several large Swedish registries to identify possible statistical associations between the disease and blood pressure medication.

There are many different blood pressure medications, grouped by their active substances. These types were included in Johan Kappelin’s study:

• Thiazides (diuretics)
• ACE inhibitors (angiotensin-converting enzyme inhibitors)
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers
• Beta blockers

Among those who used thiazides, ARBs, and calcium channel blockers, the risk of basal cell carcinoma appeared to increase by nine percent. For the thiazide group, however, this only applied to medications containing multiple active substances (so-called combination therapy). For beta blockers, the results showed a seven percent increased risk. For ACE inhibitors, on the other hand, no increased risk was found; according to these study results, the risk even appeared to decrease slightly.

Johan Kappelin is somewhat surprised that such similar risk increases were seen across several medication types.

“It’s also a bit surprising that medications containing only thiazides as the active substance did not appear to increase the risk of basal cell carcinoma. At the same time, an increased occurrence of basal cell carcinoma was seen in people who received thiazides as combination therapy. Is the risk found in the other agent, or is it the combination itself that creates the risk?” he wonders.

Other questions requiring further research include whether factors such as skin type and/or certain lifestyle factors contribute to the risk of basal cell carcinoma during blood pressure treatment.

“The increase in basal cell carcinoma risk with these medications is quite small in our study, and at present we see no reason to change any recommendations regarding the use of these drugs. However, there may be reason to be extra careful with sun protection when undergoing blood pressure treatment,” recommends Johan Kappelin.

How the Registry Study Was Conducted

To determine possible statistical associations, researchers compare people with basal cell carcinoma to people without such a diagnosed disease.

The approximately 130,000 patient cases come from the national Basal Cell Carcinoma Registry. The control group consists of roughly twice as many individuals, drawn from the Swedish Population Register. Data on prescriptions for antihypertensive medications come from the Prescribed Drug Register. Researchers also collected registry data on other ongoing medications and other diseases among the included individuals.

Many other factors were not examined in the study, such as skin type or lifestyle factors. Therefore, the researchers emphasize, it cannot be definitively determined that it is the blood pressure medications that cause the increased risk of basal cell carcinoma.

“There is no such thing as a healthy tan, as it’s really just a visual manifestation of damage to the skin,” said Rajesh Nair, MD, an oncology surgeon at the Orlando Health Cancer Institute. “But we’re fighting against a perceived positive image and health benefits of something that actually has a totally opposite reality, which is that suntanned skin represents an increased risk of a deadly disease.”

The survey, conducted by Ipsos, also found that young adults are likely to believe myths and misinformation on sun protection that may lead them away from proven methods of skin cancer prevention. About one in seven (14%) adults under 35 think daily sunscreen use is more harmful to the skin than direct sun exposure and nearly a quarter (23%) believe drinking water and staying hydrated prevents a sunburn.

“There is no scientific data suggesting that drinking water provides any protection from the sun,” Nair said. “As for sunscreens, the protective benefits far outweigh any known risks, but if you’re concerned about chemicals or ingredients in a sunscreen, mineral sunscreens like zinc oxide that offer a physical barrier to the sun are proven to be safe, as well as clothing with SPF protection.”

Nair says, with so many sources of information—and misinformation—these days, it’s difficult to decipher good advice from the bad.

“We have really hectic and busy lives, and we’re trying to find information to guide us on healthy choices and decision-making to the best of our ability. But the overwhelming number of people and organizations claiming to have the right answers makes it really hard to know what to believe,” Nair said. “Our fear is that people buy into a lot of really dangerous ideas that put them at added risk.”

It’s something Brianna Starr, 29, sees a lot of, with trends on social media spreading quickly and easily.

“I think a lot of people get their information from TikTok, Instagram, Twitter, that might not be actually legit,” Starr said. “And you’re very influenced by your friends and peers, so you see a video or hear something from your friend, you’re like, ‘Oh, yes. I need to try that,’ and you believe it.”

Starr admits that skin cancer was not top of mind in her teens and twenties and was more concerned with getting a golden tan as she laid out in the sun sans sunscreen. But after her sister was diagnosed with melanoma at the age of 19, she got serious about protecting herself.

“There is a history of melanoma in my family, and so I started seeing a dermatologist every six months and actually flagged two separate moles, one on my neck and one on my shoulder, that were dysplastic and could have developed into melanoma.”

Starr is now diligent about applying and reapplying sunscreen whenever she’s outdoors. Experts recommend using sunscreens with an SPF of 30 or higher and reapplying it every two hours, especially if you are sweating or are in the water.

Regular skin cancer screenings with a dermatologist or your primary care physician are also critical to catch any developing skin cancer early.

“Unfortunately we’re seeing skin cancer more and more in patients of a young age. And because it’s something that’s often not on their radar, it tends to be diagnosed in more advanced stages,” Nair said. “We don’t want to discourage people from being outside and being active because there are so many health benefits to that, but it’s also important to know that sun protection can be lifesaving, and the only effective way of protecting yourself is limiting the effects of UV radiation on the skin.”

IMAGE: RAJESH NAIR, MD, PERFORMS A ROUTINE SKIN CANCER SCREENING ON A PATIENT AT THE ORLANDO HEALTH CANCER INSTITUTE. NAIR SAYS HE’S SEEN AN INCREASE IN SKIN CANCER CASES AMONG YOUNG ADULTS AND THAT SUN PROTECTION IS CRITICAL TO PREVENTION.

view more CREDIT: ORLANDO HEALTH CANCER INSTITUTE