Aim Skin Cancer Warnings at the Young, Too, Experts Say
MONDAY May 7, 2012 -- Doctors should take the time to counsel children, teens and young adults on the dangers of sun exposure and tanning beds, according to new recommendations from the U.S. Preventive Services Task Force.
But rather than focus on skin cancer, discussions with young patients should center on how ultraviolet-ray exposure can damage the way their skin looks, the task force advised.
"We are not saying to young people to avoid sun exposure and indoor tanning to prevent skin cancer, because that message doesn't work," said Dr. Virginia Moyer, USPSTF chair and a professor of pediatrics at Baylor College of Medicine in Houston.
"That is the goal, but the message that works is to use appearance-based counseling," she said.
Because most research so far is based on people with fair skin -- who are at the greatest risk of skin cancer -- these new recommendations apply only to them, the authors noted.
Instead of telling these patients about the risk of skin cancer, they should be told that sun exposure leads to ugly skin: "What you end up having is wrinkled, leathery skin," Moyer said.
"If the audience you are trying to reach is young people whose concern about having skin cancer is not very high, then the more effective way to get the message across is to talk about the more immediate effects -- skin damage," she said.
For example, doctors can show patients photos taken of skin with a UV camera to demonstrate the damage UV rays can cause.
The recommendations appeared online May 8 in advance of publication in the July 3 print issue in the Annals of Internal Medicine.
Specifically, doctors should counsel children, teens and young adults aged 10 to 24 who have fair skin and no history of skin cancer about skin cancer prevention. Having light skin, hair and eyes increases the risk for skin cancer, as does overexposure to ultraviolet rays at an early age, the recommendations state.
Skin cancer affects more than 2 million Americans each year, according to background information from the USPSTF.
This recommendation is a change from the group's previous statement, which said that evidence was insufficient to be able to make a recommendation at that time, Moyer said.
"We now have data that is pretty good that counseling adolescents and young adults who are fair-skinned to avoid sun exposure, using counseling that is appearance-based, works," she said.
Moyer noted that early skin damage is a precursor to skin cancer later in life. "But by the time people are concerned about the risk of skin cancer it's too late. The damage has been done," she explained.
Appearance-based counseling by doctors can change behavior, Moyer said. "It should be part of well-person exams for fair-skinned people," she added.
Right now there is not enough evidence to recommend counseling adults about the dangers of UV exposure, the report noted.
Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine, said he isn't convinced that counseling children is enough to get them into the habit of protecting themselves from UV exposure.
"It is always a challenge to change people's behaviors," he said. Counseling and media campaigns aren't enough. These changes must be taught early, Salomon added.
In Australia, schools have an integrated program about sun protection, a large media campaign and widespread availability of sun-protection clothing and other products, he pointed out. Yet, studies show that even in Australia, the country with the highest incidence of dangerous skin cancers, media announcements only have short-term benefits in getting people to comply, he noted.
"I think that there is a clear parental responsibility to protect one's child from the largest-known cancer risk: the sun," Salomon said.
He noted that parents make their children wear bike helmets and buckle seat belts and they don't leave their children unattended.
"If children are slathered with sun-protection creams and not brought out in the midday sun, it will ultimately seem to be the normal and prudent thing to do," Salomon said.
To learn more about skin cancer, visit the Skin Cancer Foundation.
Posted: May 2012
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