A New Message from the USPSTF
Behavioral counseling to prevent skin cancer is effective in young, fair-skinned patients.
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical interventions in light of published evidence. In 2003, the USPSTF found insufficient evidence to determine whether clinician counseling effectively altered patient behavior to reduce skin cancer risk. For its latest recommendation statement, the USPSTF reviewed the literature for new evidence on the benefits of such counseling.
The current statement now recommends that primary care physicians counsel fair-skinned 10- to 24-year-olds about minimizing ultraviolet (UV) radiation exposure to reduce skin cancer risk. The task force found at least fair evidence that such counsel improves important health outcomes and that benefits outweigh harms. Sufficient evidence showed that counseling interventions in the primary care setting or referred from primary care "moderately" increased sun protection behaviors in children, adolescents, and young adults, although the evidence was inadequate for older patients. Successful interventions included appearance-focused materials and peer counseling sessions. One study also used UV facial photography to demonstrate to patients the extent of existing skin damage from UV exposure.
Comment: These recommendations follow on the heels of similar recommendations by the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the Community Preventive Services Task Force. After decades of research linking skin cancer risk with early sun exposure, a united front is emerging to provide a single message: Younger patients and their families need to understand the risks of early sun and indoor tanning exposure and practice risk reductive practices.
Although the task force recommends use of devices that can show pigment changes during the teachable moment, use is difficult even for dermatologists and may not reveal extensive damage unless the child has had severe sun exposure or a sun sensitivity syndrome. This tool is effective in younger adults and adolescents, especially for documenting improvement, but parents and primary providers of younger children should not be lulled into a false sense of security. The most dramatic findings are typically seen in older individuals.
Protection for younger children rests with parents, and the primary care workforce needs to counsel parents about these issues. The American Academy of Dermatology website provides excellent patient information and material about skin cancer (http://www.aad.org).
Published in Journal Watch Dermatology May 7, 2012
Moyer VA on behalf of the U.S. Preventive Services Task Force. Behavioral counseling to prevent skin cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012 May 8; [e-pub ahead of print]. (http://www.annals.org/content/early/2012/05/02/0003-4819-157-1-201207030-00442)
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