Few Physicians Mention Sunscreen

Jennifer Garcia

September 04, 2013

Very few physicians mention sunscreen during patient visits, even when seeing patients with a history of skin cancer, according to a new study published online September 4 in JAMA Dermatology.

The researchers, led by Kristie L. Akamine, MD, from the Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, used data from the National Ambulatory Medical Care Survey, which collects data regarding office-based physician visits in the United States. The researchers used information from the survey to identify patient visits during which sunscreen was recorded, indicating it was currently being used by the patient, was dispensed in the office, or was recommended by the physician. Patient visits associated with a diagnosis of skin disease, specifically skin cancer, were also evaluated.

Between January 1, 1989, and December 26, 2010, there were 18.30 billion patient visits nationwide; sunscreen was mentioned by the physician in 12.83 million of these visits (0.07%). There were no differences in sunscreen recommendation with respect to age or ethnicity; however, sunscreen was recommended more often for patients in their 70s and was recommended the least for children younger than 10 years.

Among patient visits associated with a diagnosis of skin disease, sunscreen was mentioned at 0.9% visits. Dermatologists had the highest rate of sunscreen recommendation (86.4% of all physician visits associated with sunscreen); however, sunscreen was mentioned at only 1.6% of dermatology visits overall. Researchers also noted that dermatologists mentioned sunscreen at only 11.2% of visits associated with a diagnosis of active or previous history of skin cancer compared with general/family physicians, who mentioned it at 55.5% of visits among this patient population.

"This low frequency of sunscreen recommendation by dermatologists is concerning because dermatologists saw more than 20 times the number of patients with a history of skin cancer (7.1 million) compared with general/family physicians (320 000)," write Dr. Akamine and colleagues. The researchers also state concern about the low levels of sunscreen recommendation among children, as they are likely to have the greatest amount of sun exposure of all age groups.

The authors note there are several limitations to the study, such as the inability to determine whether the mention of sunscreen during the visit was a result of current use or recommended use. They also note that physicians may have failed to document sunscreen recommendations at all visits.

In an interview with Medscape Medical News, Elizabeth Martin, MD, a private practitioner in Hoover, Alabama, and volunteer clinical faculty member at the University of Alabama School of Medicine at Birmingham, agreed the sunscreen recommendations may have been understated because of failure to document these in the record. "Additionally, as the study includes both new and follow-up visits, it may have been that sunscreen was discussed with the patient at a prior visit," said Dr. Martin.

"It is very important that [dermatologists] discuss sunscreen use (and sun-protective habits in general) with our patients," Dr. Martin added." Sunscreen counseling, as part of overall sun-protection counseling, is a simple discussion that should be had with our patients to help reduce the incidence of skin cancer."

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, LP. One author is a consultant for Abbott Labs, Amgen, BiogenIdec, Bristol-Myers Squibb, Centocor, Connetics, Galderma, Genentech, Photomedex, and Warner Chilcott and has received grants from Abbott Labs, Amgen, Astellas, Aventis Pharmaceuticals, BiogenIdec, Bristol-Myers Squibb, Centocor, Connetics, Coria, Galderma, Genentech, GlaxoSmithKline, 3M, Novartis, Ortho Pharmaceuticals, Pharmaderm, Photomedex, Roche Dermatology, Stiefel, and Warner Chilcott. Dr. Martin has disclosed no relevant financial relationships.

JAMA Derm. Published online September 4, 2013.

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