COMMENTARY

You Can Help Prevent Skin Cancer

David Espey, MD

Disclosures

September 03, 2014

Editorial Collaboration

Medscape &

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Hello. I'm Dr. David Espey, and I'm pleased to speak with you today as part of the CDC Expert Commentary series on Medscape.

Skin cancer is the most commonly diagnosed cancer in the United States, yet most cases are preventable. Nearly 5 million people in the United States are treated for skin cancers each year, at a cost of about $8.1 billion.[1] Most of these skin cancers are caused by too much exposure to ultraviolet radiation (UV) from the sun and indoor tanning devices.[2,3,4,5,6,7,8,9]

Almost 9000 people die each year from melanoma,[10] and incidence rates have been increasing about 3% per year for the past 35 years.[11]

Each year, about 37% of Americans report getting sunburned,[12] and nearly 1 in 3 young white women aged 16-25 years old engages in indoor tanning.[13] Despite efforts to address skin cancer risk factors, such as inadequate sun protection and tanning behaviors, skin cancer rates have continued to increase in the United States.

The Surgeon General has released a "Call to Action to Prevent Skin Cancer" to emphasize the importance of clinicians and the broader healthcare community working together to prevent skin cancer. This site provides a wealth of resources for clinicians and other stakeholders in skin cancer prevention, including links to the full report, executive summary, and consumer-friendly materials for the general public.

The US Preventive Services Task force (USPSTF) recommends that medical providers counsel children, adolescents, and young adults aged 10-24 years who have fair skin about minimizing their exposure to UV radiation to reduce risk for skin cancer.[14] This includes talking to patients about sun protection habits, as well as avoiding indoor tanning and sunbathing. USPSTF's website provides more information about the recommendation for behavioral counseling to prevent skin cancer.

Successful counseling interventions often use cancer prevention or appearance-focused messages (such as stressing the aging effect of UV on the skin) to reach specific audiences.[14] Indoor tanning is quite common among teen girls and young women; some tan regularly and others tan before such special occasions as a prom or a wedding.

Be aware of the appearance of your patients' skin. Do they look like they have been tanning? Adolescents and young adults often feel pressure to conform to certain beauty standards and to look tanned. Your reminder that tanning is not only dangerous but will harm their appearance is important. The potential for premature skin aging, wrinkles, and age spots may resonate more with adolescent and young women, those who are most likely to indoor tan, than information on their skin cancer risk alone. Appearance-based messaging is especially effective in reducing indoor tanning behaviors among adolescent girls. For more resources related to messages about indoor tanning, including materials that could be used for patient education, visit CDC's Burning Truth webpage.

As a medical provider, you can make a difference. Regular broad-spectrum sunscreen use works best if it is used in combination with other methods of sun protection. Therefore, behavioral counseling to promote skin cancer prevention should focus on improving multiple behaviors to reduce UV exposure and not improving sunscreen use alone.

You can encourage patients -- and their parents -- to protect their skin when outdoors by seeking shade and wearing protective clothing, a wide-brimmed hat, and sunglasses. Broad-spectrum sunscreen with an SPF of 15 or higher can also be used to protect exposed skin and should be reapplied every 2 hours and after swimming or sweating.

Every visit is a chance to reinforce these skin-protection messages while helping patients lead active, healthy lives. Make sure to have staff reinforce these messages, and use email, newsletters, or in-office signage to remind all families to stay safe in the sun.

Dr. David Espey, MD, graduated from medical school at Wake Forest University in Winston-Salem, North Carolina, in 1986 and completed training in internal medicine at the University of New Mexico Health Sciences Center in 1989. He worked with Doctors Without Borders in West Africa and with the Indian Health Service in Gallup, New Mexico, before joining the Centers for Disease Control and Prevention in 1993 as an Epidemic Intelligence Officer. From 1995 to 2000 he was assigned to the New Mexico Department of Health to support chronic disease prevention and control programs. He was active during that time in cancer, tobacco, and diabetes control programs and in developing a statewide clinical prevention initiative. Since July 2000 he has been assigned by CDC to Albuquerque, New Mexico, to collaborate with the Indian Health Service and American Indian and Alaska Native (AI/AN) tribal health programs on improving the quality of cancer surveillance data in support of cancer control programs in AI/AN communities. More recently, Dr. Espey has worked to improve mortality data for AI/AN. On February 2, 2014, Dr. Espey began a 6-month detail as acting director for CDC's Division of Cancer Prevention and Control.

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