Time to Get Serious About Skin Cancer Prevention

Abstract

In this commentary, we discuss the skin cancer epidemic in the United States and provide data to indicate that the United States public is not protecting itself from ultraviolet radiation, the primary risk factor for melanoma, and nonmelanoma skin cancer. In our opinion, skin cancer control in this country may be hindered by uncertainty about the effectiveness of sun protection strategies, inconsistent messages about the relative effectiveness of sun protection measures by federal and national organizations, and conventional research approaches that have identified few effective sun protection interventions for adults and targeted individuals for behavior change without considering the environmental context. A policy and research agenda is put forth to remedy the apparent insufficiencies in the current approach to skin cancer prevention in the United States. Cancer Epidemiol Biomarkers Prev; 21(11); 1893-901. Ó2012 AACR. Skin Cancer is Epidemic in the United StatesAt a time when incidence is declining for all major cancers in men and women in the United States, the long-recognized epidemic of skin cancer persists (1). Since 1992, melanoma incidence in the United States has risen 1.8% to 4.6% per year, affecting men and women of all ages; an increase in incidence of nonmelanoma skin cancer has also been documented nationally and internationally (2-5). This pattern is especially frustrating because, compared with other cancers trending upward (pancreas and kidney cancer in men and women, thyroid cancer in women, liver cancer in men), skin cancer is preventable. Both solar and artificial sources of ultraviolet (UV) radiation are established causes of skin cancer (6, 7). The relationship of UV radiation to the development of skin cancer differs for melanoma and nonmelanoma skin cancer and depends on the interplay of genetic susceptibility, the intermittent or chronic nature of time spent in the sun, and lifetime acquisition of sunburns (8, 9). Nevertheless, UV radiation is estimated to account for 50% to 90% of melanoma or basal cell skin cancer and 50% to 70% of squamous cell skin cancers worldwide (10). Thus, effective protection of the skin from UV radiation would prevent a substantial amount of melanoma and nonmelanoma skin cancer, saving 10 to 15 years of potential life lost per skin cancer death, and annual costs of $29 to $39 million in morbidity and $1 to $3.3 billion in mortality, depending on the type of skin cancer (11).The skin cancer epidemic continues because the United States population is not protecting itself from the harmful effects of UV radiation. Since 2000, national trends indicate inconsequential changes in use of shade, sunscreen, or shirts with long sleeves; less than 5% of the population reported use of all 3 strategies in 2010 ( Fig. 1A; ref. 12). As a consequence, sunburn prevalence, a marker of nonadherence to sun protection recommendations, has not changed over time (Fig. 1B). Although indoor tanning use in the United States population declined from 15% in 2008 to 6% in 2010, it...

An Observational Study of Sun-Protective Behaviour at an Outdoor Spectator Sporting Event in a Region of High Sun Exposure

“…There is also a skin cancer epidemic in the United States [37]. We agree with Lazovich that it is time to get serious about better protecting ourselves and our children from the risk of future skin cancer [37]. Further targeted public sun safety campaigns are warranted.…”

“…Incidence rates of cutaneous melanoma have been increasing during the last 30-40 years; the highest rates have been documented in Australia and New Zealand (27.9/100,000 among males and 25.0 among females) and in North America (10.9/100,000 among males and 7.7 among females) [36]. There is also a skin cancer epidemic in the United States [37]. We agree with Lazovich that it is time to get serious about better protecting ourselves and our children from the risk of future skin cancer [37].…”

Occupational Sun Protection: Workplace Culture, Equipment Provision and Outdoor Workers' Characteristics

“…The optimal approach is likely to be a comprehensive one 26) , that addresses personal factors as part of a broader program promoting the development of workplace contexts that positively support sun protection 43) . Although we found that the Pro-Tan Attitude Score was negatively associated with protective practices, indicating that attitudes merit attention, this study both confirms and extends our earlier findings about the relatively strong association of workplace equipment provision and supportive culture with workers' sun protection 24,41) , confirming that employer-led interventions may offer a potentially promising direction for policy development and implementation 25) .…”

What Turkish Nurses Know and Do about Skin Cancer and Sun Protective Behavior

“…Secondary prevention is based on early detection of skin cancer. Early detection involves regular skin examinations for high-risk individuals and screening programs to identify those at high risk (WHO, 2003;Geller et al, 2005;Jones et al, 2007;Lazovich et al, 2012).…”