SAN FRANCISCO — Recent findings that risk behaviors for skin cancer are most prevalent among 18- to 29-year-olds will be used to create a road map for efforts to curb the rising incidence of melanoma, which has climbed by 4% per year for the past 3 decades.
“We've got enough data epidemiologically now to really see where efforts have to be focused,” Dr. Darrell S. Rigel said at the annual meeting of the American Academy of Dermatology. “And if we focus our efforts, I believe we can really make a difference. In the next 10–15 years, we can begin to make an impact on the incidence of melanoma.”
Dr. Rigel cited the findings of a landmark study at Fox Chase Cancer Center in Philadelphia, where researchers analyzed trends in skin cancer risk behaviors among 28,235 adults in the 2005 National Health Interview Survey.
The majority of Americans engage in multiple skin cancer risk behaviors, the investigators found. The most common were infrequent use of sun-protective clothing and infrequent use of an SPF-15 or stronger sunscreen. The prevalence of these two risky behaviors was greatest among 18- to 29-year-olds. So, too, were rates of the other skin cancer risk behaviors tracked in the study: use of indoor tanning, staying in the sun when outside on a sunny day, and getting a sunburn within the past year, said Dr. Rigel of New York University. Indeed, more than 80% of 18- to 29-year-olds reported two or more of these behaviors, and nearly half engaged in three or more (Am. J. Prev. Med. 2008;34:87–93).
A profile emerged of adults at highest risk for skin cancer based on modifiable behaviors: individuals who were younger, male, white, living in the Midwest, smokers, risky drinkers, less educated, and with less sun-sensitive skin. This profile could be particularly helpful in primary care settings, where surveys indicate rates of assessment for skin cancer risk behaviors are low because of time pressure.
A particularly noteworthy study finding was that individuals aged 40–64 years who reported never having had a total skin exam were more than one-third more likely to engage in multiple skin cancer risk behaviors, compared with their contemporaries who had had a screening skin exam. The Fox Chase investigators argued that this observation lends support to recent calls for the creation of a national melanoma screening program targeting all white men aged 50 and older for a whole-body skin screening exam (Arch. Dermatol. 2006;142:504–7).
The Fox Chase team found that although skin cancer risk behaviors were associated with greater levels of physical activity, which often takes place outdoors, higher skin cancer risk is also associated with being overweight or obese. In anaccompanying editorial, Dr. Martin A. Weinstock observed that this finding sets the stage for a potential conflict between two worthy goals: preventing skin cancer and maintaining a healthy body weight (Am. J. Prev. Med. 2008;34:171–2).
This conflict can be minimized by promoting the “Slip! Slop! Slap!” public health message developed in Australia in the early 1980s: That is, before going outdoors, Slip on a shirt, Slop on sunscreen, and Slap on a hat, noted Dr. Weinstock, professor of dermatology and director of the division of dermatoepidemiology at Brown University, Providence, R.I.
Dr. Rigel observed that the states with the highest incidence of melanoma aren't the same ones with the highest melanoma mortality. That's because different factors are involved. Primary prevention efforts aim to reduce the incidence of melanoma through changes in the risk behaviors addressed in the Fox Chase study. In contrast, secondary prevention is a function of early detection, which results in lower melanoma mortality.