- Jennifer Middleton, MD, MPH
The U.S. Preventive Services Task Force (USPSTF) is
currently
updating its 2012 recommendations regarding counseling to prevent skin cancer,
and it couldn’t come at a better time, as the incidence of malignant melanoma
continues to rise. The USPSTF found previously that counseling
fair-skinned individuals aged 10-24 increases the use of sun-protective
behaviors, but this counseling isn’t happening frequently enough in primary care.
A 2004 study of family physicians found that only 60% were routinely
providing counseling about sun protection and skin cancer prevention; commonly
cited barriers to doing so included lack of time and limited information about
the effectiveness of counseling. A more comprehensive survey in
2014 found that family physicians provided sun safety counseling far less
frequently, and usually only in association with specific patient diagnoses
such as actinic keratosis or a history of other skin problems. In contrast to what the evidence supports, the age group most likely to receive counseling in this study was adults in their 70s; counseling at child and young adult visits was rare. Since only 30% of adults regularly
follow sun safety practices, and tanning in young adults remains highly prevalent, there are ample opportunities for family physicians to make a difference for our patients by providing
this counseling.
Other effective interventions may be worth incorporating into your practice as well. Mailing
personalized handouts about
skin cancer prevention increased sun safety behaviors (use of sunscreen, protective
clothing, hats, and sun avoidance) more than providing generic handouts in one
study. In another study, calculating
a melanoma risk score (SAMScore) and targeting counseling to patients at higher
risk decreased sunbathing. Counseling young adults about tanning should elicit the specific reasons why they tan; physicians can then target their messages, such as
discussing sunless tanning products, alternative methods to relax, or debunking
the myth that a tan protects against further skin damage.
Helping patients adopt healthier behaviors is an important part of the primary care clinician's role, and applying motivational interviewing techniques along with tailoring our counseling to each patient’s stage of change may be useful. Having a structured practice intervention to help patients adopt sun safety measures may also reduce the burden on individual clinicians.
Helping patients adopt healthier behaviors is an important part of the primary care clinician's role, and applying motivational interviewing techniques along with tailoring our counseling to each patient’s stage of change may be useful. Having a structured practice intervention to help patients adopt sun safety measures may also reduce the burden on individual clinicians.