As the most common type of cancer in most of the country, skin cancer is a significant public health issue.
1. It is estimated that in 2004 more than 1 million people will be diagnosed as having basal cell carcinoma and squamous cell carcinoma, and 2300 will die. Melanoma, predicted to affect 55,100 individuals, has a much higher mortality rate and will result in 7900 deaths.
2. Furthermore, although rates of most other cancers in the United States have been declining, the incidence of melanoma is increasing likely due in part to increased exposure to ultraviolet (UV) radiation.
The relationship between skin cancer and UV radiation is considered well-established. Several self-protective behaviors can protect from UV radiation exposure, such as seeking shade, avoiding the sun during peak hours of UV radiation, wearing protective clothing, or composite behaviors that include more than one of these. Although sunscreen is thought to be an important adjunct to other types of protection against UV exposure, recent research suggests that it is not adequate when used alone. None of these protective behaviors is highly prevalent in the United States in 1992 only 53% of adults were “very likely” to protect themselves from the sun by practicing at least one protective behavior
This report provides recommendations on community interventions to prevent skin cancer by reducing exposure to ultraviolet radiation. Interventions were reviewed and targeted various population groups in a range of settings.
The recommendations in this report represent the work of the independent, nonfederal Task Force on Community Preventive Services (the Task Force). The Task Force is developing the Guide to Community Preventive Services (the Community Guide) with the support of the U.S. Department of Health and Human Services in collaboration with public and private partners. The Centers for Disease Control and Prevention (CDC) provides staff support to the Task Force for the development of the Community Guide.
The Task Force recommendations are primarily based on the effectiveness of the intervention as determined by the systematic literature review process (described in the accompanying review article). In making its recommendations, the Task Force balances the information about effectiveness with information about other potential benefits and the potential harms of the intervention itself.
The Task Force also considers the applicability of the intervention to various settings and populations in determining the scope of the intervention. Finally, the Task Force reviews economic analyses about effective interventions. Economic information is provided to assist the reader with decision-making but does not affect the Task Force’s recommendation. The specific methods for and results of the reviews of evidence on which these recommendations are based are provided in the accompanying article. General methods employed in evidence reviews for the Community Guide have been published previously.
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- Increase to 75% the proportion of people who use at least one of the following protective measures that may reduce the risk of skin cancer: avoid the sun between 10 A.M. and 4 P.M., wear sun-protective clothing when exposed to the sun, use sunscreen with a sun protection factor (SPF) of >= 15, and avoid artificial sources of ultraviolet light.
- Reduce melanoma deaths to < 2.5 per 100,000.
Recommendations for the use of sunscreen, including recommended public health strategies, also are available from the International Agency for Research on Cancer (IARC). The CDC recommends that schools engage in skin cancer prevention activities. The U.S. Preventive Services Task Force has reviewed the evidence that sun exposure is related to melanoma but
found insufficient evidence to determine whether clinician counseling was effective in changing patient behaviors to reduce skin cancer risk.
Educational and policy approaches in primary schools are recommended
Children are in school during peak hours of UV radiation, and may often be outdoors for play or recess. They are more receptive than adolescents to practicing self-protective behaviors and are
more amenable to instruction received from adults, including teachers and parents. Based on sufficient evidence of effectiveness, the Task Force recommends interventions in primary schools to improve covering-up behavior. Evidence was insufficient to determine effectiveness in improving other sun-protective behaviors (e.g., avoiding the sun) because of inconsistent findings. Evidence was also insufficient to determine effectiveness in decreasing sunburns because only a single study, with limitations in design and execution, reported on this behavior.
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