Jennifer S. Lin, MD, MCR; Michelle Eder, PhD; Sheila Weinmann, PhD, MPH
More than 2 million cases of skin cancer are diagnosed annually in the United States, and melanoma incidence is increasing.
To assist the U.S. Preventive Services Task Force in updating its 2003 recommendation on behavioral counseling to prevent skin cancer.
Existing systematic reviews, database searches through February 2010, and outside experts.
English-language, primary care–relevant counseling trials to promote sun-protective behaviors and studies examining the association between sun-protective behaviors and skin cancer outcomes or potential adverse effects were included.
Each study was appraised by using design-specific quality criteria. Important study details were abstracted into evidence tables.
11 fair- or good-quality, randomized, controlled trials examined the counseling interventions' effect on sun-protective behaviors. In young women, appearance-focused behavioral interventions decrease indoor tanning and ultraviolet exposure. In young adolescents, computer support can decrease midday sun exposure and increase sunscreen use. Thirty-five mainly fair-quality observational studies examined the relationship between ultraviolet exposure or sunscreen use and skin cancer. Increasing intermittent sun exposure in childhood is associated with an increased risk for squamous cell carcinoma, basal cell carcinoma, and melanoma. Evidence suggests that regular or early use of indoor tanning may increase melanoma risk. On the basis of 1 fair-quality trial, regular sunscreen use can prevent squamous cell carcinoma, but it is yet unclear if it can prevent basal cell carcinoma or melanoma.
There are limited rigorous counseling trials. Observational studies are limited by the complexity of measuring ultraviolet exposure and sunscreen use, and inadequate adjustment for important confounders.
Randomized, controlled trials suggest that primary care–relevant counseling can increase sun-protective behaviors and decrease indoor tanning.
Agency for Healthcare Research and Quality.
BCC = basal cell carcinoma; KQ = key question; SCC = squamous cell carcinoma.
Appendix Table 1.
Appendix Table 2.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Lin JS, Eder M, Weinmann S. Behavioral Counseling to Prevent Skin Cancer: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;154:190–201. doi: 10.7326/0003-4819-154-3-201102010-00009
Download citation file:
Published: Ann Intern Med. 2011;154(3):190-201.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use