Community-wide Interventions to Prevent Skin Cancer: Two Community Guide Systematic Reviews

doi:10.1016/j.amepre.2016.03.020

American Journal of Preventive Medicine

Volume 51, Issue 4, October 2016, Pages 531-539

https://doi.org/10.1016/j.amepre.2016.03.020 Get rights and content

Context

Skin cancer is a preventable and commonly diagnosed cancer in the U.S. Excessive ultraviolet radiation exposure is a known cause of skin cancer. This article presents updated results of two types of interventions evaluated in a previously published Community Guide systematic review: multicomponent community-wide interventions and mass media interventions when used alone.

Evidence acquisition

Studies assessing multicomponent community-wide and mass media interventions to prevent skin cancer by reducing ultraviolet radiation exposure were evaluated using Community Guide systematic review methods. Relevant studies published between 1966 and 2013 were included and analyzed for this review.

Evidence synthesis

Seven studies evaluating the effectiveness of multicomponent community-wide interventions showed a median increase in sunscreen use of 10.8 (interquartile interval=7.3, 23.2) percentage points, a small decrease in ultraviolet radiation exposure, a decrease in indoor tanning device use of 4.0 (95% CI=2.5, 5.5) percentage points, and mixed results for other protective behaviors. Four studies evaluating the effectiveness of mass media interventions found that they generally led to improved ultraviolet protection behaviors among children and adults.

Conclusions

The available evidence showed that multicomponent community-wide interventions are effective in reducing the deleterious effects of ultraviolet radiation exposure by increasing sunscreen use. There was, however, insufficient evidence to determine the effectiveness of mass media interventions alone in reducing ultraviolet radiation exposure and increasing ultraviolet protection behaviors, indicating a continuing need for more research in this field to improve assessment of effectiveness.

Section snippets

Context

In the Call to Action to Prevent Skin Cancer,¹ the U.S. Surgeon General identified skin cancer as a serious public health concern. Each year, nearly 5 million U.S. adults are treated for skin cancer at an annual cost of $8.1 billion.² The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.³ Melanoma accounts for most skin cancer deaths and is the fifth and sixth most common cancer in white men and white women, respectively.⁴ Of the estimated

Evidence Acquisition

The Community Guide systematic review process has been described in detail elsewhere.26, 27 In brief, the process includes forming a coordination team (the team) of systematic review scientists and research fellows from CDC’s Community Guide Branch, who collaborate with subject matter experts and consultants on skin cancer prevention from CDC and other agencies, organizations, and academic institutions, with oversight from the Community Preventive Services Task Force (Task Force).

Intervention effectiveness

For the updated review, three studies31, 32, 33 from the new literature search period (June 2000–April 2013) and four studies34, 35, 36, 37 from the original review search period (1966–2000) qualified for inclusion in the analysis. Thus, evidence is based on seven studies31, 32, 33, 34, 35, 36, 37 that evaluated intervention effects on multiple UVR protective behaviors (Figure 2). All included studies in the updated review had fair quality of execution; two studies were RCTs32, 34 and five were

Summary of Findings

The available evidence showed that MCCW interventions (seven studies)31, 32, 33, 34, 35, 36, 37 are effective in reducing the harmful effects of UVR exposure by increasing sunscreen use at the community level. This suggests that using these strategies can be effective in promoting UVR protection at the community level.

However, there was insufficient evidence to determine the effectiveness of MM interventions alone (four studies)24, 31, 38, 39 in reducing UVR exposure, indicating a continuing

Acknowledgments

This review would not have been possible without the subject matter expertise and contributions of our coordination team from areas of CDC other than the Community Guide Branch as well as outside organizations. We also recognize Kate W. Harris, Kristen Folsom, and Onnalee Gomez for their assistance throughout the review process.

Author affiliations are shown at the time the research was conducted.

The findings and conclusions in this report are those of the authors and do not necessarily

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European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention–Update 2023
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Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Parents are generally influencing the sun protection behaviors of their children, including sunscreen use. In Saudi Arabia, sunscreen use was estimated in adults but not children. The objective was to estimate the prevalence and predictors of sunscreen use among parents and their children. An observational cross-sectional study was conducted in April 2022. Parents who were visiting outpatient clinics at a university hospital in Al-Kharj city, Saudi Arabia, were invited to complete an online questionnaire. A total of 266 participants were included in the final analysis. The mean age of parents was 39.0 ± 8.9 years, and the mean age of children was 8.2 ± 3.2 years. The prevalence of sunscreen use was 38.7% in parents and 24.1% in their children. Females had higher sunscreen use than males in both parents (49.7% versus 7.2%, p < 0.001) and in children (31.9% versus 18.3%, p = 0.011). The most frequent sunburn protection measures practiced by children were wearing long-sleeved clothes (77.0%), sitting in the shade (70.6%), and wearing hats (39.2%). In multivariable analysis, predictors of sunscreen use in parents included female sex, history of sunburn, and sunscreen use by children. Independent predictors of sunscreen use in children included a history of sunburn, wearing hats, and practicing other sunburn protection measures on risky occasions, and sunscreen use in parents. Sunscreen use in parents and children in Saudi Arabia is still inadequate or limited. This calls for community/school intervention programs using educational activities and multimedia promotion. Further studies are needed.
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Our analysis of the SEER database demonstrates that the trend in incidence of melanoma has fallen in the era of PDE-5i use for ED. These findings may be of value in counseling patients anxious about the potential association between PDE-5i use and skin cancer; however, continued research analyzing individual-level risk are needed.
[Translated article] Current State of Skin Cancer Prevention: A Systematic Review
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Skin cancer deaths continue to rise despite the implementation of numerous preventive campaigns and programs. The aim of this systematic review was to evaluate reviews of primary and secondary skin cancer prevention strategies as reported over the past 10 years. We analyzed 63 systematic reviews and meta-analyses: 30 (46.6%) addressing primary interventions and 35 (55.6%) addressing secondary interventions. Two of the reviews covered both. The most widely reported primary prevention approaches were education programs (63.3%), followed by risk modeling to identify individuals at high risk for melanoma (17.6%), and the promotion of sunscreen use (11.8%). The most widely reported secondary prevention measures concerned imaging systems for early skin cancer detection (40%), smartphones and new technologies (22.9%), and visual diagnosis in population-based screening (17.4%). The most effective measures were primary prevention education programs to improve sun protection habits.
La mortalidad por cáncer de piel continúa aumentando a pesar de las numerosas intervenciones dedicadas a su prevención. El objetivo de esta revisión es estudiar la situación de la prevención primaria y secundaria del cáncer de piel en los últimos 10 años. Se incluye un total de 63 revisiones, 30 (46,6%) revisiones incluyeron estrategias de prevención primaria y 35 (55,6%) de prevención secundaria, incorporando 2 de las revisiones información sobre ambos tipos de estrategias. Para la prevención primaria, las medidas más estudiadas fueron los programas educativos (63,3%), seguidos de la creación de modelos para identificar a personas con alto riesgo de desarrollar un melanoma (17,6%) y la promoción del uso de fotoprotectores (11,8%). Los sistemas de toma de imagen para el diagnóstico precoz del cáncer de piel (40%), seguidos por el empleo de smartphones y nuevas tecnologías (22,9%), así como el diagnóstico visual como cribado poblacional (17,4%), fueron las medidas de prevención secundaria más evaluadas. De todas las medidas revisadas, las estrategias de prevención primaria centradas en programas educativos para mejorar los hábitos de fotoprotección fueron las que resultaron más efectivas.
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Citation Excerpt :
Similarly, although mandatory workplace sun protection policies improve protective behaviors during working hours, high levels of sun exposure and low levels of protection persist when off-duty (level III evidence).158 The goal of multicomponent interventions is to integrate educational, behavioral, and environmental approaches into a single program that can be implemented across multiple settings in specific populations.153,157,158 In fact, multicomponent community-wide interventions but not mass media campaigns were consistently successful in increasing UV-protective behaviors while also being cost-effective (level I evidence).153
Skin cancer is the most commonly diagnosed cancer worldwide. Understanding the natural history of skin cancer provides the framework for the creation of prevention and control strategies that aim to reduce the skin cancer burden. Based on the target (individual vs population), disease stage, and risk factors (modifiable vs nonmodifiable), strategies can be categorized into 4 levels—health promotion (also known as primordial prevention), primary prevention, secondary prevention, and tertiary prevention. This is the first of a 2-part review, which will cover the epidemiology, risk factors, primordial prevention, and primary prevention of melanoma and keratinocyte skin cancers. In particular, we highlight preventive strategies centered on mitigating the impact of modifiable risk factors and potential interventions for health promotion and primary prevention of skin cancer. Summaries of existing recommendations, challenges, opportunities, and future directions are also discussed.

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^☆: Names and affiliations of Community Preventive Services Task Force members can be found at: www.thecommunityguide.org/about/task-force-members.html

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Community-wide Interventions to Prevent Skin Cancer: Two Community Guide Systematic Reviews☆

Context

Evidence acquisition

Evidence synthesis

Conclusions

Section snippets

Context

Evidence Acquisition

Intervention effectiveness

Summary of Findings

Acknowledgments

Am J Prev Med

Eur J Cancer

Ann Epidemiol

Am J Prev Med

Am J Prev Med

Am J Prev Med

Prev Med

Prev Med

Keratinocyte carcinomas (basal and squamous cell carcinomas of the skin)

Health Care Expenditures for Non-melanoma Skin Cancer Among Adults, 2005–2008 (Average Annual)

Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006

J Am Acad Dermatol

Prevalence of a history of skin cancer in 2007: results of an incidence-based model

Arch Dermatol

A systematic review of worldwide incidence of nonmelanoma skin cancer

Br J Dermatol

Common and dysplastic naevi as risk factors for cutaneous malignant melanoma in a Swedish population

Acta Derm Venereol

Common acquired naevi and the risk of malignant melanoma

Int J Cancer

High risk of malignant melanoma in melanoma-prone families with dysplastic nevi

Ann Intern Med

An international evaluation of the cancer-preventive potential of sunscreens

Int J Cancer