Nov. 8, 2011 -- Catch them when they're young.
That's the message at the heart of new guidelines by the U.S. Preventive Services Task Force (USPSTF) that call for pediatricians and primary care doctors to discuss sun safety and skin cancer prevention with fair-skinned children, adolescents, and young adults.
The guidelines update the group's 2003 recommendations, which stated that there was not enough evidence to warrant such counseling for any age group.
After reviewing all studies published since that time, the task force states that there seems to be some benefit to counseling fair-skinned people in the 10- to 24-year-old group on how to limit exposure to the sun's harmful rays.
A Different Approach
The message is also best served when it focuses on how the sun's ultraviolet rays can affect appearance, as opposed to skin cancer risk. Sun exposure causes premature aging and wrinkles.
The group says that there is still not enough data to determine whether it makes sense to counsel people aged 24 and older about how they can minimize their risk of developing skin cancer.
"It appears that the important age range is young and this is, in part, because that is where the data is," says USPSTF panel chair Virginia A. Moyer, MD, MPH. She is a professor of pediatrics at the Baylor College of Medicine in Houston, Texas.
"Ten- to 12-year-old children are very aware of how they look and most of the counseling methods that work are appearance based," she says.
"If you tell a teenager that she needs to wear a long-sleeved shirt on a hot day because she may get cancer in the future, it doesn't resonate as much as if you tell them they will develop wrinkles and start to look older than they are," Moyer says.
This approach can change risky behaviors. In one study of young adults, appearance-based prevention education reduced indoor tanning by 35%.
The bottom line is appearance trumps cancer prevention in this age group, she says.
Overall, traditional prevention messages that focus on skin cancer risk as well as those that focus on appearance do make a difference. These messages can easily be folded into visits with primary care doctors along with other important prevention topics.
Computer-based education programs, booklets, and/or peer-to-peer counseling can all help doctors get their message across.
"Counseling in the primary care office can make a difference," Moyer tells WebMD. "You have got to use time for what is effective and this is effective and doable in primary care. You can do it in the office, make a difference and not use up all of your time. That is exciting."
Recommendations Don't Go Far Enough?
Many dermatologists -- at odds with some of the panel's recommendations -- feel that more is better when it comes to counseling people on the risks of sun exposure.
Doris Day, MD, a dermatologist at Lenox Hill Hospital in New York City, says that counseling on sun-protection strategies benefits people of all ages -- from the very young to the senior crowd.
"At any age, counseling is critical," she says. "It makes a big difference and we need to do better and better at every age."
Practice Sun Safety
New York City dermatologist Michele Pauporte, MD, says the U.S. needs a national skin cancer prevention program that is modeled after successful programs in other countries like Australia.
"We know that UV exposure in early years significantly increases the risk of skin cancer especially in certain populations such as fair skinned individuals," she says via email.
"Like smoking, the damages of ultraviolet rays are sometimes only seen years later when a cancer arises so the counseling has to begin at young ages and include families and schools," Pauporte says. "It is critical that the message about the dangers of ultraviolet rays from the sun and tanning beds be heard and heeded."
The American Academy of Dermatology has these tips for sun safety:
- Use a broad-spectrum, water-resistant sunscreen with a sun protection factor (SPF) of 30 or more on all exposed skin. Broad-spectrum protects against both UVA and UVB rays.
- Wear protective clothing such as a long-sleeved shirt, pants, wide-brimmed hat, and sunglasses.
- Avoid the sun when its rays are strongest. This is typically between 10 a.m. and 4 p.m.
- Avoid indoor tanning beds.