USPSTF: Behavioral interventions do not reduce sunburn or skin cancer outcomes
1. Behavioral interventions increase sun protection behavior but do not reduce sunburn or skin cancer outcomes.
2. Behavior interventions lead to increased skin self-examinations but may lead to additional skin procedures without finding additional skin cancers.
Study Rundown: While melanoma comprises 2% of all skin cancers, it causes more than 80% of skin cancer deaths. UV radiation is a major environmental risk factor for all skin cancers, and behavioral counseling promoting behaviors could reduce UV exposure and thus skin cancer. This systematic review analyzed the current evidence on the benefits and harms of behavioral counseling for skin cancer prevention and found that these interventions can increase sun protection behavior. However, there is a lack of evidence that these interventions are associated with a reduction in the frequency of sunburn or improve skin cancer outcomes. While interventions may lead to more skin self-examinations, they can also lead to more skin procedures without finding skin cancers.
While the authors included numerous studies from the primary care setting, the review excluded studies taking place in worksites, schools, or other community settings, which may have an earlier or stronger impact on patients. It also excluded survivors of skin cancer, which may be a vulnerable group that would benefit most from increased education. Despite these limitations, it seems unlikely that behavioral interventions have a large impact on reducing sunburn and skin cancer risk.
In-Depth [systematic review]: This study reviewed 21 trials in 27 publications with a total of 20 561 patients in the Cochrane Central Register of Controlled Trials, MEDLINE, and PubMed regarding skin cancer prevention and skin self-examination. Several trials found intervention to have some increase in sun protection behavior in children (6 trials, n = 4252) and adults (12 trials, n = 13 099) but no consistent improvement in prevention of sunburn in children (3 trials, n = 2508) or adults (6 trials, n = 3959). A trial of skin self-examinations (n = 1356) found increased skin procedures in the intervention group vs. control group at 6 months (8.0% vs. 3.6%, p < 0.001).
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