No Clear Effect on Melanoma Outcomes With Behavioral Interventions

A literature review conducted for the US Preventive Services Task Force (USPSTF) found that behavioral interventions can improve sun protection behaviors in some cases, but this does not necessarily correlate with a reduction in sunburn frequency or on skin cancer/melanoma outcomes.

“UV radiation causes most skin cancers through damage to DNA and represents the major environmental risk factor for all types of skin cancer,” wrote authors led by Nora B. Henrikson, PhD, MPH, of the Kaiser Permanente Washington Health Research Institute in Seattle. “Behavioral counseling promoting behaviors for reducing UV exposure, and skin self-examination to identify and report suspicious lesions, could prevent skin cancer.”

The researchers conducted a review to aid the USPSTF in its update of a 2012 recommendation on behavioral counseling for skin cancer/melanoma prevention. That recommendation was labeled as a “B” recommendation for individuals aged 10 to 24 years; there was insufficient evidence for adults older than 24 years. The new review was published in JAMA.

The review included a total of 21 trials, incorporating 20,561 total patients. Six of these trials reported results in pediatric populations (4,252 patients), while 16 reported on adult populations (16,309 patients); 3 of the adult trials were conducted only in young adults aged 17 to 25 years.

In the pediatric trials, most of the behavioral interventions focused on parents, though some also included child-appropriate materials; adolescents were directly counseled in one trial. Five of the six trials found that the interventions-which included physician counseling, tailored mailings, or educational presentations-had a statistical significance on patient-reported sun protective behaviors. The trials showed only a small effect or no effect on sunburn, and none of the six reported outcomes on skin cancer itself.

In the adult trials, again there was a significant effect of the interventions on sun protective behavior; most commonly, this included increases in sunscreen use. One of three relevant trials found a significant change in self-reported indoor tanning behavior, with an attenuated increase in tanning sessions in the intervention group compared with a larger increase in the control group. Adult participants also reported increases in skin self-examination.

Again, though, there were limited data on the interventions’ effects on sunburn or skin cancer. One of six trials found a reduction in those reporting red or painful sunburn following the intervention. Another trial that encouraged skin self-examination found no differences in melanoma diagnosis reported at 12 months in the intervention group compared with a control group.

“Behavioral interventions can increase sun protection behavior, but there is no consistent evidence that interventions are associated with a reduction in the frequency of sunburn in children or adults and minimal evidence on skin cancer outcomes,” the authors concluded. “Intervention can increase skin self-examination in adults but may lead to increased skin procedures without detecting additional atypical nevi or skin cancers.”