USPSTF Draft Recommendation

Counsel Young Fair-skinned Patients About Skin Cancer

October 12, 2017 05:05 pm Chris Crawford

Skin cancer is the most common type of cancer in the United States.  

[Two young children wearing rash guards at the beach]

Exposure to ultraviolet (UV) radiation during childhood and adolescence increases an individual's skin cancer risk later in life. People with fair skin and/or freckles and those who sunburn easily are at a higher risk for skin cancers.

Those factors prompted the U.S. Preventive Services Task Force (USPSTF) to issue a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on Oct. 10 that address behavioral counseling to prevent skin cancer.

Based on its review of the evidence, the USPSTF recommended that physicians counsel children, adolescents, young adults and parents of young children about protective behaviors that minimize exposure to UV radiation for fair-skinned people ages 6 months to 24 years. This is a "B" recommendation.(www.uspreventiveservicestaskforce.org)

"The task force found that providing behavioral counseling to children, their parents and young adults encourages sun-protective behaviors. These actions, such as using sunscreen, wearing sun-protective clothing and avoiding indoor tanning, can help prevent skin cancer later in life," said USPSTF member Karina Davidson, Ph.D., M.A.Sc., in a news release.(www.uspreventiveservicestaskforce.org)  

Story highlights
  • The U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement and draft evidence review on Oct. 10 that address behavioral counseling to prevent skin cancer.
  • Based on its review of the evidence, the USPSTF recommended physicians counsel children, adolescents, young adults and parents of young children about minimizing exposure to ultraviolet (UV) radiation for fair-skinned people ages 6 months to 24 years.
  • For adults older than 24 who have fair skin, the task force recommended that physicians consider individual patients' risks for skin cancer when deciding whether to provide counseling on minimizing UV exposure.

For adults older than 24 who have fair skin, the task force recommended that physicians consider individual patients' risks for skin cancer when deciding whether to provide counseling on minimizing UV exposure -- a "C" recommendation.

Finally, the USPSTF concluded that current evidence was insufficient to assess the balance of benefits and harms of counseling adults about skin self-examination to prevent skin cancer -- an "I" recommendation.

In its recommendation statement, the USPSTF called for more research on providing UV exposure counseling for people with other skin types, as well as on the benefits and harms of counseling about skin self-examination.

Updates to Previous Recommendations

The USPSTF commissioned a systematic evidence review to update its 2012 recommendation on behavioral counseling for the primary prevention of skin cancer and its 2009 recommendation on screening for skin cancer with skin self-examination.

The review looked at direct evidence indicating that counseling patients about sun protection reduced intermediate adverse outcomes (e.g., sunburn or precursor skin lesions) or skin cancer. It also searched for evidence on the links between counseling and behavioral change and between behavior change and skin cancer incidence, as well as about the harms of counseling or changes in sun-protective behavior.

Additionally, the review examined evidence on skin self-examination and related skin cancer outcomes and harms.

In this updated recommendation, the USPSTF expanded the age range for the recommendation on behavioral counseling interventions to include patients ages 6 months to 24 years with fair skin; the previous recommendation applied only to those ages 10 to 24 years.

The task force's 2012 recommendations also stated that there wasn't enough evidence to recommend for or against counseling adults older than 24. The AAFP agreed with this conclusion in its own recommendation

"Now there is more evidence that counseling people to practice sun-protective behaviors can benefit some adults with fair skin," said task force member John Epling Jr., M.D., M.S.Ed., in the release.

The current draft statement's "I" recommendation on assessing the balance of benefits and harms of counseling adults about skin self-examination to prevent skin cancer remains unchanged from 2009.

Family Physician's Perspective

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News the age range for the draft recommendation on behavioral counseling interventions was expanded from the 2012 recommendation because back then, the evidence review found few studies that included children younger than age 10.

"So, they couldn't include younger children in their recommendation," she said. "The updated evidence review found more evidence that counseling parents of younger children about minimizing sun exposure resulted in behavioral change."

Frost said she counsels all patients, particularly parents, about the importance of sun protection.

"While fair-skinned individuals are at greater risk, people with darker complexions also get skin cancer," she said. "I encourage outdoor activities, but recommend sunscreen, eye protection and a hat, especially during the hottest time of the day."

Frost said newly popular "rash guards" (swim shirts), including long-sleeve options, offer protection from UV rays -- and many come with specific sun protection factor ratings.

"These are great options for kids, as they don't wash off," she said. "But don't forget about other parts of the body that are exposed."

Up Next

The USPSTF is inviting comments on its draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on behavioral counseling for skin cancer prevention.

The public comment window for both draft recommendations is open until 8 p.m. EST on Nov. 6. All comments received will be considered as the task force prepares its final recommendation.

The AAFP will review the USPSTF's draft recommendation statements and supporting evidence and provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.

Related AAFP News Coverage
Evidence Lacking to Recommend For, Against Skin Cancer Screening
USPSTF, AAFP Finalize Clinical Recommendation, Call for More Research

(8/5/2016)

Indoor Tanning Hazards Prompt Further Safety Proposals
FDA Seeks to Restrict Sunlamp Use to Adults, Mandate Informed Consent

(12/23/2015)

Help Your Patients Prepare for a Safe Summer
AAFP Resource Offers Tips for Hydration, Sun Protection and Pool Safety

(5/21/2015)

More From AAFP
Familydoctor.org: Skin Cancer(familydoctor.org)