Skin Cancer Prevention Recommendations, CDC Data Affirm Need for Counseling to Minimize Risk

Just as the AAFP and the U.S. Preventive Services Task Force (USPSTF) were updating their 2003 guidelines for prevention of skin cancer earlier this month -- issuing final recommendations to counsel fair-skinned individuals between the ages of 10 and 24 years about minimizing their exposure to ultraviolet (UV) radiation -- data published in Morbidity and Mortality Weekly Report (MMWR) indicate that the message may be needed now more than ever.

A data analysis on the use of indoor tanning devices published May 11 in MMWR, says "the highest rates of indoor tanning were found among young women, particularly white women aged 18-25 years," with nearly 58 percent of that group reporting that they had tanned indoors 10 or more times in the past year. Among all white adult women who reported tanning indoors, the average number of sessions per year was 20.3. That number jumped to nearly 28 sessions per year in women ages 18-21.

"UV radiation levels from indoor tanning devices far exceed those from sunlight," said the report's authors. "The high frequency of use among indoor tanners is of great concern given these high levels of UV radiation and the elevated risk for skin cancer with increasing numbers of sessions."

According to a CDC press release, young adults continue to increase their risk for developing skin cancer, despite data that suggest overexposure to UV light causes cancer.

Family physicians in particular can help these younger patients, according to the clinical summary for the new USPSTF recommendations. The summary suggests that behavioral counseling in a primary care setting that emphasizes cancer prevention or appearance-focused messages, such as stressing the aging effect of UV radiation on the skin, can reduce UV exposure, including indoor tanning, among people ages 10-24 years.

"In young women, the most likely group to indoor-tan, appearance-focused behavioral interventions reduced indoor tanning behavior by up to 35 percent," the authors said. "Given the high prevalence of indoor tanning among young adult women, an increased focus should be placed on this population to prevent melanoma from increasing significantly as this generation ages."

Any potential benefit of such counseling for older patients is less clear, however, leading the USPSTF and the AAFP to state in their May 8 prevention recommendations that current evidence is "insufficient to assess the balance of benefits and harms of counseling adults older than age 24 years about minimizing risks to prevent skin cancer."