On March 20, the U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on providing 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 ultraviolet (UV) radiation for fair-skinned people ages 6 months to 24 years. This is a "B" recommendation.(www.uspreventiveservicestaskforce.org)
"Clinicians should counsel children, their parents and young adults to use sun-protective behaviors. Doing things like using sunscreen, wearing sun-protective clothing and avoiding indoor tanning can help prevent skin cancer later in life," said USPSTF member and family physician John Epling Jr., M.D., M.S.Ed., in a news release.(www.uspreventiveservicestaskforce.org)
For adults older than 24 who have fair skin, the task force recommended that physicians selectively offer counseling on minimizing UV exposure by considering individual patients' risks for skin cancer when deciding whether to provide such counseling -- 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.
This recommendation statement applies only to asymptomatic individuals with no history of skin cancer.
- The U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement and final evidence summary on March 20 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 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.
This final statement is consistent with the task force's 2017 draft recommendation statement; it includes an expanded age range from the group's 2012 final recommendation statement, which only recommended counseling for patients ages 10-24.
The AAFP plans to review the USPSTF's final recommendation statement and evidence summary and make its own recommendations after that process has been completed.
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.
The USPSTF's 2012 recommendations stated there wasn't enough evidence to recommend for or against counseling adults older than 24 about minimizing risks to prevent skin cancer. The AAFP agreed with this conclusion in its own recommendation at the time.
Regarding the current recommendation to consider individual patients' skin cancer risks when deciding whether to provide such counseling, task force member Karina Davidson, Ph.D., M.A.Sc., said, "We have more evidence now that tells us that counseling people to practice sun-protective behaviors can benefit some adults with fair skin types."
In its final recommendation statement, the USPSTF called for more research on providing UV exposure counseling for people with other skin types, as well as about the benefits and harms of counseling about skin self-examination.
Response to Public Comment
A draft version of this recommendation statement was posted for public comment on the USPSTF website from Oct. 10 to Nov. 6, 2017.
Some commenters asked the task force to define what is meant by "fair skin types," which it did as "ivory or pale skin, light hair and eye color, freckles or those who sunburn easily."
Other commenters requested additional details on behavioral counseling interventions; in response, the USPSTF added information on implementation strategies in the Other Considerations(www.uspreventiveservicestaskforce.org) section of its recommendation statement. These intervention strategies include using tailored mailings, print materials and in-person counseling by health care professionals.
Several commenters asked why self-examination was included in this recommendation statement; the task force responded that the recommendation addressed some preventive counseling interventions, which included evidence about primary care physicians counseling patients to perform skin self-examinations.
Finally, the USPSTF updated its final recommendation statement in response to comments by adding suggestions for practice regarding its "I" statement under the Clinical Considerations(www.uspreventiveservicestaskforce.org) section of the statement. The task force also added information on newer technologies and included more evidence to support the expanded age ranges in the recommendations.
Related AAFP News Coverage
USPSTF Draft Recommendation
Counsel Young Fair-skinned Patients About Skin Cancer
More From AAFP
Familydoctor.org: Skin Cancer(familydoctor.org)