Behavioral Counseling for Skin Cancer Prevention: Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE: Exposure to UV radiation, especially in childhood, increases skin cancer risk. OBJECTIVE: To systematically review the evidence on the benefits and harms of behavioral counseling for skin cancer prevention to inform the US Preventive Services Task Force (USPSTF). DATA SOURCES: Cochrane C...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2018-03, Vol.319 (11), p.1143-1157
Main Authors: Henrikson, Nora B, Morrison, Caitlin C, Blasi, Paula R, Nguyen, Matt, Shibuya, Kendall C, Patnode, Carrie D
Format: Article
Language:English
Subjects:
Adults
Attitudes
Cancer
Children
Counseling psychology
Disease prevention
Documents
Health risks
Intervention
Lesions
Melanoma
Populations
Prevention
Skin cancer
Skin diseases
Sun
Sunburn
Systematic review
Tanning
Ultraviolet radiation
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Summary:IMPORTANCE: Exposure to UV radiation, especially in childhood, increases skin cancer risk. OBJECTIVE: To systematically review the evidence on the benefits and harms of behavioral counseling for skin cancer prevention to inform the US Preventive Services Task Force (USPSTF). DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, and PubMed were searched for studies published from January 2009 to March 31, 2016, for skin cancer prevention and from August 2005 to March 31, 2016, for skin self-examination. Surveillance in targeted publications was conducted through February 14, 2018. Studies included in previous USPSTF reports were reevaluated for inclusion. STUDY SELECTION: Fair- and good-quality studies of primary care–relevant behavioral interventions focused on improving skin cancer outcomes, intermediate outcomes, or skin cancer prevention and self-examination behaviors. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed abstracts and full-text articles and extracted data into evidence tables. Results were qualitatively summarized but not pooled because of heterogeneity of measures. MAIN OUTCOMES AND MEASURES: Skin cancer, sunburn, precursor skin lesions, sun protection behaviors, and any harms from interventions. RESULTS: Twenty-one trials in 27 publications were included (N = 20 561). No studies assessed skin cancer outcomes in pediatric populations; 1 adult trial (n = 1356) promoting skin self-examination found no significant difference in participants diagnosed with melanoma in the intervention group vs the control group at 12-month follow-up (0 vs 1 diagnosis). There was no consistent improvement in prevention of sunburn for children (3 trials [n = 2508]) or adults (6 trials [n = 3959]). There were small to moderate increases in sun protection behavior in pediatric populations (6 trials [n = 4252]) and adults (12 trials [n = 13 099]) and small increases in skin self-examination in adults (11 trials [n = 7771]; odds ratios, 1.16-2.6). One of 3 trials of indoor tanning found an intervention effect; an appearance-focused intervention (n = 430) resulted in a smaller increase in mean indoor tanning sessions at 6 months in the intervention group vs the control group. Harms were rarely reported: 1 trial of skin self-examination (n = 1356) found an increase in skin procedures in the intervention group vs the control group at 6 months (8.0% vs 3.6%, P 
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2017.21630