Behavioral Counseling for Skin Cancer Prevention: USPSTF Updated Recommendations

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The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of counseling adults about skin self-examination to prevent skin cancer.
The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of counseling adults about skin self-examination to prevent skin cancer.

The US Preventive Services Task Force (USPSTF) has updated both the 2012 recommendation on behavioral counseling for the primary prevention of skin cancer and the 2009 recommendation on screening for skin cancer with skin self-examination, as published in JAMA.

The task force, led by David C. Grossman, MD, MPH, from the Kaiser Permanente Washington Health Research Institute, reviewed the evidence on whether counseling patients about sun protection reduces intermediate outcomes (eg, sunburn or precursor skin lesions) or skin cancer; the link between counseling and behavior change, the link between behavior change and skin cancer incidence, and the harms of counseling or changes in sun protection behavior; and the link between counseling patients to perform skin self-examination and skin cancer outcomes, as well as the harms of skin self-examination. These recommendations apply to asymptomatic persons with no history of skin cancer.

The USPSTF recommends counseling young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer (B recommendation).

Existing evidence indicates that the net benefit of counseling all adults older than 24 years is small; therefore, physicians are advised to selectively offer individualized counseling to adults older than 24 years based on the presence of risk factors for skin cancer (C recommendation).

The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of counseling adults about skin self-examination to prevent skin cancer. There is no evidence supporting an incremental benefit that might occur with skin self-examination above the benefit from counseling for sun protection behaviors and from current levels of skin examinations being performed by clinicians.

In a related editorial, Robert Sidbury, MD, MPH, from the University of Washington School of Medicine in Seattle, stated, “How do primary care clinicians operationalize the USPSTF guidance? Though the recommendations are limited to individuals with fair skin types, it is important to remember that skin type is a continuum like skin cancer risk; primary care clinicians should consider this reality as they tailor their recommendations to their patient population and specific individuals…The exact means, frequency, timing, and venue of educational intervention will vary, and studies have not been robust enough to be prescriptive. The larger message is clear, however, that advising caution in exposure to a known carcinogen will prevent harm.”

References

  1. US Preventive Services Task Force. Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(11):1134-1142.
  2. Sidbury R. Should pediatricians be more proactive in counseling children about skin cancer risk? Implications of the USPSTF recommendation statement [published online March 20, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.0354
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