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Some melanoma survivors fail to wear sunscreen, still use tanning beds
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More than one-quarter of melanoma survivors never wear sunscreen when outside for extended periods, according to findings presented at the AACR Annual Meeting.
Although most melanoma survivors use sunscreen and take other precautions to prevent cancer recurrence, 27.3% of survivors do not use sunscreen when outdoors for more than 1 hour on warm, sunny days, the study results showed.
More than 15% of melanoma survivors reported rarely or never staying in the shade, and 2.1% reported using a tanning bed within the past year, the researchers said.
Anees B. Chagpar
“We would assume that because melanoma survivors are nine times more likely to develop a second malignancy than individuals in the general population are to develop a first malignancy, they would be extremely vigilant about sun protection,” researcher Anees B. Chagpar, MD, MSc, MPH, MA, FRCS(C), FACS, associate professor of surgery at Yale School of Medicine and director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven, told HemOnc Today. “That was not the case. While we found that they were more vigilant, they were not as hypervigilant as we expected.”
After controlling for age, race and insurance status, melanoma survivors were no less likely to use a tanning bed than individuals in the general population, Chagpar said.
“The findings are really intriguing,” she said.
Chagpar and colleagues evaluated data from the 2010 National Health Interview Survey. The survey questioned participants about a variety of health topics, and the findings included self-reported information on melanoma history and habits regarding sun protection and tanning.
The analysis included data from 27,120 adults, of whom 171 had a prior history of melanoma. The participants were asked about their habits when spending 1 hour or more outside on warm, sunny days, and researchers compared the habits of melanoma survivors with individuals in the general population.
The findings showed melanoma survivors were more likely to:
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Always wear sunscreen (32% vs. 17.2%);
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Stay in the shade (15.6% vs. 10.5%);
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Wear baseball caps/visors (31.3% vs. 18.4%) or wide-brimmed hats (20% vs. 6.1%); and
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Wear a long-sleeved shirt (12% vs. 5.2%).
“The message about using sunscreen, staying in the shade and wearing a shirt or a cap has been touted for years,” Chagpar said. “But it is clear that we could be doing a much better job at educating everyone, including survivors who are in danger of a second malignancy.”
Chagpar suggested that the relatively recent phenomenon of tanning addiction also may play a role.
“There might be a biochemical basis for some of these behaviors that is worth investigating,” she said. “This addiction may prompt these individuals to continue tanning despite our efforts at education.”
The responsibility for increasing uptake in sun protection habits extends beyond clinicians, Chagpar said.
“We as physicians have direct contact with melanoma survivors, so we need to be doing a better job of driving the message home while they are under our care,” she said. “But maybe some survivors believe that they have had cancer and it will not happen again.”
Additional efforts also must be made to educate children and teenagers about the dangers of sun exposure and tanning salons, Chagpar said.
“Everybody has a part to play in preventing these malignancies,” she said.
For more information:
Chagpar AB. Abstract #1365. Presented at: AACR Annual Meeting; April 6-10, 2013; Washington.
Disclosure: Chagpar reports no relevant financial disclosures.
Perspective
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Wen-Jen Hwu, MD, PhD
Scientific evidence has shown that ultraviolet (UV) radiation is the major environmental carcinogen for melanoma, and that those who have been exposed to UV radiation from indoor tanning have at least a 75% increased risk of contracting melanoma. Thus, reduction in UV exposure from both natural and artificial sources is a modifiable environmental factor that can decrease melanoma risk.
The American Academy of Dermatology (AAD) recommends a three-pronged strategy to avoid excessive UV exposure. First, avoid the midday sun; that is, from 10 a.m. to 2 p.m. or 11 a.m. to 3 p.m., depending on the time zone and time of year. Outdoor recreation activities can be scheduled either earlier or later in the day. Clothing protection is the second line of defense. Hats with broad brims — especially those that cover the ears — are recommended, as are shirts with short sleeves to protect the shoulders. Third, use sunscreens with a sun protection factor of 30 or higher.
Because the treatment of late-stage melanoma is of limited efficacy, emphasis on prevention and early detection remains a priority. Both the AAD and ACS offer teaching aids on how to perform skin self-examination.
This study has demonstrated that additional efforts must be made to educate melanoma survivors and the public about the importance of avoiding UV radiation in order to prevent a second primary melanoma occurrence in melanoma survivors, as well as a further increase in the incidence of melanoma and other skin cancers in the general population.
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