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Many melanoma survivors practice suboptimal sun protection
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Although most melanoma survivors effectively limit their sun exposure, a considerable number practice less-than-optimal sun exposure behaviors, according to study results published in Cancer Epidemiology, Biomarkers & Prevention.
Melanoma is the sixth most common cancer in the United States, and incidence has increased during the past 30 years. More than 76,000 cases were diagnosed in the United States last year, and more than 10,000 Americans died of the disease, according to SEER statistics.
Excessive ultraviolet radiation exposure is considered a strong contributor to melanoma risk, and efforts to limit UV exposure after melanoma diagnosis can reduce risk for second primary melanomas.
Rachel Isaksson Vogel, PhD, assistant professor in the department of obstetrics, gynecology and women’s health at University of Minnesota, and colleagues conducted a cross-sectional survey that included 724 long-term melanoma survivors — diagnosed approximately 10 years earlier — and 660 controls matched for age and sex. Age of melanoma diagnosis among cases ranged from 25 to 59 years.
Vogel and colleagues asked participants about ultraviolet radiation exposure and the protection measures they practiced in the past year. Investigators used logistic regression models — adjusted for potential confounders — to compare results from melanoma survivors and controls.
Melanoma survivors were much less likely than controls to report high sun exposure on a typical weekday (OR = 0.72; 95% CI, 0.55-0.94). Survivors also reported less frequent sunburns (OR = 0.4; 95% CI, 0.3-0.53) and use of indoor tanning (OR = 0.2; 95% CI, 0.9-0.44). Researchers reported comparable rates of high sun exposure on typical weekends between groups.
Melanoma survivors reported higher rates of optimal sun protection behaviors; however, some melanoma survivors reported indoor tanning, 10% indicated they intentionally spent time in the sun to tan, and 20% reported they continued to experience sunburns.
HemOnc Today spoke with Vogel about the study results and their potential implications.
Question: What prompted you to conduct the study?
Answer: I have done a lot of work with melanoma survivors, and I am very interested in survivorship. We conducted focus groups and found that some melanoma survivors reported using sunscreen, wearing long-sleeved shirts and doing everything else they could to ensure they were protected from the sun. Others said they didn’t change a thing. We were surprised by this, and even more surprised that this phenomenon had not been well documented in the literature. We realized we needed to examine a large group of melanoma survivors and a control group of people who haven’t had melanoma to really understand what survivors are doing after diagnosis. If we identified a problem, we would have data to support creating an intervention.
Q: How did you conduct the study?
A : We performed an observational study that included two groups — people diagnosed with melanoma and population controls — we had enrolled in a separate study about 10 years ago to determine whether indoor tanning was related to melanoma diagnosis. We followed up with these people by mail to give them an opportunity to take a one-time survey, which they completed either online or on paper.
Q: Can you provide a brief overview of the results?
A: Melanoma survivors are more likely to avoid excessive sun exposure and regularly use sun protection methods — such as using sunscreen or wearing a long-sleeved shirt than controls — than controls. However, there is a great deal of room for improvement. Twenty percent of melanoma survivors reported getting a sunburn in the past year, and more than half reported they did not wear a hat or stay in the shade during peak sunlight hours. In addition, 10% of survivors reported intentionally seeking the sun to tan.
Q: Did the findings surprise you?
A: I honestly didn’t know what to expect because this topic was not well-studied. I knew from the focus groups that some survivors were not exhibiting optimal behavior. For me, the most alarming result was the proportion of survivors who reported a sunburn in the past year. I consider sunburn a good measure of inappropriate sun exposure, either because you had prolonged exposure or inadequate protection.
Q: Why do you think some melanoma survivors are not as vigilant as they should be?
A: It is difficult to change people’s habits, and sun exposure is tied into social situations. In some of our previous work, melanoma survivors told us they didn’t avoid the sun because they didn’t think melanoma was a big deal, or they didn’t want their diagnosis to change their lifestyle. We see this difficulty with behavioral changes in other studies. For example, some people diagnosed with lung cancer continue to smoke. We know these behavior changes are difficult.
Q: What steps can be taken to change this attitude?
A: We must consistently convey the message that sun exposure can be detrimental. This means continual messaging so people hear it every time they go to their dermatologist, they hear it from the media [and] they hear it from everybody else. Really, it’s mostly about making sun protection behaviors routine. Most of the time, people don’t burn purposefully. It typically happens because they did not plan to be in the sun for more than a half-hour, but it turned into a longer ordeal and they were not wearing a hat or sunscreen. If sun protection is routine, it will really make a difference. Also, survivors must be vigilant about looking for secondary melanomas. They must make sure they check their skin and see their dermatologist regularly.
Q: Do you have additional research planned?
A: We are writing a grant to propose a study in which we would intervene with these melanoma survivors. We need more educational and behavioral interventions, particularly for this high-risk group. We are particularly interested in making use of technology and social media. – by Kyle Doherty
Reference:
Vogel RV, et al. Cancer Epidemiol Biomarkers Prev. 2017;doi:10.1158/1055-9965.EPI-16.0854.
For more information:
Rachel Isaksson Vogel, PhD, can be reached at isak0023@umn.edu.
Disclosure: Vogel reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.