National Skin Cancer Prevention Education Program: AT-A-GLANCE: 1997

"There is good news: skin cancer can be prevented. The challenge, however, lies in changing the attitudes and behaviors that increase a person's risk of developing skin cancer." David Satcher MD, PhD, Director Centers for Disease Control and Prevention

Skin Cancer

Skin cancer is the most common and most rapidly increasing form of cancer in the United States. One in five Americans will develop skin cancer in their lifetime. The three major types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and the more serious melanoma. An estimated one million new cases of highly curable basal cell or squamous cell carcinomas combined will be detected in 1997; about 40,300 new cases of melanoma will be diagnosed this year.

Skin cancers will claim the lives of approximately 9,500 people in 1997: 77 percent of these deaths will be from melanoma, and 23 percent from other skin cancers.

Basal cell carcinoma is the most common form of skin cancer. It affects men more often than women. If detected and treated early, basal cell carcinoma has a cure rate of greater than 95 percent. Untreated, this cancer can cause considerable damage and disfigurement by spreading to underlying structures, although it usually does not spread to other parts of the body like most other cancers.

Squamous cell carcinoma is the second most common form of skin cancer. It is also 95 percent curable if detected and treated early. Squamous cell carcinoma is two to three times more common in men than in women.

Basal cell and squamous cell carcinomas, also referred to as nonmelanoma skin cancer, can cause substantial illness, but death rates from these cancers are low.

Melanoma causes more than 75 percent of all deaths from skin cancer. Melanoma can spread to other organs, most commonly the lungs and liver. Melanoma detected early (thin lesion) has an excellent chance of being cured, whereas melanoma detected late (thick lesion) has a greater likelihood of spreading and causing death.

Melanoma is the most frequent cancer in women aged 25 to 29 years and the second most frequent (after breast cancer) in women aged 30 to 34 years. The National Cancer Institute's data suggest that, among people aged less than 40 years, women are more likely than men to have melanoma, whereas among those aged 40 and older, men are more likely to develop melanoma.

Who Is at Risk?

Risk Factors for Melanoma and Other Skin Cancer Risk Factors for Melanoma Light skin color Family history of melanoma Personal history of melanoma Certain types and large number of moles Presence of freckles (an indicator of sun sensitivity and sun damage) History of severe sunburns early in life Risk Factors for Squamous Cell and Basal Cell Carcinomas Light skin color Family history of skin cancer Personal history of skin cancer Chronic exposure to the sun (squamous cell) History of severe sunburns early in life (basal cell carcinoma)

Skin cancer is more common among people with lightly pigmented skin; whites are 10 times more likely than blacks to develop skin cancer.

Exposure to sunlight can be harmful, particularly if it results in sunburn. Squamous cell carcinoma is related to intense chronic overexposure to ultraviolet radiation, while melanoma and basal cell carcinoma appear to be related to intense intermittent exposure, especially in childhood.

Prevention Measures

Deaths and illnesses from skin cancer can be decreased or avoided by reducing sun exposure.

According to the 1992 National Health Interview Survey results, of the adults surveyed,

• Only 32 percent limited their exposure to the sun.
• Only 29 percent routinely used sunscreen lotion.
• Only 28 percent wore protective clothing when exposed to sunlight.

Measures to Prevent Skin Cancer Reduce direct exposure to the sun, especially from 10 a.m. to 4 p.m. If you must be out in the sun, take the following precautions. Wear a broad-brimmed hat, long-sleeved shirt, long pants, and sunglasses to reduce exposure. Use sunscreen lotion with a sun protection factor (SPF) of at least 15 to protect against ultraviolet (UV) A and B radiation. Refer to the daily UV Index (available in 58 cities) on your local weather forecast when planning outdoor activities. Avoid artificial sources of UV light, including tanning beds and sun lamps.

Results of recent studies have shown that many adults have little knowledge of skin cancer and its risk factors. In a national survey of adults aged 18 years and older conducted by the American Academy of Dermatology in 1995 and reported in the CDC's Morbidity and Mortality Weekly Report (May 3, 1996), approximately 50 percent of men and 35 percent of women did not recognize the term melanoma. The youngest adults in the survey (aged 18-24 years) were found to be the least knowledgeable about risk factors, early warning signs, and the sites on the body where melanoma most commonly occurs. This lack of knowledge among young adults is of special concern, particularly if this knowledge decreases with younger age, because a severe sunburn at an early age is associated with the development of melanoma later in life.

Prevention education is as important for children as it is for adults. Sun exposure during childhood (up to 18 years old) is estimated to account for almost 80 percent of a person's lifetime sun exposure, so children have the greatest potential for benefiting from sun-protective measures. In addition, healthy behavior patterns established in early childhood often persist throughout life.

Parents, health care providers, schools, and community organizations can develop and provide strategies for young people that reinforce the importance of protecting themselves from the sun (for example, staying out of direct sunlight, seeking shade, or timing outdoor activities for hours when UV light is less intense)and change attitudes about exposure to the sun (such as the opinion that a person looks more attractive with a tan).

CDC Program Activities

The National Skin Cancer Prevention Education Program is designed to help the nation achieve the skin cancer prevention goals established by the Healthy People 2000 National Health Promotion and Disease Prevention Objectives. The Healthy People 2000 target goal is to increase to at least 60 percent the proportion of people of all ages who 1)limit their sun exposure, 2)use sunscreens and wear protective clothing when they are exposed to sunlight, and 3)avoid artificial sources of UV light (e.g. sun lamps and tanning booths).

In its fourth year, with FY 1997 appropriations of $1.8 million, CDC's efforts in the National Skin Cancer Prevention Education Program include the following highlights:

• Coordinating national efforts to prevent skin cancer.
• Developing partnerships with professional organizations, other federal agencies, voluntary organizations and the private sector to educate the public about measures to prevent skin cancer.

Federal Agency Collaborations. CDC is collaborating with the U.S. Environmental Protection Agency and the National Weather Service to improve the effectiveness of the UV Index program. The UV Index is a public health education and information tool reported by meteorologists in 58 U.S. cities as a daily forecast of the levels of UV rays. The Index predicts UV levels on a 0-10+ scale, representing minimal to very high exposure. The federal partners are continuing to gather information through surveys about the use of the UV Index and public knowledge of skin cancer.

This project has included meetings with weather broadcasters, health educators, skin cancer experts, and corporate sponsors to critically review the results from the national public and meteorology surveys; evaluation of the differences in sun protection practices and knowledge between respondents in the proposed 168 cities and the 58 cities currently reporting the UV Index; and development of a safe-sun packet for broadcast meteorologists; the packet includes guide-lines for delivering effective messages and information on accessing materials for distribution.

• Participating in the annual National Melanoma/Skin Cancer Detection and Prevention Awareness media campaign conducted in May.
• With the American Academy of Dermatology, cosponsoring a series of national conferences that provide direction and input from experts in health, media, industry, and education to set an agenda for sun protection for children, parents, and care givers.
• Supporting the development of national skin cancer prevention guidelines for schools and communities; the development, implementation, and evaluation of innovative strategies for skin cancer prevention education in five state health departments; and the development and evaluation of two skin cancer prevention and detection curricula for nurses.

Prevention Guidelines for Schools and Communities. CDC experts in cancer prevention and in school health education, in partnership with the University of Alabama at Birmingham Prevention Center, are developing guidelines for education programs and sun protection policies in schools and communities. These guidelines will address sun protection education for children and their parents/caregivers and instructors in day care, pre-K, and grades K-12. When the guidelines are completed, a national marketing and dissemination campaign will be developed in coordination with CDC.

Innovative Education Strategies in State Health Departments. Through funding from CDC, five states implement education strategies in collaboration with community advisory boards, elementary school education departments, local and county health departments, parent groups, day care centers, voluntary organizations, medical schools, cancer research institutes, dermatologists, and the American Cancer Society.

• Arizona's "Best Practices Sun Safety Awareness Program" is advocating for sun protection policies, education, and training among parents, caregivers, and day care staff.
• California is developing a sun protection education and training module for parents, caregivers, and preschool staff. In addition, a radio public service announcement recorded by children is being developed for preschoolers.
• Georgia's "Got Youth Covered" project is aimed at improving the knowledge and personal practices regarding sun protection of coaches, team sponsors and leaders, day camp instructors, parents', youths' and other outdoor recreational staff.
• Hawaii's "SunSmart" initiative is training parents and recreational staff through the Summer Fun programs. For the children in these programs, the initiative provides sunscreen, hats, shaded areas, games, educational activities, and incentive gifts.
• Massachusetts "Ban the Burn Safe Skin Project" is developing education programs for children, parents and caregivers. These programs are being implemented in hospitals, in elementary schools, and throughout a coastal community.

Prevention and Detection Curricula for Nurses. CDC funds two professional education activities, one at the University of North Carolina (UNC) at Chapel Hill and a second at the University of Texas (UT) Houston Health Science Center. The UNC project developed and conducted a 5-hour continuing education teleconference program for public health nurses to increase their knowledge of skin cancer prevention and early detection. UT's program, a 1-week course for public health nurses, provides didactic and clinical instruction in skin cancer prevention and early detection.

• In partnership with other organizations, developing skin cancer prevention education materials for the public.
• Participating in efforts to develop and enhance national skin cancer surveillance data.
• Developing epidemiologic research and surveillance systems for monitoring program effectiveness and national trends in sun protection behavior and attitudes about exposure to the sun.

In addition, CDC has set out to learn more about and from successful programs in other countries, such as the SunSmart Program in Victoria, Australia. Linkages have already been established, and collaborative work begun, in Australia and Canada.

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