Authors' objectives:

This study addresses the following questions: - Is reducing sun exposure effective in reducing melanoma? - Does the use of sunlamps and tanning beds increase risk for melanoma? - Is the use of sunscreen effective in preventing nonmelanoma skin cancer and melanoma? - Do sun protection behaviors have significant adverse effects? - Is skin self-examination effective in reducing the incidence of melanoma? - Does counseling by a primary care clinician increase sun protective behaviors?

Authors' recommendations: The evidence on the efficacy of sun avoidance and use of protective clothing for the prevention of melanoma is complex, but overall supports the hypothesis that intermittent sunburn in childhood is a preventable risk factor. There are no data from randomized trials linking sun avoidance and use of protective clothing to a reduced cancer incidence. Evidence to support avoiding artificial tanning devices is still weak. There is good evidence from 1 trial for a modest benefit of sunscreen in preventing squamous cell cancer. Based on this randomized trial, 140 people would need to use daily sunscreen for 4 1/2 years to prevent 1 squamous cell cancer. In another trial, sunscreen use led to the development of fewer nevi, but the study had substantial flaws and the users still had many new nevi, making the clinical significance of this finding unclear. In a meta-analysis of population-based case-control studies, sunscreen use was not associated with an increased risk for melanoma, and in one randomized trial use of sunscreen with a high SPF was associated with an increased incidence of sunburn because users were overconfident about the degree of protection. There is good evidence from 1 trial for the effectiveness of counseling by a physician in the context of a broader, community-based educational intervention. The specific contribution of the office-based component to the overall effectiveness of the intervention was not described.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspsskco.htm

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)