New USPSTF recommendation highlights pediatricians’ role in skin cancer prevention
Sophie J.Balk, M.D., FAAP
The U.S. Preventive Services Task Force (USPSTF) has updated its recommendation for
counseling about skin cancer prevention in primary care practices.
In its statement Skin Cancer Prevention: Behavioral Counseling (http://bit.ly/2wFXAwO) released in March, 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.”
The USPSTF is an independent organization of experts who evaluate and make recommendations
about the effectiveness of clinical preventive health services. Previously, it advised
clinicians to counsel 10- to 24-year-old fair-skinned individuals about protecting themselves from excessive ultraviolet radiation. The new recommendation
underscores the important role pediatricians have in talking to families — starting
early in a child’s life — about ways to prevent skin cancer.
Unlike the USPSTF, the AAP recommends that pediatricians discuss skin cancer prevention
with all families, not just with people having fair skin.
Skin cancer rates rising
In 2014, The Surgeon General’s Call to Action to Prevent Skin Cancer (http://bit.ly/2oDZyKz) established skin cancer prevention as a U.S. public health priority. Most skin cancers
result from DNA damage due to exposure to ultraviolet radiation (UVR), a known human
carcinogen emitted by the sun and artificial tanning devices.
Skin cancer is the most common cancer in the U.S., and rates continue to rise. According
to the American Cancer Society, more than 5 million skin cancers are expected to occur
in 3.3 million Americans in 2018. Most skin cancers are basal cell and squamous cell
carcinomas — usually treatable and curable — and occur in older adults.
Melanoma comprises about 1% of skin cancers but accounts for 80% of skin cancer deaths.
When discovered early, melanoma generally is successfully treated but is less treatable
when it has metastasized.
Melanoma a common cancer in young people
Although cancer is uncommon in young people, melanoma is one of the most common cancers
in teens and young adults, and young people are among the individuals who die from
melanoma. Early-life sunburns and other UVR exposure contribute to the risk.
Therefore, it is important to discuss skin cancer prevention during health maintenance
visits and when teachable moments arise, such as when a patient has many nevi, freckles
or a sunburn. Although people with fair skin are at highest risk, anyone can develop
Advice at different developmental stages
Infants and young children must rely on adults to protect them. Therefore, discussions
can begin with parents early in a child’s life. As children get older, it’s important
for them to be active but to avoid sunburns and other excessive sun exposure when
playing outside. Kids should be protected at the beach and should be taught to avoid
deliberate tanning there.
Advice to adolescents and young adults includes avoiding indoor tanning at salons
and other venues. The prevalence of indoor tanning has decreased in recent years,
possibly due in part to more state restrictions on minors’ use of tanning salons.
Nevertheless, more than 15% of white non-Hispanic high school girls reported indoor
tanning in 2015. Rates of indoor tanning are highest in non-Hispanic white individuals
and in women ages 18 to 29 years.
UVR protection involves steps recommended by the Academy and other organizations:
Do not burn; avoid sun tanning and tanning beds.
Wear protective clothing such as swim shirts and swim shorts.
Wear a hat; hats with a 3-inch brim can shade the cheeks, nose and back of the neck.
When possible, time activities before 10 a.m. and after 4 p.m. The sun is strongest
between 10 a.m. and 4 p.m.
Use extra caution near water, snow and sand, which reflect the sun.
Apply a broad-spectrum sunscreen labeled with a sun protection factor (SPF) of at
least 15. Make sure to apply enough and to reapply after two hours, and after swimming
Wear UV-rated sunglasses.
Pediatricians have roles as advocates for state legislation that bans minors under
age 18 from salon tanning. Currently, 44 states and the District of Columbia have
laws restricting teen tanning; 19 states and the District of Columbia ban salon tanning
for minors under age 18.
Pediatricians also may be called on to advocate for legislation allowing kids to bring
sunscreen to school without a doctor’s prescription. These and other steps can help
save lives, including young lives.
Dr. Balk is a member of the AAP Council on Environmental Health. She is an attending pediatrician at the Children's Hospital at Montefiore, Bronx, N.Y.