A meta-analysis of 18 studies that explored the association between melanoma risk and previous sunscreen use illustrates widely differing study qualities and suggests little or no association.
Behavioral Interventions to Change Sun-Protective Practices
As noted previously, direct evidence that interventions, such as sunscreen or protection from UV light exposure, decrease the risk of skin cancer is sparse. However, given the association between UV light exposure and subsequent risk of skin cancer, counseling interventions aimed at increasing sun-protective behaviors have been examined. The U.S. Preventive Services Task Force (USPSTF) commissioned a systematic review of this evidence. Although the USPSTF review found no randomized trials directly linking counseling strategies to skin cancer reduction, it found 11 trials, rated as fair in quality, that tested the effect of interventions on sun-protective behaviors. Several trials of behavioral interventions in adults, sometimes as part of an intervention addressing multiple health-related behaviors, such as smoking and nutrition, showed a short-term increase in self-reported sun-protective behaviors. However, the effect sizes were small to modest, without clear evidence that the differences were clinically meaningful.[32,33,34,35,36] Likewise, appearance-based behavioral interventions in young women have had a favorable impact on self-reported indoor tanning behavior, but no long-term follow-up or health outcomes were reported.[37,38,39] A randomized, primary care office-based counseling intervention in adolescents showed an increase in self-reported midday sun avoidance and sunscreen use in the intervention group for up to 24 months. A randomized trial of a provider-based sun protection promotion counseling program for parents for their infant children showed a small increase in sun-protective actions, of questionable clinical importance according to the researchers.
Nevertheless, studies of intervention strategies for reducing UV radiation exposure suggest that the best approach is education about the risks associated with sun exposure and sunburn and education about sun-protection strategies.[42,43] In one study, an educational intervention at the time of treatment for skin cancer-a time when an individual may have heightened awareness of his or her susceptibility to skin cancer-seemed to have the greatest effect. However, even in such a high-risk group, it was difficult for many individuals to maintain sun-protective behaviors. In a community skin cancer screening study, researchers found that, although regular use of sunscreens was not related to personal or family history of skin cancer, it was more common among persons who perceived themselves to be at moderate or high risk of developing melanoma.
Sun-protective strategies may include avoiding sun exposure at times of the day when the exposure is more intense and wearing clothing that protects skin from sun exposure. Self-examination for skin-pigmentary characteristics associated with melanoma (e.g., freckling status) may be a useful way to identify individuals at an increased risk of developing melanoma. Skin type (propensity to burn after sun exposure and tanning ability), alone or with other physical characteristics, such as hair color, has been used as a measure of sun sensitivity in epidemiologic studies.