Doctors rarely talk to patients about using sunscreen, even
when patients have a history of skin cancer, according to surveys of US
physicians over two decades.
Despite professional guidelines encouraging doctors to
educate their patients about sun protection, in more than 18 billion patient
visits from 1989 to 2010, sunscreen was mentioned less than 1% of the time.
Even dermatologists managed to mention sunscreen in less than
2% of visits, researchers found. "The rate of discussing sunscreen at
visits, especially for high-risk patients with cancer or pre-cancerous lesions,
was lower than we would have expected," said one of the study's authors,
Scott Davis, of the dermatology department at Wake Forest School of Medicine in
Winston-Salem, North Carolina.
The survey data may not capture all mentions of sunscreen
with complete accuracy, but that does not change the conclusion that the frequency
is much too low, Davis told Reuters Health. Failing to mention sunscreen often
enough is contributing to excessive unprotected sun exposure, especially for children,
which will lead to skin cancer later in life, he said.
Davis and his co-authors examined data from an ongoing annual
government survey that asks randomly selected doctors representative of their
areas to record their patient interactions in detail for one week.
Over the two decades of the survey, there were about 18.3
billion patient visits to outpatient physician offices, and based on doctors'
survey responses, sunscreen came up at less than 13 million of those visits,
which is 0.07%.
When visits specifically concerned skin disease, doctors
still mentioned sunscreen less than 1% of the time, according to the results
published in JAMA Dermatology. Dermatologists talked about sunscreen more than
any other specialty, at 1.6% of all visits and 11.2% of visits involving a
patient with current or past skin cancer.
"I don't think the results are surprising, at least not
for someone who is familiar with what research has said about skin cancer
counselling practices," said Dr Jennifer S. Lin, who studies evidence-based
healthcare decision making at The Center for Health Research of Kaiser
Permanente Northwest in Portland, Oregon. "It is certainly disappointing,"
said Lin, who has conducted reviews to support the US Preventive Services Task
Force for the past seven years, but is not herself part of the USPSTF.
In the study, Davis and his co-authors found that doctors
mentioned sunscreen most often to white patients, and to those in their 80s,
but least often during visits by children.
Evidence supports UV and sun protection counselling to
prevent skin cancer, especially for kids and teens, so extremely low counselling
for those groups is "incredibly problematic", Lin said. But she
cautions that sunscreen is only one part, and not the most important part, of
UV protection, which includes avoiding midday sun, wearing appropriate clothing
and avoiding tanning beds.
Counselling not valued enough
"My belief as a primary care doctor, not based on my
research, is that our health system does not value counselling or patient
education as much as it does procedures, testing, medications, etc.,"
Even for patients who already know about sunscreen,
discussing it can help, Davis said. As with smoking and unhealthy eating, most
people are aware of the risks, but bringing it up during an office visit shows
the patient that the doctor is concerned and wants to help change the behaviour,
The American Academy of Pediatrics recommends bringing up
sun protection at annual checkups, Davis said. "The fact that it was
recommended least frequently to children is very concerning, since children
tend to get the most sun exposure, and may develop lifelong habits of poor sun
protection," Davis said.
"This may be where physicians have the greatest
opportunity to fight the ongoing, growing epidemic of skin cancer." Skin
cancer continues to be the most common form of cancer in the US, diagnosed in
more than 60 000 people yearly, according to the Centers for Disease Control
Patients may need to take the initiative and bring up sun
protection themselves if they have questions, he said. "Physicians are
pressed for time and feel they cannot take the extra time needed for discussion
of preventive care topics," Davis said. "But the main thing may be
that physicians just aren't thinking of it. This research may make health care
providers more aware of the need to encourage commonsense sun protection,
especially for younger patients," he said.