Multiple behavioral risks for skin cancer among U.S. adults

Whether you're basking on the beach during vacation, coasting down glittering white snow on a weekend ski trip, or simply walking the dog or running errands, sunlight's ultraviolet rays can damage your skin year-round.

Yet a new study by behavioral researchers at Fox Chase Cancer Center shows that most American adults engage in multiple behaviors that boost their risk of skin cancer by increasing their exposure to UV rays.

These behaviors include infrequent use of sun-protective clothing; staying outside in the sun rather than seeking shade; infrequent use of sunscreen with a sun-protection factor (SPF) of 15 or more; indoor tanning with a sunlamp or tanning bed within the past year; and getting sunburned within the past year.

Collectively, skin cancer of all types is the most common cancer in the United States and the incidence has increased over the past three decades. During 2007, an estimated 1.1 million Americans received a diagnosis of basal- or squamous-cell skin cancer or the more invasive, potentially lethal melanoma, according to the American Cancer Society.

Heredity plays an important role in skin cancer. For example, a typical portrait of someone at risk of skin cancer would show a natural blonde or redhead with very fair skin that freckles and burns more easily than it tans. Melanoma, in particular, is known to run in certain families.

However, overexposure to ultraviolet light - something controlled by behavior - is a major factor in increased skin cancer risk, noted Fox Chase psychologist Elliot Coups, Ph.D., an assistant member in the psycho-oncology program at Fox Chase and lead author of the new study. The report appears Jan. 8 in the online edition of the American Journal of Preventive Medicine and in the February 2008 issue of the print edition.

The Fox Chase researchers found that younger adults were particularly likely to engage in multiple behaviors that increase skin cancer risk. Men, Caucasians, smokers, persons who consume high levels of alcohol and persons who report having skin that is not especially sensitive to the sun were also more likely to engage in behaviors that placed them at increased skin cancer risk.

“Descriptive information about the prevalence of multiple skin cancer risk behaviors and related factors such as age may inform the development of targeted protective strategies for specific high-risk groups,” Coups said.

“Since the UV damage to the skin is cumulative, lack of protection by young people is likely to drive a continued increase in skin cancers as these generations grow older over the next decades,” noted Stuart R. Lessin, M.D., director of dermatology at Fox Chase. “This new research on behavior relating to skin cancer risk may help us target the highest-risk groups with educational messages tailored for them.”

“Ultraviolet radiation exposure is the most important modifiable risk factor for all types of skin cancer,” Coups said. “Wearing protective clothing like a wide-brimmed hat, avoiding sun exposure during the middle of the day, when rays are strongest, seeking shade, using sunscreen and avoiding indoor tanning have all been recommended by various agencies, but all available data suggest that the majority of American adults don't follow this advice and instead have high rates of UV exposure and sunburns.”

“A comprehensive approach to skin cancer prevention requires attention to multiple skin cancer risk behaviors that are common in the U.S. population,” Coups and his fellow authors concluded.

Although previous research had suggested that individuals had multiple risk-increasing behaviors, the current study is the first comprehensive analysis of the prevalence and correlates of multiple behavioral risks for skin cancer among U.S. adults. Correlates examined in this study include geographic location; demographic factors such as age, gender and education; health-care access; behavioral health risks such as smoking; family history of melanoma; perceived cancer risk; skin sensitivity to the sun; and having total skin exams.

Data for the study came from the 2005 National Health Interview Survey, an annual representative U.S. health survey in which 31,428 individuals participated. The researchers excluded individuals who had already had skin cancer or whose questionnaires contained missing data in key areas of the study, resulting in a study sample of 28,235 individuals.