Although the incidence of skin cancer in increasing, “the rate at which physicians are mentioning sunscreen at patient visits is quite low, even for patients with a history of skin cancer,” according to an analysis of data from more than 18.30 billion patient visits. “Sun-protection counseling ranks among the lowest topics of primary prevention discussed between physicians and patients,” the study authors wrote in JAMA Dermatology.
The National Ambulatory Medical Care Survey was used to identify the frequency of sunscreen recommendations during patient visits to nonfederal outpatient physician offices at U.S. ambulatory care practices between 1989 and 2010. The results showed that physicians mentioned sunscreens at approximately 12.83 million visits or 0.07%. “The frequency of sunscreen recommendation was 12 times greater for patient visits associated with a diagnosis of skin disease compared with visits with no reported skin disease,” the authors stated, but that was still less than 1% of visits.
“Analysis by physician specialty revealed that dermatology visits accounted for most of the appointments associated with sunscreen recommendation (86.4%), followed by visits with general and family practitioners (9.6%), pediatricians (1.4%), other specialists (1.4%), and internists (1.1%),” the data showed. Still just 1.6% of all dermatology visits included a mention of sunscreens. “In addition, sunscreen was mentioned by dermatologists at 11.2% of visits associated with a diagnosis of active or remote history of skin cancer. This low frequency of sunscreen recommendation by dermatologists is concerning because dermatologists saw more than 20 times the number of patients with a history of skin cancer (7.1 million) compared with general/family physicians (320,000). Moreover, the frequency with which dermatologists recommended sunscreen to this population of patients was significantly less than that of general/family physicians (11.2% vs 55.5%),” the authors noted.
While no differences in sunscreen recommendations were found based on patients’ sex or ethnicity, there were differences by race and age group. “Compared with black patients, white patients were 9 times more likely to be recommended sunscreen. Children and adolescents were recommended sunscreen the least compared with all patient age groups,” the analysis showed.
“The findings are concerning because children and adolescents get the most sun exposure of any age group, as they tend to spend much of their time playing outdoors. Up to 80% of sun damage is thought to occur before age 21 years, and sunburns in childhood greatly increase the risk for future melanoma,” the authors wrote. They pointed out that new guidelines advise pediatricians to discuss sun protection with patients and to be strong proponents of other sun-protective policies. ■
Akamine KL, et al: JAMA Dermatol. September 4, 2013 (early release online).