Much like eating healthy or quitting smoking, wearing sunscreen is a habit that many people see the benefits of, but fail to practice on a daily basis. New data suggests that even talking about the practice presents a problem for most doctors, as nearly 100 percent of all physicians surveyed excluded sunscreen advice from consultations with patients.
Sunblock has long been known to protect a person’s skin from the sun’s harmful ultraviolet (UV) rays — skin cancer from UVA, sunburn from UVB — but according to a comprehensive study from 1989 to 2010, physicians have been shirking the responsibility of cautioning patients from going out in the sun without proper sunscreen. In the United States, skin cancer currently stands as the most common form of cancer, with more than 60,000 cases diagnosed annually, according to the Centers for Disease Control and Prevention.
"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, N.C.
Less than one percent of the 18.3 billion patient visits collected in the study made reference to sunscreen or sunblock. Thirteen million, or 0.07 percent of cases, saw doctors broach the topic with their patients. Among dermatologists, arguably the most ardent defenders against skin cancer, sunscreen was mentioned less than two percent of the time. In talks with patients who previously had or currently suffered from skin cancer, it was brought up 11.2 percent of the time.
While the absence of sunscreen discussion in patient visits could be explained by doctors advising other methods, such as increased usage of hats, other protective clothing, or limited sun exposure overall, Davis believes his team’s findings give clear indication that the issue is being neglected.
Failing to tell patients, especially children, about sunscreen’s immense benefits in preventing the development of skin cancer is doing a severe disservice to the general population, Davis told Reuters Health. According to his team’s findings, published in JAMA Dermatology, visits that particularly concerned skin diseases still kept sunscreen off the table more than 99 percent of the time.
"It is certainly disappointing," said Dr. Jennifer S. Lin, who studies evidence-based healthcare decision making at the Center for Health Research of Kaiser Permanente Northwest in Portland, Ore. However, Lin could accept the findings as representative of the current landscape.
"I don't think the results are surprising, at least not for someone who is familiar with what research has said about skin cancer counseling practices," she noted.
Raising A Generation At Risk
Children’s skin is more sensitive to the sun’s UV rays. The World Health Organization (WHO) advises parents and educators to consider incorporating healthy habits into lessons with children, in order to ingrain skin health as a top priority.
“Sun protection education can be integrated into a range of curriculum areas,” a 2003 WHO report states. “The most obvious of these is science, where, for example, the nature of UV radiation can be explored, and students can investigate the structure and function of the skin, the eye and the immune system, and the effects of UV radiation.”
Such absence of sunscreen discussion strikes Lin as “incredibly problematic,” she said, mirroring one of Davis’s concerns that future damage is at the heart of talking about sunscreen.
"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."
Preventative care is often one of the hardest, and least talked about, aspects of patient visits. Present conditions receive much more attention, with warning signs often getting swept under the rug. Critics of the system point to doctors’ tendency to rely on medication after-the-fact and purchasing tests once a problem has already been identified. Money isn’t the only issue, however.
"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.”
Source: Akamine K, Gustafson C, Davis S, Levender M, Feldman S. Trends in Sunscreen Recommendation Among US Physicians. JAMA Dermatology. 2013.