The association between skin characteristics and skin cancer prevention behaviors

Summer sun-exposure in Australian childhood cancer survivors and community reference groups

PURPOSE

Sun-exposure can cause health problems, including melanoma and nonmelanoma skin cancer, especially in Australia where the incidence of skin cancer is particularly high. Childhood cancer survivors (CCSs) have an augmented risk due to previous cancer history and treatment. Despite recommendations advising sun protection, CCSs may be placing themselves at risk. We considered daily summer sun-exposure in an Australian cohort of CCSs and in community reference groups, and identified factors associated with sun-exposure in these populations.

METHODS

Summer sun-exposure data were collected on 471 CCSs (119 parents of survivors aged <16, and 352 survivors aged ≥16) and a reference group of 470 participants from the community (155 parents of children aged <16, and 355 adults aged ≥16). Survivors completed paper questionnaires and the reference groups completed an online survey. Medical records confirmed survivors' clinical information. Ordinal logistic regressions identified factors associated with daily summer sun-exposure.

RESULTS

More daily summer sun-exposure was reported by both parents reporting for the young survivors (U = 5,522.5, P < .001; U = 31,412, P < .001) and by older survivors (U = 5,039.5, P < .001; U = 29,913, P < .001). Among younger participants greater sun-exposure was associated with being a CCS, while in older participants, greater sun-exposure was associated with being a CCS, a male, smoker/ex-smoker and was also increased in those with more sensitive skin reaction to sunlight. Focusing only on the CCSs, when treatments were considered, none statistically predicted sun-exposure in young CCSs while older CCSs who received radiotherapy were less likely to spend excess time in the sun.

CONCLUSION

CCSs have sun-exposure at times of day when sun-related skin damage is highest, despite advice to avoid highest risk times. This data can inform sun-protection programs and lifestyle advice aimed at ameliorating the potential increased risk of skin cancer in CCSs.

Influence of Air Temperature on the UV Exposure of Different Body Sites Due to Clothing of Young Women During Daily Errands

Clothing is one of the main influencing factors for personal ultraviolet radiation (UVR) exposure. Despite that, little attention was put on this topic till now. In this study, the clothing habits of young females have been investigated in dependence of meteorological conditions. Observations were made from spring to autumn during daylight in the urban region of Vienna, Austria. For this, a scheme dividing the body into six different sections was developed as well as a coding scale that corresponds to the different garments and indicates the body sites that are exposed. It was found that air temperature is the dominating factor for exposure. With increasing temperature, the first area of the body to be exposed to solar UVR is, aside from face and hands, the décolleté, followed by nape, ankles, instep and forearms. Observations further indicate that the frequency of people's being outdoors decreases significantly at temperatures higher than 30°C. This paper provides detailed frequency distributions of uncovered body sites in dependence of temperature. These can be used together with measurements of temperature and UVR to calculate the relative exposure at any time and at many locations, and could help to explain the body distribution of UVR caused skin alterations.

Epidemiology of Keratinocyte Carcinoma

Purpose of the review

To provide a synopsis of recent research advances in the epidemiology of keratinocyte carcinoma (KC), with a focus on indoor tanning and known risk factors for other forms of cancer such as cigarette smoking and alcohol drinking.

Recent findings

The evidence is strong enough to infer that use of UVR-emitting indoor tanning devices cause KC. Epidemiologic studies of cigarette smoking, alcohol drinking, and menopausal hormone therapy all show some suggestion for increased risk of KC but the evidence is not yet strong enough to determine if there is a true etiologic role. Body mass index is clearly inversely associated with KC risk but this is more likely to be due to lower UVR exposure in overweight and obese individuals than it is due to a true etiologic role.

Summary

The epidemic of KC continues unabated, and the causal role of indoor tanning is contributing to this unfavorable trend in KC incidence rates. Advances in understanding the etiology of KC should not divert attention away from the fact that the primary public health strategy to prevent KC is known: minimize population exposure to UVR from the sun and from UVR-emitting indoor tanning devices, particularly among those with sun-sensitive phenotypes.

Keratinocyte Carcinoma as a Marker of a High Cancer-Risk Phenotype

Keratinocyte carcinoma (KC) (also referred to as nonmelanoma skin cancer) is by far the most common form of human cancer. A personal history of KC is well established to be associated with increased risk of recurrent KC and malignant melanoma, a less common yet more fatal form of skin cancer. More surprising is that a substantial body of epidemiologic evidence now indicates that a personal history of KC is significantly associated with an overall elevated risk of noncutaneous malignancies. This association is not limited to one or a few types of cancer but applies across many different types of malignancy. This association has been consistently observed in prospective studies across genders for both major histologic types of KC, basal cell carcinoma and squamous cell carcinoma. The risk of other cancers has been even stronger in those with younger compared with older age of onset of KC. A robust body of evidence lends support to the notion that KC may be a marker of a high cancer-risk phenotype. The underlying mechanisms for this association remain to be elucidated, but the cross-cutting nature of this association across numerous malignancies suggests that research to uncover these mechanisms is a promising line of inquiry that could potentially yield valuable insight into human carcinogenesis.

Patterns of sunscreen use on the face and other exposed skin among US adults

BACKGROUND

Sunscreen is a common form of sun protection, but little is known about patterns of use.

OBJECTIVE

We sought to assess patterns of sunscreen use on the face and other exposed skin among US adults.

METHODS

Using cross-sectional data from the 2013 Summer ConsumerStyles survey (N = 4033), we calculated descriptive statistics and adjusted risk ratios to identify characteristics associated with regular sunscreen use (always/most of the time when outside on a warm sunny day for ≥1 hour).

RESULTS

Few adults regularly used sunscreen on the face (men: 18.1%, 95% confidence interval [CI] 15.8-20.6; women: 42.6%, 95% CI 39.5-46.7), other exposed skin (men: 19.9%, 95% CI 17.5-22.6; women: 34.4%, 95% CI 31.5-37.5), or both the face and other exposed skin (men: 14.3%, 95% CI 12.3-16.6; women: 29.9%, 95% CI 27.2-32.8). Regular use was associated with sun-sensitive skin, an annual household income ≥$60,000, and meeting aerobic activity guidelines (Ps < .05). Nearly 40% of users were unsure if their sunscreen provided broad-spectrum protection.

LIMITATIONS

Reliance on self-report and lack of information on sunscreen reapplication or other sun-safety practices are limitations.

CONCLUSION

Sunscreen use is low, especially among certain demographic groups. These findings can inform sun-safety interventions and the interpretation of surveillance data on sunscreen use.

Men's experiences of an appearance-focussed facial-ageing sun protection intervention: a qualitative study

The study investigated men's experiences of taking part in an age-appearance-focussed intervention which involved seeing how their faces would age with and without UV exposure. Thirty-five men gave accounts of their experiences whilst taking part in the intervention, and eight men discussed their experiences retrospectively in focus groups. Transcripts were analysed using inductive thematic analysis. Men were shocked about the impact of ageing on their faces, and particularly the added impact of UV exposure, with a subgroup of men expressing lack of concern. The findings are discussed in relation to gender roles and appearance concerns in men, and comparisons are made between the thematic model produced and that produced in a similar study focussing on women's experiences of the same intervention. It is concluded that appearance-based interventions have a role to play in healthcare and educational settings with regards to UV exposure and sun protection intentions in men.

A community-based study of nucleotide excision repair polymorphisms in relation to the risk of non-melanoma skin cancer

Nucleotide excision repair (NER) is responsible for protecting DNA in skin cells against ultraviolet radiation-induced damage. Using a candidate pathway approach, a matched case-control study nested within a prospective, community-based cohort was carried out to test the hypothesis that single nucleotide polymorphisms (SNPs) in NER genes are associated with susceptibility to non-melanoma skin cancer (NMSC). Histologically-confirmed cases of NMSC (n=900) were matched to controls (n=900) on age, gender, and skin type. Associations were measured between NMSC and 221 SNPs in 26 NER genes. Using the additive model, two tightly linked functional SNPs in ERCC6 were significantly associated with increased risk of NMSC: rs2228527 (odds ratio (OR) 1.57, 95% confidence interval (CI) 1.20 – 2.05), and rs2228529 (OR 1.57, 95% CI 1.20 – 2.05). These associations were confined to basal cell carcinoma of the skin (BCC) (rs2228529, OR 1.78, 95% CI 1.30 – 2.44; rs2228527 OR 1.78, 95% CI 1.31 – 2.43). These hypothesis-generating findings suggest functional variants in ERCC6 may be associated with an increased risk of NMSC that may be specific to BCC.

UV photography, masculinity, and college men's sun protection cognitions

This study examined the impact of an ultraviolet (UV) photography intervention and masculinity on college men's sun protection cognitions, including: perceived vulnerability to skin damage, attitudes toward sun protection, willingness to engage in sun protection behaviors, and intentions to receive a skin cancer exam. After completing a baseline survey, participants (N = 152) viewed a black-and-white photo of their face. Half also viewed a photo showing their UV damage. Participants then completed a second survey assessing sun protection cognitions. Regressions revealed that masculinity predicted lower sun protection cognitions, and men in the UV photograph condition reported higher sun protection cognitions. Masculinity by condition interactions showed that the positive effect of UV photography was stronger among masculine men. Negative associations between masculinity and sun protection cognitions were significant only among men who did not receive the intervention. Findings suggest that UV photography is a promising sun protection intervention among masculine men.

Tobacco smoking and cutaneous squamous cell carcinoma: a 16-year longitudinal population-based study

BACKGROUND

Although tobacco smoking is commonly cited as a risk factor for cutaneous squamous cell carcinoma (SCC), the evidence from previous clinical and case-control studies is conflicting. We therefore aimed to prospectively examine the role of tobacco smoking in the development of SCC of the skin in a population-based study.

METHODS

Study participants were 1,287 adults aged 25 to 75 years in 1992, randomly selected from the Nambour community, with no previous history of SCC. Standard skin pigment and sun-sensitivity profiles were obtained at baseline. Detailed prospective information on sun exposure, smoking, and skin cancer occurrence (histologically confirmed) was collected over a 16-year period, 1992 to 2007.

RESULTS

Of 1,287 participants, 43% were male and average age was 48 years. A total of 188 first cutaneous SCCs were identified during the study period. After adjustment for other known risk factors, neither former nor current smokers were at raised risk of SCC: relative risk (RR) = 1.1, 95% CI: 0.8-1.5 and RR = 1.1, 95% CI: 0.7-1.5, respectively, compared with lifelong nonsmokers, nor were there any dose-response relationships with amount smoked or duration of smoking and risk of SCC.

CONCLUSIONS

In this Australian follow-up study, tobacco smoking did not increase the risk of SCC of the skin.

IMPACT

These prospective adjusted data provide strong evidence which suggests that cutaneous SCC should not be on the list of tobacco-related cancers.