Free skin cancer screenings are critical educational tools to help attendees better understand the need for good sun protective habits and the potential risk of suspicious lesions. The American Academy of Dermatology’s SPOTme program, for example, has screened nearly 2 million Americans since its inception in 1985. While these events can prove invaluable—identifying more than 20,000 melanomas, 32,000 squamous cell carcinomas, and 129,000 basal cell carcinomas so far—they aren’t necessarily reaching the most vulnerable patients, according to new data (J Drugs Dermatol 2019;18(7):649-653).
“Are we really capturing a broad and diverse population when we offer these programs?” asked Adam Friedman, MD, Interim Chair of the Department of Dermatology at the George Washington (GW) School of Medicine and Health Sciences and Director of the Supportive Oncodermatology Clinic at the GW Cancer Center. This was the question that launched his recent study, which found the patients attending these events don’t, in fact, represent the general population.
Friedman and his team discovered this after surveying the general population on the streets of Washington, D.C., and comparing their findings to a free screening event held the same day. Overall, those attending the free screening event have better photoprotective habits than the general population, and this raises the concern that patients not attending the screenings are precisely those most in need of it.
For the public cohort, the researchers surveyed a total of 285 people at six public locations, asking each one eight questions related to demographics and sun safety, including their use of sunscreen and sun-protective clothing, history of sunburn, and shade-seeking and tanning habits.
The team compared these data to 144 patients who attended a free skin cancer screening event held at the university. They found sex didn’t differ between the screening and public groups, but women were more prevalent in both (69.8% in the screening group and 64.5% in the public). Older patients were more likely to attend a screening event, considering 44.1 percent of the screening group were older than 60, while only 13 percent of the public were of the same age group. Although the study cohorts were too small to allow race-specific analysis, the team combined all of the non-white responses—including Black, Hispanic, Asian, and mixed/other—to find most screening attendees were white (73%), while less than half of the public cohort were white (48.2%).
As for sun safety habits, the researchers found significant differences between the screening and public responses—notably, screening patients reported better sun-protective habits and fewer skin cancer risk behaviors. Within the screening group, 34.3 percent said they always wear sunscreen, while only 18.7 percent of the public survey-takers said the same. More screening event attendees also said they seek shade whenever possible compared with the public (51.5% vs. 32.3%) and are more likely to always wear sun-protective clothing (16.4% vs. 9.2%).
The public was more likely to engage in risky behaviors, although the difference did not prove to be statistically significant: 7.1 percent of the public cohort reported having had 11 or more sunburns before age 20 compared with 4.6 percent of screening attendees. They also used indoor tanning more often than screening patients, again without statistical significance, with 10.2 percent of screening attendees reporting tanning between one and 10 times compared with 14.5 percent of the public.
“We also sought to examine whether younger and non-white participants, who were less likely to attend our free screening, have different practices and risk factors than older and white participants, respectively,” Friedman explained.
To better understand this breakdown, they combined both cohorts and analyzed the data between white and non-white patients. They found non-whites were less likely to wear sunscreen (52.2% vs. 84.2%) and sun-protective clothing (55.4% vs. 67.5%) than white patients. White patients also reported more blistering sunburns than non-whites, and were more likely to use indoor tanning.
With age comes wisdom, especially when it comes to sun protection, the study found. While 53.2 percent of patients 60 or older said they were more likely to always seek shade, only 24 percent of those younger than 35 did so. The team was encouraged to see sunscreen use did not vary based on age.
Given that ultraviolet radiation exposure accounts for 90 percent of all melanoma cases in the U.S., the findings are a call to action for clinicians and researchers. The older and predominately white screening cohort suggests event planners should shift their focus to target younger and non-white attendees. The researchers noted that non-white patients have significantly lower melanoma survival rates, further emphasizing the need for better sun safety education among this patient population.
To target the right audience, Friedman suggests screening event planners think carefully about how and where they advertise. Planners should use several avenues to get the word out, including print, digital, and social media. “Especially for those populations who tend not to utilize these free resources, bite size, easily digestible factoids regarding skin cancer risk and outcomes could also help drive those typically missed into the office,” he added.
Although Friedman’s study revealed shortcomings of free screening events, it also highlighted their utility, considering 22 percent of screening attendees admitted they rarely or never wore sunscreen. A more comprehensive skin cancer prevention program, which could prevent 20 percent of melanoma cases by 2030, according to the CDC, needs to include events and education tailored to younger, non-white Americans.
“It’s up to us to get the right messaging out to everyone and seek help to identify how to do so,” Friedman emphasized. “This could include partnering with an institutional communications department when considering academic dermatology or, in the community, seeking help from both local and national societies. The American Academy of Dermatology has tremendous media friendly resources for this very purpose (www.aad.org).”
Friedman and his colleagues at GW are already working on expanding the demographics of their screening event attendees—and where these events happen.
“We also plan to evaluate the impact of going into the community, at health fairs and high traffic locations to see if bringing the screening to the masses works better,” he explained.