Innovative programs for skin cancer prevention

Skin cancer prevention advocates can learn from the experiences of two skin cancer prevention programs aimed at identifying opportunities to educate young people about sun safety. Leaders of those programs spoke about what they’re doing and how they’re doing it, in April 2015, during the Center for Disease Control and Prevention’s (CDC’s) Prevention and Control of Skin Cancer Public Health Grand Rounds.

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MD Anderson’s Melanoma Moon Shot

MD Anderson has launched the Melanoma Moon Shot, a program focused on reducing skin cancer deaths by accelerating the conversion of scientific discoveries into clinical advances. Its two flagship projects are a primary prevention effort to protect youth from ultraviolet radiation and a research program to increase long-term survival in melanoma by targeting cancer genes and the anti-tumor immune response.

Jeff Gershenwald, M.D., medical director of the Melanoma and Skin Center, University of Texas MD Anderson Cancer Center, and co-leader of the Melanoma Moon Shot, said scientific advances in melanoma have opened the door to targeted therapies and immunotherapies alike.

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“Importantly, there’s clear and compelling epidemiologic evidence that UV radiation, both from the sun and UV tanning devices, contribute to melanoma risk. The role of UV is also supported by recent research on genetic mutations of melanoma,” Dr. Gershenwald said.

Dr. Gershenwald leads the Melanoma Cancer Genome Atlas program, which in recent years has published research showing that melanoma has the highest mutation rate, in terms of overall frequency of somatic or tumor-based mutations, among about 40 cancer types analyzed to date. The researchers have also found that most of melanoma’s mutations are C-to-T transitions.
“Interestingly, the C-to-T transition pattern is classically associated with a UV signature,” Dr. Gershenwald said.

Next: Moon shot program a multipronged approach

The Moon Shot program is taking a multipronged approach to reducing UV exposure among young people. Prevention is based on facilitating and evaluating legislative actions and maximizing reach and impact of evidence-based interventions, targeted across the age continuum. This includes a UV photography program aimed at middle schools students, as well as a skin cancer prevention toolkit being developed for colleges and universities.

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Part of the program is to promote policies that advance the national goal of preventing skin cancer, according to Dr. Gershenwald. Texas Senate Bill 329, a collaborative effort with MD Anderson, medical societies, foundations and patients, became law September 2014. That’s when Texas became the 4th state in the U.S. to prohibit tanning bed use for people younger than 18.

MD Anderson is sharing lessons learned and directly assisting efforts in other states that are pursuing legislation to prohibit tanning bed use before age 18.

“Understanding how the legislation is implemented and how well tanning facilities comply with the ban is a critical next step. We’re starting a study to determine the proportion of Texas tanning facilities that comply with SB329 soon,” Dr. Gershenwald said.

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It’s a good time to promote prevention, according to Dr. Gershenwald.

The FDA recently changed the classification of indoor tanning devices from class I to class II. Tanning beds used to be in the same classification as tongue depressors and elastic bandages. Now they’re in a category with x-ray machines. The FDA also issued a black box warning stating: This sunlamp product should not be used on persons under the age of 18 years.

Dr. Gershenwald and colleagues are reaching out to the medical community on issues related to indoor tanning. They recently published an editorial in the March Annals of Surgical Oncology, Teens and Indoor Tanning: Time to Act on the U.S. Food and Drug Administration’s Black-Box Warning.1 The editorial highlights the importance of educating policymakers about the harmful effects of artificial sun exposure in youth.

The Moon Shot program hopes to answer important research questions, to develop evidence-based prevention approaches. One example: recent research has focused on appearance-focused interventions to reduce indoor tanning and sun exposure behaviors. 

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“Our Moon Shot intervention will conduct a study to examine the effects of this intervention for adolescents in middle schools. The intervention involves taking a standard and UV photo of the face, using a camera with a UV filter. We’ll study whether this intervention is effective at increasing adolescent sun protective behaviors and whether it acts to decrease tanning behaviors and sunburns,” he said.

NEXT: Arizona SunWise program

Arizona SunWise program

If Arizona were a country, it would rank second, after Australia, in skin cancer incidence, according to research cited by Sharon McKenna, program manager, Arizona SunWise Skin Cancer Prevention Program, Arizona Department of Health Services.
One of the first steps in prevention is to define the problem. When McKenna and colleagues looked at the state’s data on invasive melanoma, it showed a rate somewhat higher than the national rate.

“But we, in the field, felt the rate was lower than expected. So a … taskforce was born to compare the number of cases from our registry with the number of cases logged within individual dermatology practices. By comparing cases reported to cases treated, we found an unreported rate of 70%,” she said.

Now, the task at hand is to clean up the melanoma data from 2000 to 2014, by collecting data from the state’s 531 dermatologists, she said. The state is attempting to improve melanoma data gathering by revising its reporting form and creating a monthly newsletter focused on providers and reporting requirements.

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McKenna and colleagues will use the more accurate data to map and rank Arizona’s census blocks in terms of highest to lowest melanoma rates. They’ll release reports to the media and spread the word about where melanoma rates are high and low.

The state’s skin cancer prevention efforts are focused on educating youth about sun safe behaviors. McKenna created and implemented the state’s sun safety program, starting with a simple grassroots effort to talk with staff members at schools. She would call and ask to talk about skin cancer prevention and sun safety for 10 minutes during school staff meetings. That led to longer lectures, and, today, McKenna delivers about 300 presentations to schools in Arizona.

“We’re proud that Arizona is the first state to pass a sun safety education mandate. Over 700,000 students in 1,100 K through 8 public and charter schools learn how to protect their skin and prevent skin cancer. Private and nontraditional schools can also use the program, voluntarily,” McKenna said.

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The SunWise school curriculum is an easy-to-use and incorporate template that includes activities involving school subjects. It’s a modified version, consistent with the Community Preventive Services guide and the Surgeon General’s Call to Action to Prevent Skin Cancer. 

“We modified the curriculum to meet our state’s standards, wrote tips sheets and created a physical education module to show kids how to be active outside and sun safe,” McKenna said. 

The program has expanded to more than 2,400 childcare providers, who are required to meet the state’s sun safety standard, which has detailed protocols for applying sunscreen and providing outdoor shade in play areas. The state’s SunWise program also partners with about 250 organizations, including sports teams, summer camps, libraries, and afterschool programs.
In a study of 281 Arizona educators during a seven-year period, McKenna and colleagues found the educators surveyed reported a 63% increase in student ability to provide examples of the harmful health effects of the sun on skin. And 85% of educator respondents cited Arizona’s program as their primary source of sun safety education.

Full results will be released July 2015, according to McKenna.

NEXT: Websites for more information

Websites that offer more information

• Dermatologists can see the entire CDC Grand Rounds on skin cancer prevention at http://www.cdc.gov/cdcgrandrounds/.

• Arizona’s SunWise program information is at: www.azdhs.gov/phs/sunwise. 

• The Guide to Community Preventive Services website: www.thecommunityguide.org/index.html

• Learn about the Melanoma Moon Shot and melanoma research at MD Anderson at: http://www.cancermoonshots.org/cancer-types/melanoma/

Next: References

Drs. Gershenwald and McKenna report no relevant disclosures.

References:
1. http://link.springer.com/article/10.1245/s10434-014-4257-6/fulltext.html