Cloudy Evidence on Skin Cancer Screening Shines Light on Prevention

The U.S. Preventive Services Task Force (USPSTF) reported today in the journal, JAMA, that there is not enough evidence to recommend that adults get screened for skin cancer. Though some professional medical organizations recommend physician-performed visual checks for skin cancer — and many physicians carry them out — the USPSTF found no solid evidence that “early detection of skin cancer through visual skin examination by a clinician reduces morbidity or mortality.” Essentially, screening was not found to save lives.

On top of this, skin cancer screening itself is not without some risks. Though the Task Force concluded that was not enough evidence to fully explore the potential harms related to screening, it is likely to lead to unnecessary biopsies and other follow up tests as well as increased stress and worry in patients told they have a suspicious mole or other lesion.

On balance, the evidence was just too sparse and too ambiguous on potential harms and benefits for the Task Force to recommend skin cancer screening.

While research on screening continues to develops, these current conclusions point to the importance of also working to control skin cancer through a greater focus on prevention — a point made in an accompanying editorial in JAMA Internal Medicine by Eleni Linos, Kenneth Katz, and CNiC’s Graham Colditz. In addition to educating individuals about UV-safe behaviors (figure), policy approaches need to focus on areas such as limiting youth access to indoor tanning, promoting comprehensive campaigns that help change social norms related to tanning, and developing infrastructure that supports UV-safe behaviors, like shade structures and sunscreen dispensers.

Admittedly, it can be hard to believe that skin cancer screening has not been found to be a net health benefit.  It seems such a simple and common sense way to save lives.  Unfortunately, cancer is a very complex disease and not all screening exams have been proven to be effective tools to help prevent disease and lower mortality.  In fact, there are only a handful of cancers with recommended screening tests — breast, colon, cervical, and lung cancer.
As the science develops, skin cancer may be added to that list, but right now efforts to combat skin cancer through prevention are key. As Linos and colleagues conclude: “we should…fully implement skin cancer primary prevention by eliminating indoor tanning exposure, especially among youths, and increasing the use of sun-protection strategies that work.”

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