Aim Skin Cancer Warnings at the Young, Too, Experts Say

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MONDAY, May 7 (HealthDay News) -- Doctors should take the time to counsel children, teens and young adults on the dangers of sun exposure and tanning beds, according to new recommendations from the U.S. Preventive Services Task Force.

But rather than focus on skin cancer, discussions with young patients should center on how ultraviolet-ray exposure can damage the way their skin looks, the task force advised.

"We are not saying to young people to avoid sun exposure and indoor tanning to prevent skin cancer, because that message doesn't work," said Dr. Virginia Moyer, USPSTF chair and a professor of pediatrics at Baylor College of Medicine in Houston.

"That is the goal, but the message that works is to use appearance-based counseling," she said.

Because most research so far is based on people with fair skin -- who are at the greatest risk of skin cancer -- these new recommendations apply only to them, the authors noted.

Instead of telling these patients about the risk of skin cancer, they should be told that sun exposure leads to ugly skin: "What you end up having is wrinkled, leathery skin," Moyer said.

"If the audience you are trying to reach is young people whose concern about having skin cancer is not very high, then the more effective way to get the message across is to talk about the more immediate effects -- skin damage," she said.

For example, doctors can show patients photos taken of skin with a UV camera to demonstrate the damage UV rays can cause.

The recommendations appeared online May 8 in advance of publication in the July 3 print issue in the Annals of Internal Medicine.

Specifically, doctors should counsel children, teens and young adults aged 10 to 24 who have fair skin and no history of skin cancer about skin cancer prevention. Having light skin, hair and eyes increases the risk for skin cancer, as does overexposure to ultraviolet rays at an early age, the recommendations state.

Skin cancer affects more than 2 million Americans each year, according to background information from the USPSTF.

This recommendation is a change from the group's previous statement, which said that evidence was insufficient to be able to make a recommendation at that time, Moyer said.

"We now have data that is pretty good that counseling adolescents and young adults who are fair-skinned to avoid sun exposure, using counseling that is appearance-based, works," she said.

Moyer noted that early skin damage is a precursor to skin cancer later in life. "But by the time people are concerned about the risk of skin cancer it's too late. The damage has been done," she explained.

Appearance-based counseling by doctors can change behavior, Moyer said. "It should be part of well-person exams for fair-skinned people," she added.

Right now there is not enough evidence to recommend counseling adults about the dangers of UV exposure, the report noted.

Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine, said he isn't convinced that counseling children is enough to get them into the habit of protecting themselves from UV exposure.

"It is always a challenge to change people's behaviors," he said. Counseling and media campaigns aren't enough. These changes must be taught early, Salomon added.

In Australia, schools have an integrated program about sun protection, a large media campaign and widespread availability of sun-protection clothing and other products, he pointed out. Yet, studies show that even in Australia, the country with the highest incidence of dangerous skin cancers, media announcements only have short-term benefits in getting people to comply, he noted.

"I think that there is a clear parental responsibility to protect one's child from the largest-known cancer risk: the sun," Salomon said.

He noted that parents make their children wear bike helmets and buckle seat belts and they don't leave their children unattended.

"If children are slathered with sun-protection creams and not brought out in the midday sun, it will ultimately seem to be the normal and prudent thing to do," Salomon said.

More information

To learn more about skin cancer, visit the Skin Cancer Foundation.

SOURCES: Virginia A. Moyer, M.D., M.P.H., professor of pediatrics, Baylor College of Medicine, Houston, and chair, U.S. Preventive Services Task Force; Jeffrey C. Salomon, M.D. assistant clinical professor of plastic surgery, Yale University School of Medicine, New Haven, Conn.; May 8, 2012, Annals of Internal Medicine, online

Copyright © 2012 HealthDay. All rights reserved.

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Warnings on Cigarette Packs May Keep Ex-Smokers From Relapse

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WEDNESDAY, April 25 (HealthDay News) -- Warnings on cigarette packages about the health hazards of smoking can help deter many ex-smokers from lighting up again, a new international study finds.

The findings may be especially timely for policymakers in the United States, since the U.S. Food and Drug Administration is poised to mandate graphic anti-smoking images on cigarette packaging in September.

One expert said he believes smokers and ex-smokers need more reminders of the ravages of smoking.

"I keep an empty package of cigarettes at hand when talking to smokers, and ask them if they look at the warnings," said Dr. Len Horovitz, pulmonary specialist at Lenox Hill Hospital in New York City. "While most say that they do, they cannot repeat more than two health risks -- usually lung cancer and emphysema are the responses."

Horovitz believes that more prominent warnings -- especially about non-lung-cancer conditions such as heart disease, bladder cancer and erectile dysfunction -- would help more ex-smokers stay that way.

The new findings, published April 25 in the journal Tobacco Control, are based on a poll involving about 2,000 former smokers in Canada, Australia, Britain and the United States.

The content and graphic nature of cigarette-package warnings varies widely between these countries, the authors noted. Regardless of nationality, however, the survey found a common trend: ex-smokers who said they found anti-smoking messaging on packaging helpful were more apt to avoid relapse.

"This study provides the first evidence that health warnings can help ex-smokers stay quit," researchers led by Dr. Ron Borland of the VicHealth Centre for Tobacco Control at the Cancer Council Victoria in Carlton, Australia, said in a journal news release.

The team believes the anti-smoking messages "help generate reasons for resisting temptations to relapse."

In the United States, public health messaging on cigarette packaging is now the subject of considerable debate and potentially dramatic change. The FDA has already approved plans to overhaul the packaging of all cigarettes sold in the United States by replacing text-only warnings (in place since 1984) with extremely graphic cautionary images, some of which depict smoking-related disease.

Although a court battle over the FDA's plan is now underway, nine such images already have been composed, illustrating things such as a smoker exhaling through a tracheotomy hole in his neck and a mother and child enveloped in a cloud of cigarette smoke. Images would cover the top section of all cigarette packs.

One expert believes these images and warnings will help cut U.S. smoking rates.

"Although U.S. citizens are not routinely exposed to warning labels on cigarette packs, many have seen graphic commercials and advertisements related to the health effects of tobacco use," said Patricia Folan, director of the Center for Tobacco Control at the North Shore-LIJ Health System in Great Neck, N.Y. "When these types of commercials are aired, calls to state smokers' quit-lines have increased dramatically. This increase in calls indicates that the ads appear to be motivating smokers to quit."

In Canada, similar graphic warnings have been in place since 2000, covering half of each pack's surface on both sides. Since 2006, graphic warnings have covered 30 percent and 90 percent of the cover and back, respectively, of all cigarette packs sold in Australia. In the United Kingdom, text-only warnings have taken up 30 percent and 40 percent of the respective fronts and backs of all packaging.

The survey was conducted between 2002 and 2009. Smokers were tracked for a year, at which point they indicated their thoughts on package messaging exposure, as well as their current smoking status.

In all, nearly 58 percent of smokers who had quit remained free of cigarettes by year's end. Those who said they viewed such messages as very helpful had a relapse rate of 41 percent, compared with a rate of 50 percent among those who said the messages were not particularly helpful.

Meanwhile, another international study also published in the same issue of Tobacco Control suggests that during the next two decades the global rate of smoking will barely drop unless governments improve their anti-smoking policies.

In the study, a team led by Dr. David Mendez, of the department of health management and policy at the University of Michigan's School of Public Health in Ann Arbor, looked at the situation in the 60 nations that account for 90 percent of all smokers (and 85 percent of the world's population). They speculate that unless these countries' governments change course and push for effective anti-smoking initiatives by 2030, the global rate of smoking will fall by only 1.7 percent.

If these nations were to adopt the World Health Organization's 2008 package of anti-smoking measures, however, global smoking prevalence would drop from roughly 24 percent today to about 13 percent by 2030.

Such measures include the implementation of tobacco monitoring, second-hand smoke exposure protection, cessation assistance, publicity about health dangers, bans on cigarette advertising, and cigarette taxation.

The study authors noted that the nations with the largest smoking populations include China (28 percent of the world's smoking population), India (11 percent), Indonesia (5 percent), the United States (5 percent) and Russia (4 percent).

More information

For more on the proposed U.S. cigarette-package warning labels, head to the U.S. Food and Drug Administration.

SOURCES: Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; Patricia Folan, R.N., M.S., director, Center for Tobacco Control, North Shore-LIJ Health System, Great Neck, N.Y.; Tobacco Control, April 25, 2012, news release.

Copyright © 2012 HealthDay. All rights reserved.

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