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1.
Rogers HW, Weinstock MA, Harris AR,  et al.  Incidence estimate of nonmelanoma skin cancer in the United States, 2006.  Arch Dermatol. 2010;146(3):283-287PubMedArticle
2.
Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model.  Arch Dermatol. 2010;146(3):279-282PubMedArticle
3.
Chen JG, Fleischer AB Jr, Smith ED,  et al.  Cost of nonmelanoma skin cancer treatment in the United States.  Dermatol Surg. 2001;27(12):1035-1038PubMed
4.
Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage; 1998
5.
Lemal M, Van den Bulck J. Testing the effectiveness of a skin cancer narrative in promoting positive health behavior: a pilot study.  Prev Med. 2010;51(2):178-181PubMedArticle
6.
Ordonana JR, Gonzalez-Javier F, Espin-Lopez L, Gomez-Amor J. Self-report and psychophysiological responses to fear appeals.  Hum Commun Res. 2009;35(2):195-220Article
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Research Letter
Mar 2012

Medical Students' Perceptions of Skin Cancer: Confusion and Disregard for Warnings and the Need for New Preventive Strategies

Author Affiliations

Author Affiliations: Division of Dermatology and Cutaneous Surgery, University of Texas Health Science Center, San Antonio (Ms Nanyes and Dr Krejci-Manwaring), and Department of Human Communication, Trinity University (Dr McGrath), San Antonio, Texas.

Arch Dermatol. 2012;148(3):392-393. doi:10.1001/archdermatol.2011.2728

Although skin cancer is one of the most preventable and easily detected forms of cancer, it is the most prevalent cancer in the world and its incidence is increasing annually, more than all other cancers combined, making it one of the most expensive cancers to treat.13 Given the cost of treatment, potentially deadly consequences, and the well-known causal relationship between UV light and skin cancer, it is unclear why many people ignore warnings and do not protect themselves from the sun.

Methods

To understand the perceptions of skin cancer and to gather information that could be used as baseline information for future research or educational campaigns, we conducted 4 focus group interviews of approximately 30 minutes each with 20 medical students from the University of Texas Health Science Center in San Antonio. The students discussed what they understood about skin cancer, how to avoid it, the extent to which they engaged in sun-protective behaviors, risk perceptions, adherence to warnings, and the effectiveness of various channels used to communicate information about skin cancer. The interviews were audiotaped and transcribed, and all 3 of us used content analysis to identify several themes.4 The study was approved by the University of Texas Health Science Center institutional review board.

Results

Findings showed that respondents understood the causes of skin cancer but were confused about sun protection factor (SPF) and proper use of sunscreen. Most students did not know the meaning of SPF numbers, what SPF sunscreen would be most appropriate to use, how often to reapply sunscreen, and whether sunscreen was immediately effective or required time to activate. Perhaps most surprisingly, most students used a tanning bed or tanned in the sun to improve their appearance.

The most common reason for ignoring skin cancer warnings, as one student stated, was “because it is not as scary as other cancers, ” such as breast and lung cancer, which were described as widely publicized. Other reasons included confusion about sunscreen, lack of understanding of the risks of skin cancer, lack of realization that it could happen to them, lack of awareness of skin cancer, unwillingness to deal with the issue, and the belief that prevention efforts might not pay off. One student noted that “people have the perception that they can fix their skin later because companies sell products for age reversal, so people think they can fix the problem later and not worry about it now. ”

To make the risks of skin cancer seem “real, ” students recommended media campaigns featuring celebrity spokespersons telling real-life stories about skin cancer. As one student noted, “they put [breast cancer] in the movies, on big billboards, or in a big race; there's nothing like that for skin cancer. ” Another student pointed out that “celebrities have causes, but I don't think anyone's tackled skin cancer in particular. ” Students also recommended graphic depictions of illness, with media campaigns using pictures of the devastating physical outcomes of skin cancer to increase people's awareness. The use of both narratives and “fear ” appeals may be ideas worth pursuing, given that research shows that those strategies can be persuasive.5,6

Students suggested that patients may be more influenced by face-to-face communication with physicians than by media campaigns. They also recommended that primary care providers discuss skin cancer risks and sun-protection behaviors as part of routine history taking with all patients; this is preferable to relying on dermatologists, who are specialists and therefore not the best source of initial screenings and/or warnings. In general, patients seek dermatology care only after discovering a skin problem rather than on a routine basis, starting in childhood, and therefore miss the opportunity for early education on sun protection and skin cancer risks. Hence, by highlighting skin cancer risks and prevention strategies in the medical curriculum and by training our students to include skin cancer discussion as part of their routine patient history taking, dermatologists, with the assistance of primary care physicians, may dramatically expand patient education.

Comment

The results of this study suggest that well-educated medical students do not understand the importance of preventive behaviors and level of skin cancer risk. Therefore, new strategies to persuasively communicate information and warnings about skin cancer are needed to diminish the rise of this highly preventable disease.

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Article Information

Correspondence: Dr Krejci-Manwaring, Division of Dermatology, University of Texas Health Science Center, 7979 Wurzbach Rd, MC 7879, San Antonio, TX 78229 (krejcimanwar@uthscsa.edu).

Accepted for Publication: November 12, 2011.

Author Contributions: Drs McGrath and Krejci-Manwaring had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Nanyes, McGrath, and Krejci-Manwaring. Acquisition of data: Nanyes and McGrath. Analysis and interpretation of data: Nanyes, McGrath, and Krejci-Manwaring. Drafting of the manuscript: Nanyes, McGrath, and Krejci-Manwaring. Critical revision of the manuscript for important intellectual content: Nanyes, McGrath, and Krejci-Manwaring. Statistical analysis: McGrath. Administrative, technical, and material support: Nanyes and McGrath. Study supervision: McGrath, Krejci-Manwaring.

Financial Disclosure: None reported.

References
1.
Rogers HW, Weinstock MA, Harris AR,  et al.  Incidence estimate of nonmelanoma skin cancer in the United States, 2006.  Arch Dermatol. 2010;146(3):283-287PubMedArticle
2.
Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model.  Arch Dermatol. 2010;146(3):279-282PubMedArticle
3.
Chen JG, Fleischer AB Jr, Smith ED,  et al.  Cost of nonmelanoma skin cancer treatment in the United States.  Dermatol Surg. 2001;27(12):1035-1038PubMed
4.
Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage; 1998
5.
Lemal M, Van den Bulck J. Testing the effectiveness of a skin cancer narrative in promoting positive health behavior: a pilot study.  Prev Med. 2010;51(2):178-181PubMedArticle
6.
Ordonana JR, Gonzalez-Javier F, Espin-Lopez L, Gomez-Amor J. Self-report and psychophysiological responses to fear appeals.  Hum Commun Res. 2009;35(2):195-220Article
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