Carol Reed Ash, EdD, RN, FAAN
An estimation that a skin cancer of some type will
have developed in more than one million Americans in the year 1996, with
38,300 of these being malignant melanomas, raises the management of skin
cancer in the year 2000 to an increasing level of priority for nurses.
1,2
Estimated lifetime risk for an American having invasive melanoma is projected
be 1 in 75 by the year 2000, an increase from the 1 in 1,500 reported in
1930. This shows a consistent annual increase in incidence of approximately
6%, with melanoma ranked behind only lung cancer in percentage increase
in deaths per year.
3
To be responsive to the increasing problem, a number
of challenges must be addressed, including environmental, societal, educational,
and public health policies. Environmental issues such as stratospheric
ozone depletion,4 which allows more intense UV light to reach
the earth’s surface, may not be something nurses can change, but we can
contribute significantly to societal, educational, and public health issues.
A collaborative effort of all health care workers is needed to bring about
the behavior changes necessary to decrease the rapidly escalating skin
cancer statistics.
Future changes in the ozone layer and an increase
in the amount of leisure time people have available to spend in the sun
may also be contributing factors. The length of time from first sun exposure
to the actual appearance of skin cancer can contribute to a sense of unreality
and false security in the populations. Increasing awareness by both the
public and the professional practitioner will be the key to changing behavior
and increasing skin cancer prevention and detection activities.
Public awareness campaigns need to be developed to
focus attention on the problem and to increase the level of knowledge about
what causes cancer and how individuals can protect themselves. A recent
national survey revealed that only one third of Americans know that melanoma
is a skin cancer and only 50% know it is even a cancer.5 While
dermatologists may be the best diagnosticians of malignant melanoma, most
people are initially seen in the primary care setting. A primary care physician
or a nurse practitioner is often the first contact for the patient, and
sometimes the diagnosis is secondary to presentation of another problem
or symptom. Education programs to increase the skill and expertise of the
professional practitioner, as well as to increase emphasis on skin cancer
in professional school curricula, need to be initiated.
Educational programs must focus on modifying behavior
as well as increasing knowledge. Behavior changes are needed that demonstrate
the knowledge for all age groups and over a sustained period of time. Attention
to different teaching methods, learning tools, materials that are age-
and cultural-sensitive, and the needs of the disadvantaged learner will
be critical. Public education efforts should begin with the mass media
but should also directly target schools, workplaces, physicians’ offices,
and public health organizations.6
GatorSHADE, a community education program developed
to address sun protection issues, is an example of a way to increase public
awareness of the critical skin cancer prevention message. Designed to involve
both children and their parents in the learning process, it utilizes sun
protective hats, teaching cards, and sun screen to facilitate learning.
GatorSHADE demonstrates how multiple disciplines working in a collaborative
effort can address a serious health care problem.
The challenges in meeting the needs are great, but
they can be met. They include improvement in early detection rates, integration
of health promotion and early detection into professional education, and
practice and integration of health promotion and detection at an early
age and throughout life.
References
1. Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States:
incidence. J Am Acad Dermatol. 1994;30:774-778.
2. Parker SL, Tong T, Bolden S, et al. Cancer statistics, 1996. CA
Cancer J Clin. 1996;46:5-27.
3. Ries LAG, Miller BA, Henkey BF, et al, eds. Bethesda, Md: US Department
of Health and Human Services, Public Health Service, National Institutes
of Health DHHS Publication No. NIH-94-2789. 1994.
4. Schaart FM, Garbe C, Orfanos CE. Disappearance of the ozone layer
and skin cancer: attempt at risk assessment. [Article in German.] Hautarzt.
1993;44:63-68.
5. Rigel DS, Friedman RJ, Kopf AW. The incidence of malignant melanoma
in the United States: issues as we approach the 21st century. J Am Acad
Dermatol. 1996;34:839-847.
6. Goldsmith LA, Koh HK, Bewerse BA, et al. Full proceedings from the
National Conference to Develop a National Skin Cancer Agenda. American
Academy of Dermatology and Centers for Disease Control and Prevention,
Washington, DC, April 8-10, 1995. J Am Acad Dermatol. 1996;35:748-756.