Physicians miss 99.9% of their opportunities to counsel patients about use of sunscreen, and dermatologists pass up 98% of those teaching moments, based on data from approximately 18 billion patient visits recorded between January 1989 and December 2010. The findings were published online on Sept. 4 in JAMA Dermatology.
Despite the rising incidence of skin cancer and recommendations from medical organizations that clinicians counsel patients about sun-protective behaviors, "sun-protection counseling ranks among the lowest topics of primary prevention discussed between physicians and patients," said Dr. Kristie Akamine of Wake Forest University in Winston-Salem, N.C., and her colleagues.
To identify trends in sunscreen recommendations by different specialties, the researchers reviewed data from the National Ambulatory Medical Care Survey (NAMCS), an ongoing survey conducted by the National Center for Health Statistics (JAMA Dermatol. 2013 Sept. 4 [doi:10.1001/jamadermatol.2013.4741]).
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Despite the rising incidence of skin cancer and recommendations from medical organizations that clinicians counsel patients about sun-protective behaviors, "sun-protection counseling ranks among the lowest topics of primary prevention discussed between physicians and patients," said Dr. Akamine.
Overall, sunscreen was recommended at only 12.9 million of 18.3 billion patient visits (0.07%). Most of the appointments at which sunscreen was recommended were visits to a dermatologist (86%), followed by visits to family physicians or general practitioners (10%), pediatricians (1.4%), other specialists (1.4%), and internists (1.1%).
Although dermatologists were the most frequent recommenders of sunscreen, the mention of sunscreen was recorded at only 1.6% of all dermatology visits and 11% of visits associated with a diagnosis of skin cancer, the researchers said. Of note, dermatologists recommended use of sunscreen to skin cancer patients less frequently than did general/family physicians (11% vs. 56%), they added.
Overall, sunscreen was least often recommended for children younger than 10 years; by contrast, patients in their 70s were most likely to receive a recommendation for sunscreen use.
In addition, white patients were nine times more likely than black patients to receive a recommendation for sunscreen use.
Across all specialties, patients with a diagnosis of actinic keratosis accounted for 21% of the visits at which sunscreen was recommended.
The study was limited by several factors, including the cross-sectional nature of the data, which included both new and follow-up visits, and the lack of information about whether sunscreen was discussed at an earlier visit or not documented by the physician on the survey report, Dr. Akamine and her associates noted.
The results, however, suggest that sunscreen use recommendation is less frequent than advised by multiple medical organizations. "The high incidence and morbidity of skin cancer can be greatly reduced with the implementation of sun-protection behaviors, which patients should be counseled about at outpatient visits," the researchers said.
Lead author Dr. Akamine had no financial conflicts to disclose. Corresponding author Dr. Steven Feldman disclosed financial relationships with multiple pharmaceutical companies, but this study was not sponsored by a pharmaceutical company.
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