The prevention of skin cancer: is there a gap between evidence and practice?

Stabilizing of skin cancer incidence by 2005 is a Health of the Nation target and many purchasers and practitioners are actively endeavouring to meet it. This study aims to describe the extent and nature of primary and secondary prevention programmes amongst health authorities in the UK and general practices in Avon and to comment upon the evidential basis for these measures.

Questionnaire survey (with a second mailing to non-responders), sent to the 205 health authorities in the UK England, Wales, Scotland and Northern Ireland) and 179 general practices in Avon.

Primary prevention programmes are being implemented by 89% of health authorities in the UK and 56% of general practices in Avon. Sun avoidance, and use of protective clothing and sunscreens were advised by over 90% of authorities with such programmes. 34% of general practices and 41% of health authorities were providing or purchasing secondary prevention programmes, ranging from conveying information about warning signs in skin lesions to undertaking full scale screening.

Most authorities are appropriately promoting ultraviolet reduction by use of thickly woven clothing, hats and avoidance of the midday sun. There is greater uncertainty about the appropriate role of sunscreens, which have not been shown experimentally to reduce skin cancer incidence. Whilst there is some evidence of the effectiveness of campaigns to encourage rapid referral to pigmented lesion clinics, there is none to support screening for skin cancers by clinical examination and this approach should not be pursued under our current state of knowledge.