0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letters |

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

Jennifer Edwards Nanyes, BA; John M. McGrath, PhD; Jennifer Krejci-Manwaring, MD
[+] 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.
Text Size: A A A
Published online

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.

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.

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.

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.

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.

Rogers HW, Weinstock MA, Harris AR,  et al.  Incidence estimate of nonmelanoma skin cancer in the United States, 2006.  Arch Dermatol. 2010;146(3):283-287
PubMed
Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model.  Arch Dermatol. 2010;146(3):279-282
PubMed
Chen JG, Fleischer AB Jr, Smith ED,  et al.  Cost of nonmelanoma skin cancer treatment in the United States.  Dermatol Surg. 2001;27(12):1035-1038
PubMed
Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage; 1998
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):178-181
PubMed
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):195-220

Figures

Tables

References

Rogers HW, Weinstock MA, Harris AR,  et al.  Incidence estimate of nonmelanoma skin cancer in the United States, 2006.  Arch Dermatol. 2010;146(3):283-287
PubMed
Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model.  Arch Dermatol. 2010;146(3):279-282
PubMed
Chen JG, Fleischer AB Jr, Smith ED,  et al.  Cost of nonmelanoma skin cancer treatment in the United States.  Dermatol Surg. 2001;27(12):1035-1038
PubMed
Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage; 1998
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):178-181
PubMed
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):195-220

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics