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Preventing skin cancer
Short Text
Introduction
This pathway focuses on preventing the first occurrence (primary prevention) of skin cancer attributable to overexposure to natural and artificial ultraviolet (UV) light. Unless otherwise stated, the term 'skin cancer' encompasses non-melanoma (basal cell and squamous cell carcinoma) and malignant melanoma.
The aim is to raise everyone's awareness of the risks of UV exposure, influence people's attitudes and prompt behaviour change. Some groups are more likely to benefit than others (for example, outdoor workers, those who are immuno-suppressed, children and young people and those who use sunbeds).
The recommendations focus on national mass-media campaigns, local information provision, developing and evaluating information campaigns and interventions, and the provision of shade when designing new buildings.
The pathway is for GPs, pharmacists, practice nurses, public health practitioners, school nurses, skin cancer specialists and everyone else with any kind of responsibility for preventing skin cancer. This includes organisations running national information campaigns. It is also for local authority planners and others responsible for providing areas of shade.
Source guidance
The NICE guidance that was used to create the pathway.
Skin cancer prevention: information, resources and environmental changes. NICE public health guidance 32 (2011)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Costing support
Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Slide sets
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Pathway information
Benefits of exposure to the sun
Exposure to the sun has a number of benefits. For example, it increases people's sense of wellbeing, allows them to synthesise vitamin D and provides opportunities for physical activity.
Vitamin D
Vitamin D is essential for bone health and there is ongoing research to assess other positive health benefits. Although the optimum level of vitamin D is subject to debate, it is accepted that a plasma level below 25 nanomoles/litre increases the risk of rickets and osteomalacia. Several population groups in the UK face this riskRuston D, Hoare J, Henderson L et al. (2004) The national diet and nutrition survey: adults aged 19-64 years. Volume 4: nutritional status (anthropometry and blood analytes), blood pressure and physical activity. London: The Stationery Office. Hypponen E, Power C (2007) Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. American Journal of Clinical Nutrition 84: 18-28..
The sun is the predominant source of vitamin D. However, it is difficult to determine how much sunlight is needed to produce a given level, as the length of time needed to synthesise it depends upon several factors. These include skin type, the amount of skin exposed, the time of day and year and how far someone is from the equator.
Ultimately, a balance needs to be struck to attain an adequate vitamin D status without increasing the risk of skin cancer. Further information on vitamin D can be obtained from the Department of Health or the Food Standards Agency.
Physical activity
Regular physical activity is key to a healthy lifestyle. It can help reduce the risk of developing chronic diseases and improves people's overall physical and mental wellbeing. Skin cancer prevention activities may inadvertently reduce physical activity levels as people aim to avoid exposure to the sun. It is important that prevention activities do not discourage outdoor physical activity but, rather, encourage people to use sensible skin protection.
Behaviour change
The principles outlined in NICE's Behaviour change guidance were used as the basis for making recommendations on how to change people's health-related behaviours. The behaviour change guidance highlights the need for careful planning that takes into account the local and national context and the needs of the target community. It advises building upon the existing skills and resources within a community, and ensuring practitioners have the necessary competencies and skills to support behaviour change. The guidance also recommends evaluating interventions and programmes thoroughly.
Updates to this pathway
13 January 2012 minor maintenance update.
Supporting information
Glossary
People with skin types I and II burn rapidly For skin type classification, visit the SunSmart website..
Type of recommendation
What type of recommendation are you interested in?
Mass-media campaigns
View the 'Commissioning, organising and planning national mass-media skin cancer prevention campaigns' pathPrimary prevention
View the 'Primary prevention of skin cancer' pathChildren, young people and outdoor workers
Schools, leisure services and other employers and managers involved in protecting children, young people and outdoor workers
Schools, leisure services and other employers and managers involved in protecting children, young people and outdoor workers
Who should take action?
Employers and managers in leisure or educational settings (examples of the latter include head teachers, healthy schools coordinators and personal, social, health and economic education [PSHE] lead teachers).
Other employers, managers and practitioners in contact with employees who work outdoors (such as workplace health practitioners and health and safety officers).
What action should be taken?
Assess if there is a risk of harmful exposure to the sun. Where this is the case, develop, implement and monitor a specially tailored policy to ensure people are protected as much as possible.
Ensure policies aim to prevent children and young people from getting sunburnt by encouraging them to seek shade whenever possible. When it is not possible, they should be encouraged to wear hats, other clothing and sunscreen to protect themselves. Policies should also encourage parents to provide their children with sunscreen. Guidelines should be provided on how to help children apply it (and how children can help each other to apply it).
Ensure policies encourage outdoor workers to wear clothing to avoid getting sunburnt (including a hat that shades the face and back of the neck, where possible). They should also be encouraged to stay in the shade when possible, especially during breaks and in the middle of the day (11 am to 3 pm). When it is not possible to stay in the shade or wear protective clothing (for example, because of work requirements) they should be encouraged to wear a sunscreen with UVA and UVB protection (at least SPF 15). For more details see tone and approach in this pathway. Further information on the development of education, leisure or workplace-based policies can be obtained from the SunSmart and Health and Safety Executive websites.
See also training and messages to help prevent skin cancer in this pathway.
Source guidance
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Training
Training
Who should take action?
Employers and managers in leisure or educational settings (examples of the latter include head teachers, healthy schools coordinators and personal, social, health and economic education [PSHE] lead teachers).
Other employers, managers and practitioners in contact with employees who work outdoors (such as workplace health practitioners and health and safety officers).
What action should be taken?
Assess the training needs of staff responsible for policy-making in outdoor, educational or leisure environments. Ensure they have the necessary skills and information to give their colleagues advice on sun protection issues. For example, teachers and others working in education may need training in the risk factors, the types of behaviours to avoid and how to encourage children and young people to apply their own sunscreen. Employers and managers may need training in how to carry out risk assessments in relation to sun exposure during the working day.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeProvision of shade
Architects, designers, developers, planners and employers involved in providing shade
Architects, designers, developers, planners and employers involved in providing shade
When designing and constructing new buildings, consider providing areas of shade created either artificially or naturally (for example, by trees).
When developing or redeveloping communal outdoor areas, check whether it is feasible to provide areas of shade. Shade could be created by constructing a specific structure or by planting trees.
For all new developments, ensure there is adequate access to areas of shade for people with a disability.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePaths in this pathway
- Commissioning, organising and planning national mass-media skin cancer prevention campaigns
- Messages to help prevent skin cancer
- Primary prevention of skin cancer
Pathway created: October 2011 Last updated: January 2012
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