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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): The incidence of cutaneous malignant melanoma (CMM), the most deadly type of skin cancer, is increasing by epidemic proportions. There are both primary prevention methods and skin cancer surveillance methods for CMM. Because there is substantial evidence from cohort and case-control studies that melanoma is associated with sun exposure, primary prevention involves limiting exposure to solar radiation and applying sunscreen. Because thickness of the lesion is the best predictor of prognosis, skin cancer surveillance by total cutaneous examination (TCE) and skin self-examination (SSE) is thought to increase the chances of detecting thinner melanoma lesions and thereby reducing mortality and morbidity from this disease. However, epidemiologic data supporting regular skin cancer surveillance remains equivocal compared to data supporting other cancer detection and prevention practices. Thus, it may be premature to target average risk populations for interventions to improve skin cancer surveillance practices. However, a strong case can be made for focusing prevention and surveillance efforts on subgroups of individuals at increased risk for melanoma. These individuals would benefit from information about the health behavior changes that may reduce their melanoma risk. In the proposed study, we focus on first degree relatives of individuals diagnosed with melanoma who have one additional risk factor (e.g., blonde hair). Research indicates that family members pay little attention to sun protection and to skin cancer surveillance. Guided by the Preventive Health Model and the Theory of Planned Behavior, we have been able to elucidate key attitudinal factors that play a role in UV protection and CMM surveillance practices among family members at increased risk. We have utilized these data to design a tailored print and telephone counseling intervention targeted to family members of individuals with melanoma. The primary aim of the proposed study is to refine our tailored messages and conduct a randomized clinical trial testing a tailored print and phone counseling intervention against the best available public health education materials for skin cancer prevention. We will target family members who are not compliant with TCE and who are minimal performers of SSE and sun protection. 396 family members will complete the study. Outcomes will be evaluated in terms of TCE, SSE and sun protection habits, as well as changes in attitudes and knowledge about CMM