Text messages a new tool in the fight to prevent skin cancer

Australians’ love affair with mobile phones could save their life according to a joint QUT, Cancer Council Queensland and University of Queensland study using text messages to improve skin cancer prevention and promote sun protection.

Funded by Cancer Australia, the 12-month trial targeted individuals aged between 18 and 42 - an age group in which mobile phone use is almost universal - and the results have just been published in international journal Preventative Medicine.

A Queensland-first, the Healthy Text trial tested the impact and value of SMS-delivered messages promoting sun protection along with skin self-examination for early detection of skin cancer, while a third group received texts encouraging physical activity.

Weekly texts for the first 12 weeks were followed by monthly text messages for another nine months and a final in-depth telephone interview was conducted.

Lead investigator Associate Professor Monika Janda from QUT’s Institute of Health and Biomedical Innovation said the study involved more than 500 participants and concluded that SMS-delivered intervention was effective, far-reaching, flexible and individualised.

“Australia has the highest rate of skin cancer incidence in the world and melanoma is the most common cancer in those aged 15-44,” Associate Professor Janda said.

The most important way to prevent skin cancer is to protect your skin from the harmful effects of the sun’s rays. This leaflet gives tips on how to protect your skin from the harmful effects of sunlight. In particular, it is very important to protect children from the sun. The delicate skin of a child is more sensitive to sun damage than the skin of an adult. This damage can lead to skin cancer in later life. You and your children can still enjoy sunshine and the outdoors. This leaflet aims to help you to do so in safety.

Sun and skin damage

Too much exposure to sunlight is harmful and can damage the skin. Some of this damage is short-term (temporary), such as sunburn. However, allowing your skin to burn can lead to future problems, such as skin cancer due to long-term skin damage.

There are two main types of damaging ultraviolet (UV) sunlight: UVA and UVB. UVA rays penetrate deeper into the skin, damaging the middle layer (the dermis). The dermis contains the elastic tissues that keep the skin stretchy. UVA rays therefore have the effect of ageing the skin and causing wrinkles. UVB rays are absorbed by the top layer of skin (the epidermis). This causes sun tanning but also burning.

Both UVA and UVB rays increase your risk of developing skin cancer. Getting sunburnt is therefore a warning sign that you are putting yourself at risk. Skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Melanin is the coloured pigment in our skins. When skin is exposed to sunlight, more melanin is produced to help protect the skin against the UV rays. This makes the skin darker - what people refer to as a suntan. Although melanin stops your skin burning so easily, it does not prevent the harmful effects of UV rays.

Most skin cancers are caused by too much exposure to the sun. This includes both the non-melanoma type of skin cancer, and the melanoma type of skin cancer. Non melanoma skin cancers include basal cell carcinomas and squamous cell carcinomas.

“SMS messages are an acceptable and feasible way to reach people, particularly those under 45, with personalised skin cancer prevention texts which take into account a person’s age, skin type, gender and risk factors.”

Text messages a new tool in the fight to prevent skin cancer The text messages reminded recipients to wear sunscreen and sun smart clothing as well as limit their time in the sun between 10am and 4pm. They also asked participants whether they or someone other than a doctor, such as a spouse or partner, had checked any part of their skin for early signs of skin cancer.

“Text messages are conversational in tone and those used for the trial were designed to suggest and reinforce understanding and behavioural skills in relation to skin cancer prevention and early detection of symptoms,” Professor Janda said.

“They are highly effective in promoting personal responsibility and providing positive reinforcement.

“By the end of the 12 months, the self-reported sun protection habits of those who participated in the sun protection and skin self-examination groups showed significant improvement. The proportion conducting any skin self-examination, not specifically of the whole-body, significantly increased in the skin self-examination group from 37 per cent to 63 per cent.

Prevention Guidelines
1. All doctors are not created equal: When researchers from Emory University School of Medicine looked at the records of more than 2,000 melanoma patients, they found that those whose growths had been diagnosed by a dermatologist were more likely to have early-stage cancer - and to survive their disease - than those who’d been diagnosed by another kind of doctor. It may be that dermatologists are more skilled at finding smaller tumors - and less likely to brush them off as “nothing.”

2. So-called harmless basal cell cancers aren’t always so harmless: True, the growths are usually easy to remove, but of the million new cases each year, about 5 to 10 percent can be resistant to treatment, recurring over and over and requiring more extensive surgery. And some basal cells can be very aggressive, damaging the skin around them and even invading bone and cartilage. That’s why if you have a suspicious growth, you should see a doctor promptly. “You want it removed before it disfigures your face,” says Kishwer Nehal, M.D., director of Mohs and dermatologic surgery at Memorial Sloan-Kettering Cancer Center.

3. Your daily coffee fix may help you fend off skin cancer: For each cup of caffeinated java that you drink every day, there’s a 5 percent drop in your odds of developing non-melanoma skin cancer later in life, researchers recently reported. Down a couple of Starbucks’ venti coffees at 20 ounces apiece, and you may score a 30 percent drop in risk (or more - researchers didn’t ask study participants about more than six cups a day). “It’s possible coffee’s antioxidant effect helps to protect against skin cancer,” says Ernest L. Abel, Ph.D., professor of OB-GYN at Wayne State University School of Medicine. “But part of it may be that people who drink a lot of coffee tend to stay indoors more.”

4. You can see a dermatologist for wrinkles a lot faster than for mole checks: In a study from the University of California, San Francisco School of Medicine, researchers posing as patients called more than 800 dermatologists across the country to see how long it would take to get different kinds of appointments. The disturbing results: When “patients” asked for a Botox treatment, the typical wait was eight days. But when their request concerned a changing mole, it went up - to 26 days, on average. Doctors may argue that the current state of health insurance has driven them to sometimes favor cosmetic patients, who pay in full on the day of treatment (insurance companies can take months to reimburse with only a fraction of the fee). Still, a changing mole isn’t a trivial symptom. Make sure the receptionist knows why you need an appointment. If that doesn’t work, ask your primary-care doc to intervene or to recommend another specialist.

5. SPF is only half the story: By law, sunscreen labels must list the familiar sun protection factor, which tells you how effectively the product blocks UVB rays, the ones primarily responsible for sunburn. But there’s no rating system yet for how well a sunscreen stops UVA rays, which penetrate deeper into the base layer of the skin and can cause dangerous cell changes. The FDA has proposed a new sunscreen rule that would include label revisions for UVA. Until they’re in place, David J. Leffell, M.D., professor of dermatology and surgery at Yale School of Medicine, recommends choosing a broad-spectrum sunscreen, which offers greater UVA (as well as UVB) protection. To check if a product fits the bill, look for UVA-screening ingredients, including avobenzone (Parsol 1789) and ecamsule (Mexoryl SX). Or use zinc oxide or titanium dioxide, which are physical blocks that protect against all rays. But the FDA cautions that, no matter how broad-spectrum, sunscreen isn’t enough - you must wear sun-protective clothing, too.

6. If you live in Fargo, ND, and always use sunscreen, your risk of melanoma can be greater than your friend’s in Miami: For years, researchers had puzzled over the fact that sunscreen users seemed more likely to develop melanoma than those who didn’t protect themselves. But now scientists from the University of California, San Diego, may have figured out why. In a recent study, they found that the unexpected connection applies mainly to people with fair complexions in northern latitudes (north of Philadelphia or Boulder). They speculate that sunscreen users in northern areas never feel the burning that would warn them to cover up or get out of the sun because their lotions do a good job of blocking UVB rays. But meanwhile, they’re being exposed to hundreds of times more cancer-causing UVA rays than they’d be able to tolerate if they weren’t using sunscreen. Bottom line: Whatever your latitude, you need to practice sun-safety measures.

“The final sample concluded that those who participated in the trial were probably more health conscious than the general population of a similar age.

“It was pleasing to see the improvements, and it may be possible to see greater improvements in people who are less health conscious.”

Katie Clift from Cancer Council Queensland said the implications of the trial outcomes were very encouraging.

“Delivering health messages to young Queenslanders to inspire a change of lifestyle can be very challenging,” Ms Clift said.

“It’s exciting to think the use of a simple text message, as seen in this trial, may help to reduce skin cancer risk in the future.

“Around 136,000 Queenslanders are diagnosed with skin cancer every year - around 370 every day. Any effective intervention measures we can use to encourage young people to stay as SunSmart as possible, and to check their own skin regularly, are imperative.”

Ms Janda said the trial demonstrated that in the future a database could be set up for people to subscribe to receive ongoing text messages to trigger greater sun protection awareness, promote skin self-examination for early detection and reduce the rates of skin cancer.

“Many participants in our trial would have liked more regular SMS messages and I think future research could incorporate multimedia messages and the opportunity for individuals to have an input into programs to allow them to control the timing and frequency of the messages,” she said.


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Amanda Weaver, QUT Media, 07 3138 9449, .(JavaScript must be enabled to view this email address)

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Amanda Weaver

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Queensland University of Technology

  Preventive Medicine

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