Skin Cancer Message May Mislead

The young woman in the American Cancer Society ad holds up a photo of a smiling woman. "My sister accidentally killed herself. She died of skin cancer," reads the headline.

The public-service announcement, financed by the sunscreen maker Neutrogena, is running in 15 women's magazines this summer. It warns readers that "left unchecked, skin cancer can be fatal," and urges them to "use sunscreen, cover up and watch for skin changes."

The woman in the picture is a model. And the ad's implicit message -- that those who die of skin cancer have themselves to blame -- has provoked a sharp response from some public-health doctors, who say the evidence simply does not support it. As the ad says, skin cancer is the most common form of cancer. But most skin cancer is not life-threatening: It represents less than 2 percent of all cancer deaths, an estimated 10,850 people this year. Almost all of those deaths are from melanoma, which makes up only 6 percent of all skin-cancer cases.

And the link between melanoma and sun exposure is not straightforward. Dr. Marianne Berwick, an epidemiologist at the University of New Mexico who studies skin cancer, led a study published in The Journal of the National Cancer Institute in 2005 finding that people who had a lot of sun exposure up to the time they got a diagnosis of melanoma actually had better survival rates than those who had little sun exposure. The researchers are conducting a large-scale follow-up aimed at clarifying the relationship between sun exposure and melanoma.

Until that is made clear, many doctors say, it is premature to suggest that people are endangering their lives by failing to use sunscreen.

"It's just not that simple," said Dr. Barry Kramer, associate director for disease prevention at the National Institutes of Health.

"We do have some pretty good evidence that sunscreen will reduce your risk of the less lethal forms of skin cancer," Kramer added. "There's very little evidence that sunscreens protect you against melanoma, yet you often hear that as the dominant message."

Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, acknowledges that the advertisement is aggressive. "We have taken some license in taking that message and using it the way we've used it because that's the way to get the message to our target audience," he said.

The ad's creators settled on the approach with the help of focus groups, who told them: "To get the message through to me, you have to shock me and get my attention," he added.

"Our focus groups showed us that these young women as a group were oblivious to the risk and felt that skin cancer isn't a serious problem," Lichtenfeld said. "The issue is to try to prevent that sun exposure earlier in life so we reduce the risk for people later in life."

In an effort to spread awareness about sun safety, the cancer society has joined with Neutrogena, a division of Johnson & Johnson whose sunscreens carry the society's logo.

As part of the agreement, Neutrogena is paying for the public-service campaign, though its name is not mentioned in the advertisement.

The partnership benefited both parties, said Iris Grossman, director of communications for Johnson & Johnson. "We have the common goal of raising awareness," she said.

But this financial relationship raises red flags for some experts. "When people see an American Cancer Society public-service announcement, they expect it to reflect the best evidence," said Dr. Lisa Schwartz, co-director of the Outcomes Group at the Veterans Affairs hospital in White River Junction, Vt. "We don't want people who have a financial interest to be telling you the benefit of doing something."

Neutrogena did not influence the cancer society's message on skin cancer, Lichtenfeld said.

By Christie Aschwanden, New York Times News Service, July 17, 2007
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