SUN PROTECTION:

1
SUN PROTECTION AN EDUCATIONAL PROGRAM IN
SCHOOL-AGE CHILDREN
Maria Cecilia Cercato, MDDepartment of
Epidemiology Pier Giorgio Natali, MDMolecular
Pathology
Regina Elena National Cancer Institute ROME -
ITALY
Splitz, March 2008
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Cutaneous Melanoma

• Incidence rates are increasing in most countries
  (3-7 yearly in fair-skinned populations)
• Genetic alterations and enviromental stresses are
  key players in its development
• Highly aggressive with propensity to early
  metastatization and resistant to current
  therapies
• Educational programs designed to improve the
  early detection have led to an increasing
  proportion of thin melanoma at diagnosis
  resulting in improved outcomes

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MELANOMA RISK FACTORS
CONSTITUTIVE-HEREDITARY
ENVIROMENTAL

• Acute sun light exposure particularly in childhood

• Skin colour
• Number of naevi in fair-skinned individual
• Tendency to freckles
• Propensity to tan
• Family history (p14 INK, Braf )

A UV at 3.5 days and 6 wks
B UV at 6 wks
C UV at 3.5 days (erythemogenic)
D no UV
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STRATEGY
PREVENTION
PRIMARY reduction of exposure to risk factors
POPULATION
CHILDREN aged between 2 and 14 years
TOOL
PUBLIC HEALTH PROGRAM personal
reccomandation campaign based on selected risk
profiles assessed by questionnaire
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QUESTIONNAIRE ON SUN SENSITIVITY FACTORS AND
PROTECTION PRACTICES 1. What colour are your
eyes? ? CHESTNUT ? BLACK
? BLUE or GREEN 2. What colour is your
hair? ? RED ? FAIR/LIGHT
BROWN ? DARK BROWN/BLACK 3. What colour is
your complexion? ? FAIR ? MEDIUM
? SWARTHY 4. Count the number of moles
or nevi you have on your left arm ? NONE
? 0-5 ? MORE THAN 5 5. Do you have you
freckles? ? YES ? NO 6. Do you easily
get sunburnt? ? YES ? NO 7.
Have you already had sunburns? ? YES ? NO
8. When you stay too long in the sun, do
watery blisters appear on your face and body?
? YES ? NO 9. Are you suntanned at the
end of your holiday?
? YES ? NO 10. Do you put on a
protective body and face cream before you go out
in the sun? ? YES ? NO 11.When
you are out in the sun you wear a T-shirt ?
YES ? NO a hat or a cap ? YES
? NO sunglasses ? YES ? NO
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STUDY NETWORK
ITALY
SPAIN
Ajuntament de Granollers Servei de Salut
Pùblica Fundacion Istituto Valenciano de Oncologia
Seven Regions
NIÑOS
7.120
BAMBINI 161.504
BELGIUM
TUNISIA
Centre Hospitalier Universitaire du Sart Tilmar
Service de Dermatophatologie de Liège
ENFANTS 5.430
RUSSIA
BULGARY
HUNGARY
Dept. Public Health Univ. Pécs
Humgary
CHILDREN 2.365
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CLASSIFICATION OF "FOTOR" ITEM
FOTOR
Skin
Eyes
Hair
fair
blue/green
red-fair/light brown
fair
blue/green
other
fair
other
red-fair/light brown
FOTOR -
Skin
Eyes
Hair
all the other combinations
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DISTRIBUTION OF FOTOR AMONG CHILDREN IN SELECTED
EUROPEAN AREAS
9
USE OF SUNSCREENS AMONG CHILDREN IN SELECTED
EUROPEAN AREAS
ITALY
8
92
YES 21523
NO 1942
10
BLISTERS FREQUENCY AMONG CHILDREN IN SELECTED
EUROPEAN AREAS
ITALY
8
92
YES 1783
NO 21546
BULGARY
13
87
YES 281
NO 1930
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CONCLUSIONS
According to the distribution of three main
phenotyic features (skin, eyes, hair), the
questionaire could classify the study population
in two risk levels FOTOR (fair complexion
subjects) and FOTOR- (all the other subjects).
Risk factors (high number of moles, freackles,
etc.) segregated in FOTOR group.
Through this simple and low-cost educational
program individuals of the study population could
be given sun protection ad hoc advices
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M.C. Cercato, E. Nagore, V. Ramazzotti, C.
Guillén, I. Terrenato,J. Villena, M. Lomuscio,
P.G. Natali, and H.J. Schünemann

Preventive Medicine, in press
SELF AND PARENT-ASSESSED SKIN CANCER RISKFACTORS
IN SCHOOL-AGE CHILDREN
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PILOT STUDYSUN PROTECTION AND SCHOOL-AGE
CHILDRENIMPROVING PARENTS KNOWLEDGE AND
BEHAVIOUR

• Principal Investigator
• Maria Cecilia Cercato, MD Department of
  Epidemiology
• Italian National Cancer Institute Regina Elena,
  Rome, ITALY.
• (cercato_at_ifo.it )
• Co-Investigator
• Eduardo Nagore, MD Department of Dermatology
• Fundación Istituto Valenciano de Oncología,
  Valencia, SPAIN.

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PILOT STUDYSUN PROTECTION AND SCHOOL-AGE
CHILDREN IMPROVING PARENTS KNOWLEDGE AND
BEHAVIOUR

• OBJECTIVE
• a) To improve knowledge, attitude and sun
  protection behaviours in parents of primary
  school children
• b) To evaluate the effectiveness of the health
  educational program
• c) To identify determinants which influence
  parental behaviour in sun protection practices
• METHOD
• Study duration
  May- October 2008.
• Population
  100 parents of children attending primary
  schools in Valencia, Spain.
• Pre-intervention questionnaire will assess
  pre-intervention parents knowledge of the risks
  
  related to sun exposure, their attitude and
  behaviour
  towards sun protection practices.
  
• Educational programme
  dermatologists will inform the parents using ad
  hoc training aids (slides,
• 
  videos, booklets, etc). Written
  recommendations to be adopted during
  children
  sun exposure will be also provided.

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Development of the project and future directions

• From the pilot study, an educational sun
  protection programme suitable for selected
  populations could be defined to be adopted in
  Spanish primary schools.
• In cooperation with dermatologists the
  educational programme will be tested in different
  populations to optimize its effectiveness by
  taking into account environmental, phenotypical,
  socio-educational and cultural factors.
• Future efforts could be made in exploring
  childrens perceptions, attitude and knowledge
  about the risks related to sun overexposure in
  order to develop successfull sun protection
  messages.