Causation, risk prevention and early detection

The Department of Health (DH) aims to reduce cancer deaths in patients below 75 years by 20% by 2010 (Department of Health, 1999, 2000b, 2007). At least half of all cancers are preventable by promoting awareness and changing lifestyle (DH, 2007), especially skin cancer (Health Development Agency, 2002).

The International Cancer (International Cancer Research Funding Organisations, 2008) highlights US educational prevention research with young people. Although childhood sun exposure is an important preventable factor, since risk develops in childhood (Armstrong and Kricker, 2001) through genetic mutation and learnt risk behaviour, educating this group remains problematic. Adolescents continue to seek exposure to secure a tan (e.g. Melia et al., 2000; Cokkinides et al., 2002). Recent qualitative evidence suggests that in young women sun-related behaviours are complex but their activities in the sun are directed towards meeting their physical and psychological comfort needs and not health protection (Norton, 2008). A review argues that prevention is also valuable later in life, especially for those with high childhood sun exposure (Armstrong and Kricker, 2001). Achieving attitude and UVprotective behaviour in adults, who may be parents, may result in good practice being passed to children (parental risk-behaviour predicts that by young people; Cokkinides et al., 2002). However, adults received limited attention in preventive studies.

Attitudes and behavioural change
Limited knowledge and unsafe sun practices continue in the UK (Miles et al., 2005; Office of National Statistics, 2009). Research is required to promote and evaluate behavioural change to prevent cancer and promote early detection (National Cancer Research Institute, 2005). The SunSmart campaign aims to achieve this by ‘action … to inform and empower patients so that they can play an active role in decisions’, but delivery models other than UV-awareness campaigns are not detailed (Department of Health, 2007; Cancer Research UK, 2009f). A review of evidence of primary care prevention proposes due caution when drawing from US/Australian strategies (Melia et al., 2000). Melanoma prevention guidelines advise sun-avoidance and effective sunscreen/clothing use (Royal College of Physicians, 2007).
Using theory on effective behaviour change is likely to maximise the effectiveness of lifestyle interventions (Berwick et al., 2000; National Institute for Health and Clinical Excellence, 2007). Research applying the Self-efficacy Theory (Bandura, 1996, 1997) highlights it as an important predictor of healthy behaviours (Havas et al., 1998; Rosal et al., 1998; Clark and Dodge, 1999). Ajzen’s Theory of Planned Behaviour (Ajzen, 1991, 2001) is the most widely applied model of beliefs, attitudes and intentions that precede action (Connor and Sparks, 2005).