Cancer nurse Kerry Guile, who has developed a new skin cancer questionnaire and used it to test whether awareness would lead to behaviour modification, discovered that in her study at least, it hasn't.
Even oncologists and cancer nurses, who scored well when it came to their knowledge of the sun and skin cancer and what they should do to protect themselves, were not acting on the lessons they were giving the public.
"My study showed that they were continuing to expose themselves intentionally to undesirable amounts of UV radiation, despite their universally high awareness of risk factors for malignant melanoma," she said. "The implication behind prevention programmes is that higher levels of awareness lead to behaviour modification, and prevention programmes have been based on the opinion that increased knowledge of risk factors for skin cancer will lead to a change in sun-related habits. The relationship between knowledge, perceived risk of disease and preventive behaviour is more complex."
Ms Guile, senior chemotherapy sister at St George's Hospital, London, UK, who presented the results of her new questionnaire in a research poster at the conference, said that similar studies had questioned medical students and the public, but not healthcare professionals.
She designed SAMPLE (the Sun Awareness/Melanoma-Prone Lifestyle Enquiry) as a tool for researchers interested in studying the epidemiology of malignant melanoma – the most dangerous form of skin cancer. SAMPLE comprises more than 30 questions related to exposure, sun protection behaviour and knowledge about moles, melanoma and the sun's biological effects, together with demographic details.
Ms Guile gave the questionnaire to five groups involving nearly 340 people – oncologists, oncology nurses, non-oncology nurses, medical students and lay public – and elicited an average 55% response (ranging from 46% among oncologists to 64% among non-oncology nurses). A behaviour score was derived from the answers to the sections on exposure, protection and knowledge with a statistical analysis undertaken to assess whether there was any correlation between knowledge and behaviour.
"There was a statistically significant difference across the five groups in the headings of protection and knowledge with oncology nurses scoring highest on sun protective behaviour and oncologists on knowledge. But, there were no significant differences in behaviour and no correlation between knowledge and behaviour scores.
"These findings are consistent with studies in some other populations: it means that assumptions by public health bodies that improving awareness of the risks of sun exposure will reduce the incidence of melanoma are probably not correct," said Ms Guile.
She added that an Australian cohort analysis had shown that while the incidence of melanoma among older people in that country was increasing, among young people it had slowed and appeared to be levelling off. Mortality rates among younger people had fallen. "Public awareness campaigns may be responsible for this effect, although early diagnosis and treatment have probably played a greater role in reducing mortality. Perception of risk may be higher in Australia than the UK due to the higher incidence of malignant melanoma."
Abstract no: 1.289 (Monday 22 September. Poster. Research in Oncology Nursing)
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