A Randomized Trial of Precision Prevention Materials to Improve Primary and Secondary Melanoma Prevention Activities among Individuals with Limited Melanoma Risk Phenotypes.

John Charles A Lacson,Scarlet H Doyle,Richard G Roetzheim,Rodrigo Carvajal,Stella Valavanis,Stephanie M Forgas,Jocelyn Del Rio,Youngchul Kim,Lu Qian,Steven K Sutton,Peter A Kanetsky,Guillermo Gonzalez-Calderon,Susan T Vadaparampil

doi:10.3390/cancers13133143

John Charles A Lacson, Scarlet H Doyle + Show 11 more

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https://doi.org/10.3390/cancers13133143

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Journal: Cancers	Publication Date: Jun 23, 2021
Citations: 11	License type: CC BY 4.0

Affiliation: Moffitt Cancer Center, University of South Florida

Abstract

Simple SummaryInherited genetic variation at the MC1R gene is associated with increased risk of melanoma among non-Hispanic whites (NHWs), especially among those with skin and pigmentation characteristics that are associated with average to lower melanoma risk, for whom MC1R genetic testing may reveal unrecognized melanoma risk. We conducted a randomized trial to examine whether providing MC1R genetic risk information together with precision prevention materials would increase primary and secondary melanoma preventive behaviors compared to providing generic prevention materials only. We found that among participants with MC1R variants associated with higher risk of melanoma, the intervention increased shade-seeking or using an umbrella, increased wearing sleeved shirts, and decreased sunburns among their young children. We conclude that MC1R genetic testing and precision prevention materials may increase the practice of some sun-protective behaviors.Inherited variation at MC1R is associated with elevated melanoma risk among non-Hispanic whites (NHWs). MC1R genetic testing may unmask previously unrecognized disease risk, especially among individuals with few melanoma phenotypic risk factors. We recruited NHW individuals with limited phenotypic risk factors from two primary care clinics in west-central Florida. Participants (n = 1134) were randomized within MC1R genotype risk group (average/higher) to receive mailed precision prevention (i.e., intervention) or generic prevention materials. Participants reported hours of weekday and weekend sun exposure, frequency of intentional outdoor tanning and sun protection behaviors, number of sunburns, indoor tanning episodes, and skin examinations at baseline, and after 6 and 12 months. Among MC1R higher-risk participants, the intervention increased the likelihood of often or always wearing a shirt with sleeves (OR = 1.49, p = 0.03) and seeking shade or using an umbrella (OR = 1.42, p = 0.046), and it decreased the number of sunburns among their young children (β = −0.13, p = 0.03). Intervention effects were not noted among MC1R average-risk participants. Moderation analyses identified intervention effects within subgroups in average-risk and higher-risk participants. Precision prevention information conveying MC1R testing results can increase the practice of some sun protection behaviors among at-risk individuals with limited melanoma risk phenotypes and may provide a cross-generational tool to counteract increasing incidence of melanoma.

Highlights

Incidence of cutaneous malignant melanoma has increased over the past 50 years in populations with predominantly European ancestry [1,2]
There were 32 individuals whose baseline surveys were received at least one week after mailing their intervention materials. These participants were included in our primary intent-to-treat analyses reported but were removed in secondary per protocol analyses
Among melanocortin-1 receptor (MC1R) average-risk participants, we found no differences in any outcomes reported for children between post-intervention and baseline, regardless of intervention arm (Table 4), nor did we find any intervention effects on any outcomes

Summary

Introduction

Incidence of cutaneous malignant melanoma has increased over the past 50 years in populations with predominantly European ancestry [1,2]. Secondary prevention activities to detect melanoma at an early stage when surgically curable include skin examinations performed by oneself, partner, or health provider [6,7,8]. These prevention activities are not well-practiced across the population [9,10]. The risk conferred by MC1R variants is notably stronger among individuals with phenotypes associated with average to lower melanoma risk, including those with darker natural hair color, those who tan well, do not severely burn, and/or develop fewer freckles after sun exposure [12,13]. For individuals with phenotypes associated with lower to average melanoma risk, MC1R genetic testing can reveal information about melanoma risk not otherwise deduced from clinical observation alone, has the potential to unmask at-risk subgroups in this population who may be unaware of the constitutional risk imparted by their genetic inheritance, and can impact overall melanoma rates [13]

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