Socioeconomic factors associated with skin cancer screening

When it comes to getting screened for skin cancer, only one in 14 U.S. Hispanic adults is shown to have ever gone through the process, compared to one in four non-Hispanic white adults. Research from The Cancer Institute of New Jersey (CINJ) shows socioeconomic factors such as lack of health insurance and poorer access to healthcare serve as barriers for Hispanics who might otherwise receive this potentially lifesaving check-up. The findings show there is a need to develop interventions to promote skin examinations among Hispanics at risk for skin cancer. CINJ is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.

Recent research has shown that, compared to non-Hispanic whites, Hispanics are more likely to be diagnosed at an earlier age and with thicker, more advanced melanoma, the deadliest of all skin cancers. Prior research has also shown that full body, head-to-toe skin examinations by a doctor may reduce the incidence of thick melanomas that have a poor prognosis. There has been little research reviewing the rate of these examinations among Hispanics in the U.S. CINJ investigators explored the prevalence of skin cancer screenings in this population. Their research appears in the current print edition of Archives of Dermatology (doi:10.1001/archdermatol.2012.615).

This current study, Skin Cancer Screening among Hispanic Adults in the United States, used data from the 2010 U.S. National Health Interview Survey conducted by the National Center for Health Statistics. The study sample consisted of 4,766 adults who self-reported Hispanic ethnicity and had no personal history of skin cancer. Participants indicated their Hispanic national origin, sex, age, level of education, whether they were born in the U.S., the language they generally use when speaking and their skin sensitivity to the sun. They also reported the location where they receive their routine preventive medical care, whether they had healthcare coverage, and whether they ever had a full head-to-toe skin exam by a dermatologist or other doctor.

Of the total participants, only seven percent reported ever having had a full skin examination by a physician. Six percent of participants born outside of the U.S. noted they had undergone a full skin exam, compared to nine percent among those born in the U.S. Low exam rates were also noted for those who reported speaking little or no English. Of those who spoke mostly or only Spanish, four percent said they had received a skin exam.

The rate of skin cancer screening also varied significantly among Hispanics of different national origin. Lower rates of skin exams were found among those from Mexico (six percent) and the Dominican Republic (six percent), but higher rates were seen for those of Cuban (13 percent) or Puerto Rican (ten percent) descent.

Men, individuals aged 18 to 29, and those with some high school education or less had lower screening rates (six percent, four percent and four percent, respectively). Individuals lacking health insurance also had lower screening rates (three percent), as did those with no source of preventive care (two percent) or those who received such care somewhere other than a doctor's office (five percent). Individuals reporting less sun sensitive skin had lower screening rates (six percent) than those with the most sun sensitive skin (ten percent).

Elliot J. Coups, PhD, behavioral scientist at CINJ and associate professor of medicine at UMDNJ-Robert Wood Johnson Medical School, is the lead author of the study. "Although the skin cancer screening rates were higher for several Hispanic subpopulations, the overall rate of screening we found among adult U.S. Hispanics was very low," noted Dr. Coups. "It is of concern that Hispanic individuals with a language barrier, lower level of education and lack of access to healthcare had especially low screening rates. While additional research is needed, it is clear from this study that this population may greatly benefit from interventions that promote these screenings, particularly for individuals at risk for skin cancer."