Impediments to Skin Cancer Prevention Among Minorities, Uninsured

Lack of knowledge and a belief that dark skin protects against skin cancer are among the barriers preventing minority, uninsured, and immigrant populations from adopting methods for skin cancer prevention, according to results of a survey of uninsured individuals at a large, free medical clinic in South Florida. The study was published in JAMA Dermatology.

The rate of skin cancer diagnosis is rising in minority populations; among Hispanics it has increased by 22% since 1992, according to one estimate. Moreover, there is evidence that minorities are more likely to present with advanced stage and thicker melanomas that are not curable.

John Strasswimmer, MD, PhD, of the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Florida, and colleagues conducted the survey to identify gaps in education on sun protection and find ways to spread awareness among these populations.

Strasswimmer and colleagues devised a 23-question survey available in English, Spanish, or Haitian Creole and gave it to 206 individuals who were all uninsured and living at least 200% below the federal poverty level. The individuals were recruited in the waiting room of a medical clinic; only those not scheduled to see a dermatologist were included.

The mean age of study participants was 43, and 75% of the responders were women who typically worked indoors. Participants were largely immigrants from Central America (37.9%), Mexico (27.7%), South America (14.1%), and the Caribbean (12.1%). A total of 8.8% had no formal education; 36.8% had primary level education.

Almost one quarter of the participants (24.5%) had never heard of skin cancer or melanoma, and 44.3% had never conducted a skin self-examination. One in five individuals believed that people with dark skin cannot get skin cancer, and 39.6% thought that they were “very unlikely” or “unlikely” to get skin cancer.

Three-quarters of the participants (75.7%) generally had low or inconsistent sun protection, with 37.7% citing that they generally forgot to protect themselves from the sun. The most frequently cited sun protection behavior, in 35.9% of participants, was wearing a hat. Sun protection, such as long-sleeved shirts, was cited by nearly 40% of individuals as being “too hot.”

Most participants (87.9%) stated that they wanted to learn about ways to prevent skin cancer. Video (37.3%) and text messaging (30.8%) were both identified by participants as the preferred ways to receive information on skin cancer prevention.

“We identified culturally appropriate topics for populations with low health literacy, including defining skin cancer and melanoma, dispelling the misbelief that dark-skinned individuals are not at risk, and emphasizing skin self-checks,” wrote the study authors.

In another study, published in the same issue of JAMA Dermatology, researchers from the University of New Mexico conducted a survey of 429 American Indian and non-Hispanic white participants and found that American Indian individuals were much less likely to regularly practice safe sun behaviors. Non-Hispanics whites who took part in the survey were more likely to use sunscreen, wear sunglasses, and undergo skin checks by a physician (P < .001).

“Our study underscores the importance of further assessment of the motivators and barriers to screening among Southwestern American Indian persons, a population at risk for thicker melanomas, poorer prognoses, and subsequently higher mortality rates,” wrote Marianne Berwick, PhD, MPH, of the department of dermatology at the University of New Mexico Health Sciences Center in Albuquerque, New Mexico, and coauthors.