Trends in Primary Skin Cancer Prevention Among US Hispanics: A Systematic Review

May 2012 | Volume 11 | Issue 5 | Original Article | 580 | Copyright © May 2012

Jonathan Weiss MD, Robert S. Kirsner MD PhD, and Shasa Hu MD

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL

Abstract
Objective: To evaluate trends and identify deficiencies and disparities in primary skin cancer prevention efforts among Hispanics in the US.
Methods: PubMed/MEDLINE and SCOPUS were searched using the following keywords: awareness, knowledge, behavior, sunscreen, hat, clothing, minorities, ethnic skin, Hispanic, Latino, and skin. Reference lists of selected studies were checked for additional studies. Studies that quantitatively evaluated primary skin cancer prevention efforts among US Hispanics were selected. Primary outcome measures included 1) use of sunscreen or sunblock, 2) use of sun-protective clothing and/or hats, and 3) shade seeking behavior. Selected studies were reviewed and quantitative data for each primary outcome measure were extracted. Additionally, we examined survey methodology and demographics of the studied populations.
Results: Studies evaluating primary prevention of skin cancer among US Hispanics are limited in number and study populations. Overall, 9.5-29.9% of the Hispanics evaluated reported wearing sunscreen either most of the time or always compared to 16.5-35.9% of NHW. Hispanics reported slightly higher rates of wearing hats compared to NHW, with 23.9-25.0% of Hispanics reporting wearing hats either most of the time or always compared to 20-20.7% of NHW. Trends in wearing sun protective clothing and shade seeking varied between different Hispanic populations evaluated, but overall prevalence of these practices remained low.
Conclusion: The limited studies suggest that improvements are needed in primary skin cancer prevention practiced by Hispanics. Future studies and interventions need to account for heterogeneity in socio-cultural backgrounds, degree of acculturation, and occupation among US Hispanics.

J Drugs Dermatol. 2012;11(5):580-586.

INTRODUCTION

Hispanics represent the largest and fastest growing minority group in the United States. Over the past decade the Hispanic population has increased by 43% and now accounts for 16.3% of the total US population. 1 The US Census Bureau estimates that Hispanics will constitute 30% of the US population by 2050. 2 Recent studies have called attention to an emerging melanoma epidemic among US Hispanics: the incidence of melanoma among Hispanics is increasing by 2.9% annually, 3 and Hispanics with melanoma present with more advanced disease 4-10 and experience poorer 5-year survival rates. 9 Nonmelanoma skin cancers (NMSC), the most common malignancies in the US, also carry significant healthcare and financial burderns, 11 and impart substantial morbidity among Hispanics. 11,12 Hispanic populations exhibit considerable diversity in skin phenotype and sun sensitivity. 13 Nevertheless, ultraviolet (UV) radiation has been linked to DNA damage and skin carcinogenesis across skin types. 12,14-16 Additionally, Hispanic populations are highly concentrated in regions with high UV index, with over 55% of the Hispanics in the US residing in California, Texas, and Florida. 1 For these reasons, it is becoming increasingly important to identify factors contributing to skin cancer risks as well as disparities in melanoma diagnosis and survival in the US Hispanic population.
Advanced melanoma stage at diagnosis and worse survival can be attributed to suboptimal primary and secondary prevention efforts among Hispanics. Recent studies have focused on disparities in secondary prevention. 17 It is equally important to identify the trends and barriers to primary prevention of melanoma and NMSC among Hispanics, particularly the use of sunscreen, widebrimmed hats, sun-protective clothing, and shade seeking or sun avoidance. These sun-smart behavior patterns can reduce UV induced skin damage and carcinogenesis. 18 Though many studies have evaluated the trends in sun-smart behaviors in the US, few have explicitly scrutinized such behaviors among Hispanic populations. Our objective is to review the available literature to identify the current trends and potential deficiencies and disparities in sun-protective behaviors among Hispanics in the US.

METHODS

We conducted an extensive literature search of the MEDLINE/ PubMED and SCOPUS databases through December 2011 using the following keywords: awareness, knowledge, behavior, sunscreen, hat, clothing, minorities, ethnic skin, Hispanic, Latino, and skin. From 497 retrieved articles, we selected studies that quantitatively evaluated sun-protective behaviors among US Hispanic populations.