survey of 4,013 Hispanic adults explores not only their access to health care, but also their sources of health information and their knowledge about a key disease (diabetes) at greater depth and breadth than any national survey done to date by other research organizations or the federal government. It finds that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated, and those with no health insurance. A similar demographic pattern applies to the non-Hispanic adult population. The new survey also finds that foreign-born and less-assimilated Latinos— those who mainly speak Spanish, who lack U.S. citizenship, or who have been in the U.S. for a short time—are less likely than other Latinos to report that they have a usual place to go for medical treatment or advice.23 To clarify the impact of race and ethnicity on late-stage melanoma diagnosis, a spatial analysis of geocoded melanoma cases diagnosed in Florida, 1999–2008 was done to identify geographic clusters of higher-than-expected incidence of late-stage melanoma and developed predictive models for melanoma cases in high-risk neighborhoods accounting for area-based poverty, race/ethnicity, patient insurance status, age, and gender. In the adjusted model, Hispanic ethnicity and census tract-level poverty are the strongest predictors for clustering of late-stage melanoma. Hispanic whites were 43% more likely to live in neighborhoods with excessive late-stage melanoma (P less than 0.001) compared with non-Hispanic whites (NHW). For every 1% increase in population living in poverty, there is a 2% increase in late-stage melanoma clustering (P less than 0.001). Census tract-level poverty predicted late-stage melanoma similarly among NHW and Hispanic whites. The impact of insurance coverage varied among populations; the most consistent trend was that Medicaid coverage is associated with higher odds for late-stage melanoma. The finding that Hispanics are most likely to reside in high-risk neighborhoods, independent of poverty and insurance status, underscores the importance of addressing, and overcoming community-level barriers to melanoma care.24 The largest analysis of melanoma incidence in U.S. Hispanics to date, observed that the distribution and overall burden of cutaneous melanoma, and particularly the associations between SES and melanoma incidence and thickness, differed substantially between Hispanic Californians and NHW Californians.It was observed a much stronger burden of disease among lower SES Hispanics than among NHWs, particularly for men. The association between low SES and higher risk of thicker tumors at diagnosis was also much stronger among Hispanic men.25 Melanomas in low-SES Hispanics were more than twice as likely to be >2mm thick than those in high-SES Hispanics.Melanoma histologic subtype differed strongly by SES among Hispanic men, with less SSM and more NM (the subtype accounting for thicker melanomas) in lower SES Hispanic men. It was observed that roughly 66% the melanoma burden among Hispanic men occurred among those in the middle SES and low SES groups. By contrast, >60% of melanomas among NHWs occurred among those in the high SES group.25, 26
These results suggest that lower-SES Hispanics may have poorer access to social, cultural, educational or job-related benefits which increases the physician delay in melanoma diagnosis compared with their lower-SES NHW counterparts. Differences between lower- and higher-SES Hispanics are likely to be complex and may involve language barriers, knowledge about and access to health institutions, and/or other difficult-to-measure components of social capital. Sun-related behaviors and cultural norms may also differentially impact melanoma risk and detection among lower-SES Hispanics.
For cancer control efforts to succeed, we must better understand the major causes of advanced presentation of melanoma in Hispanics (Hispanics and Latinos) who represent the most rapidly expanding demographic segment in the U.S. Increased awareness of skin cancer and ways to prevent it on the part of providers and patients has the potential to decrease incidence, increase early diagnosis, and improve outcomes among Hispanics.15 Current recommendations for behavioral counseling by health care providers on skin cancer prevention only include fair-skinned youth ages 10–24.27 Although this recommendation is based on skin tone and not race, some providers may not consider Hispanics fair-skinned despite their actual skin tone15 and miss an appropriate opportunity to educate young patients. Hispanics may be more likely to believe that there is little they can do to prevent skin cancer, to believe their risk is below average compared with others of similar age, and to report they are unsure about which prevention recommendations to follow.28-30 Primary care physicians and dermatologists can dispel the myth that melanoma only affects NHWs, and educate Hispanic patients in a culturally appropriate manner on melanoma risk factors, how to recognize sunburn, how to identify abnormal lesions, and the need to check non sun-exposed areas for ALMs that are comparatively more common among Hispanics than among NHWs.31-32
- www.pewresearch.org/fact-tank/2017/.../how-the-u-s-hispanic-population-is-changing...Sep 18, 2017
- https://www.census.gov/newsroom/facts-for-features/2017/hispanic-heritage.html 2
- www.pewhispanic.org/.../us-hispanic-country-of-origin-counts-for-nation-top-30-metropolitan areas.
- Siegal RL,Fewea SA, Miller KD,et al. CA Cancer J Clin. 2015;65(6):457-80. doi:10.3322/caac.21314
- Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population. JAMA Dermatol. Published online April 30, 2015.
- Loh TY, Ortiz A, Goldenberg A, Brian Jiang SI. Prevalence and clinical characteristics of Non-melanoma skin cancer among Hispanics and Asian patients in the United States: a 5 year, single-institution retrospective study. Dermatol Surg. 2016 May; 42(5):639-45. doi: 10.1097/DSS.0000000000000694.
- Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev. 2014. 23(6);1080-1089.
- Daya-Grosjean L, Dumaz N, Sarasin A. The specificity of p53 mutation in sunlight induced human cancers. J Photochem Photobiol B. 1995 May;28(2):115-24.10
- Battie C, Gohara M, Verschoore M, Roberts W. Skin Cancer in skin of color: an update on current facts, trends and misconceptions. J Drugs in Dermatol. 2013;12:194-8
- Ting W, Schultz K, Cac NN, Peterson M, Walling HW. Tanning bed exposure increases the risk of malignant melanoma. Int J Dermatol. 2007 Dec; 46(12):1253-7.
- Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909
- Golster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol. 2006;55:741-60.
- Agbai ON, Buster K, Sanchez M, Hernandez C, et al. Skin Cancer and photo protection in skin of color: A review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70:748-62.
- Wu XC, Eide MJ, King J, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the USA 1999-2006. J Am Acad Dermatol. 65(5 supplement 1):S26-37.
- Garnett E, Townsend J, Steele B, et al. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control. 2016;27:647-659.
- Hu S, Parmet, Y, Allen G, et al. Disparity in melanoma: a trend analysis of melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida. JAMA Dermatol. 2010;145:1369-1374.
- Rouhani P, Pinheiro PS; Sherman R, Arheart K, Fleming L, MacKinnon J, Kirsner RS. Increasing rates of melanoma among nonwhites in Florida compared with the United States. Arch Dermatol. 2010;146(7):741-746
- Kim M, BA; Boone SL, MD; West DN, PhD; Rademaker AW, PhD; Liu D, MS; Kundu RV, MD. Perception of Skin Cancer Risk by Those with Ethnic Skin. Arch Dermatol. 2009;145(2):207-208. doi:10.1001/archdermatol.2008.566
- Coups EJ, Stapleton JL, Hudson SV et al. Linguistic acculturation and skin cancer-related behaviors among Hispanics in the Southern and Western US. JAMA Dermatol. 2013;149:679-86.
- Ma F MD PhD, Collado-Mesa F MD, Hu S MD, Kisner RS. Skin cancer awareness and sun protection behaviors in white Hispanic and white non-Hispanic high school students in Miami Florida. Arch Dermatol. 2007;143(8):983-8.
- Hu S, Sherman R, Arherat K, Kirsner RS. Predictors of neighborhood risk for late-stage melanoma: addressing disparities through spatial analysis and area-based measures. J Invest Dermatol. 2014;134:937-45.
- Pollitt RA, PhD, Clarke CA, PhD, MPH, Swetter SM, MD, Peng DH, MD, MPH, Zadnick J, MS, and Cockburn M. The expanding melanoma burden in California Hispanics: importance of socioeconomic distribution, histologic subtype and anatomic location. Cancer. 2011; 117:152-61.
- Harvey VM, Oldfield CW, Chen JT, Eschbach K. Melanoma disparities among US Hispanics: use of the social ecological model to contextualize reasons for inequitable outcomes and frame a research agenda. J Skin Cancer. 2016;2016:4635740
- U.S. Preventive Services Task Force. Behavioral Counseling to Prevent Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement website. [Accessed May 16 2013]; 2012 http://www.uspreventiveservicestaskforce.org/uspstf11/skincancouns/skincancounsrs.htm.
- Santiago-Rivas M, Wang C, Jandorf L. Sun protection beliefs among Hispanics in the US. J Skin Cancer. 2014;2014:161960.
- Buster KJ, You Z, Fouad M, Elmets C. Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol. 2012;66(5):771–779.
- Coups EJ, Stapleton JL, Manne SL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Tatum KS, Robinson JK, Natale-Pereira A, Goydos JS. Psychosocial correlates of sun protection behaviors among U.S. Hispanic adults. J Behav Med. 2014;37(6):1082–1090.
- Kundu RV, Kamaria M, Ortiz S, West DP, Rademaker AW, Robinson JK. Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin. J Am Acad Dermatol. 2010;62(5):777–784.
- Hu S, Kirsner RS. Practice gaps—suboptimal skin cancer screening and delayed melanoma diagnosis in Hispanics: comment on “cutaneous melanoma and other skin cancer screening among Hispanics in the United States”. Arch Dermatol. 2011;147(6):745–746.