Skin Cancer Epidemiology and Sun Protection Behaviors Among Native Americans

May 2019 | Volume 18 | Issue 5 | Original Article | 420 | Copyright © May 2019

Melody Maarouf MHS, a,* Shannon W. Zullo BS,a,* Timothy DeCapite MD,b Vivian Y. Shi MDc

aUniversity of Arizona, College of Medicine, Tucson, AZ bTuba City Regional Health Care Corporation, Tuba City, AZ cUniversity of Arizona, Department of Medicine, Division of Dermatology, Tucson, AZ *Co-first authors

Introduction: Sun protection behaviors in Native American populations are historically under-reported, though the greatest proportion lives in Western states that have the greatest UV-index burden within the United States. Materials/Methods: We deployed an anonymous questionnaire online, in-clinic, and in the community to Native Americans belonging to federally recognized tribe and have resided on a reservation. The questionnaire explored demographics, sunscreen use and preference, skin cancer screening, and personal and family history. Results: One-hundred fifty-nine respondents fit the inclusion criteria. Greater than 80% reported experiencing at least one sunburn, though only 10.7% and 36.4% reported regular sunscreen use on their body and face, respectively. The participants reported a myriad of reasons for which they do not utilize sunscreen, with 9% believing that Native Americans, or other skin of color persons, do not develop skin cancer. This was additionally observed in the low reports of ever receiving a skin exam (7.5%). Discussion: Sunscreen use among Native Americans (36.4%) appears to be greater than other skin of color users, but less than that of non-Hispanic Whites (40.4%). We postulate that this may be due to the respondents living in states with high UV burden, or an intrinsically greater propensity to burn. Native American populations tend to lack skin cancer screenings by dermatologists and understanding of skin cancer etiology. Efforts are needed to encourage education and dermatologic services to Native American reservations.

J Drugs Dermatol. 2019;18(5):420-423.


The latest 2010 United States Census indicates that 2.9 million people identify as Native American (NA). Forty-one percent live in the Western states (Arizona, California, Colorado, Montana, Nevada, New Mexico, Alaska, Hawaii, Idaho, Oregon, Utah, Washington, Wyoming).1 Despite the prevalence of NA residing in these UV-intense geographic regions, there is very limited data on skin cancer in this population.In the last 20 years, only 11 publications have mentioned NA sun protection behavior and skin cancer prevalence. Herein, we aim to fill the knowledge gap on skin cancer epidemiology and sun protection behaviors in NA.


Between 2017-2018, an anonymous questionnaire was deployed to adult NA participants both in person at a dermatology clinic in Tucson, AZ, a local community powwow, and via email listservs and Facebook groups (Indians into Medicine, NA Student Affairs, and American Indian Science and Engineering Society, and NA Research Network). The questionnaire explored demographics, sunscreen use and preference, skin cancer screening, and personal and family history. Inclusion criteria included participants >18 years of age who self-identified as a NA member of a federally recognized tribe with a history of residing on a reservation. This study was approved and exempted by the University of Arizona Institutional Review Board.


Respondents were 159 federally recognized NA tribal members (87% female, mean age: 31.9, SD, 10.4, range, 18-67). Allrespondents have lived on a reservation (mean, 20.0 years, SD,11.1, range, 1-67).Eighty-seven percent (n=139) had been sunburned at least once, most commonly associated with skin redness (90%, n=125), peeling (82%, n=114), swelling (9%, n=12), blistering (7%, n=10), and scabbing (4%, n=6). Despite the prevalence of sunburns,only 10.7% (n=17) of participants reported regular sunscreen use (multiple times a day or once daily) on their body (Table 1). The most common reason for sunscreen use was to prevent sunburn, followed by prevention of skin cancer, sunspots, or