Skin Cancer in Hispanics in the United States

March 2019 | Volume 18 | Issue 3 | Supplement Individual Articles | 117 | Copyright © March 2019


Maritza I. Perez MD

Mount Sinai Icahn School of Medicine, New York, NY

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

RESULTS

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.

CONCLUSIONS

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

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