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Research Letter |

Cutaneous Melanoma and Other Skin Cancer Screening Among Hispanics in the United States: A Review of the Evidence, Disparities, and Need for Expanding the Intervention and Research Agendas FREE

Valentina A. Andreeva, PhD; Myles G. Cockburn, PhD
[+] Author Affiliations

Author Affiliations: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California (Drs Andreeva and Cockburn); UREN, University of Paris XIII, Bobigny, France (Dr Andreeva).


Arch Dermatol. 2011;147(6):743-745. doi:10.1001/archdermatol.2011.140.
Text Size: A A A
Published online

Skin pigmentation and sun sensitivity vary widely among US Hispanics,1 whose median number of nevi (the strongest melanoma risk factor) is somewhat lower than in whites yet higher than in Asians or blacks.2 The correlation between number of nevi and age is stronger in Hispanics and non-Hispanic whites than in other ethnoracial groups.2 Among Hispanics, acculturation to the United States might lead to decreased sun safety practices.3 Nationwide data from 1992 through 2007 reveal that melanoma incidence among Hispanics increased by more than 22%.4,5 Hispanics display higher rates of thick melanoma at diagnosis, and in the absence of cure, targeted prevention might be the best strategy for countering the epidemic.6 Hence, our objective was to synthesize the evidence about skin cancer screening among US Hispanics.

We identified observational population-based US studies on melanoma or other skin cancer screening that evaluated participants of Hispanic descent, without any age, time, or language restrictions. Hispanic or Latino ethnicity was defined as Mexican, Puerto Rican, Cuban, or Central or South American heritage regardless of race.7 Screening techniques included skin self-examination (SSE), clinical skin examination (CSE), dermoscopy, and biopsy. We conducted an extensive literature search through October 2010 using MEDLINE (from 1950), EMBASE (from 1974), CancerLit (from 1963), and Lilacs (from 1982) and reviewed the bibliographies of all relevant articles. The following keywords and indexing terms were used: melanoma, skin neoplasms, self-examination, early detection of cancer, and mass screening. From the 1029 retrieved articles, we excluded duplicates, reviews, non-US studies, and those with patient or survivor samples, selecting 138 articles for detailed review. Studies with missing ethnoracial data were excluded. Nine studies met all inclusion criteria, and from each we extracted the age range, population type, health care access status, setting, number and/or percentage of Hispanics with reported melanoma or other skin cancer screening, year of assessment and measurement method.

The reviewed articles816 are summarized in the Table. Heterogeneity was observed in sample size and composition, SSE and CSE definitions, and screening reference periods. An estimate of the relative odds ratio for CSE by ethnicity was available in only 1 study, indicating that Hispanics were almost 40% less likely to report a recent CSE than non-Hispanic whites.8 Overall, SSE was reported by 14% to 50% of Hispanics, while CSE was reported by 7% to 17%. Only 1 study showed screening rates by sex, with 18.2% of Hispanic women and 8.3% of Hispanic men reporting SSE within the past 2 months.9 Research with nationally representative samples documented a decreasing trend in CSE prevalence, possibly attributable to measurement modification in the most recent assessment.8 Specifically, 5.6%, 5.7%, and 3.7% of Hispanics reported a recent CSE in 1992, 1998, and 2000, respectively (the corresponding percentages among whites were 11.4%, 12.5%, and 8.9%).8 No studies on dermoscopy or skin biopsies by Hispanic ethnicity were found; also none pertained to melanoma screening among children or adolescents. All 9 studies relied on self-reports, and none documented CSE validation. The paucity of research along with considerable heterogeneity in sample characteristics and screening measures prevented subgroup analyses or meta-analyses.

Table Graphic Jump LocationTabel . Summary of Observational Epidemiologic Studies on Melanoma/Skin Cancer Screening Involving US Hispanics, 1992-2006

The US Hispanic population is rarely the focus of melanoma screening research despite sufficient epidemiologic evidence that this population merits increased attention. Our review suggests that Hispanics' high rate of advanced melanoma could be attributed to insufficient prevention initiatives,6,10,11 lack of SSE instruction or awareness about signs or symptoms,12 delay in seeking follow-up care for suspect lesions,13 and decreased risk awareness among individuals and physicians.12 Our review further suggests that health care access might not be the strongest enabling factor in melanoma screening of Hispanics.

A limitation of this review was the inability to make skin color or skin sensitivity distinctions among Hispanics because such data were not provided in the studies. One of the reviewed studies noted that Hispanics were less likely than non-Hispanic whites to report oral cancer screening,11 whereas another study observed a significant link between CSE and breast, colorectal, or prostate cancer screening.8

Recent research highlights the lack of relevance of skin cancer to Hispanics, whose knowledge about the disease is not derived primarily from physicians but rather from the media,17 which has also been identified as a reason for SSE.13 However, applicability of the ABCDE rule for Hispanics remains to be clarified. Research notes that physicians' experience with non-Hispanic whites and melanoma diagnosis patterns might not be relevant to Hispanics.6 The extremely high costs for thick melanoma management further warrant an increased emphasis on developing early detection strategies.18

The Hispanic population growth rate is over 3 times higher than that of the total US population,19 which has strong implications for health care providers, policy, and research. Potential similarities in important melanoma risk factors such as skin or nevi characteristics between Hispanics and non-Hispanic whites, the high rates of thick melanoma among Hispanics, and the suboptimal prevention efforts with Hispanics strongly reinforce the need for increased public health focus to correct misconceptions about skin cancer, improve the frequency and efficacy of SSE and CSE, and reduce existing disparities.

ARTICLE INFORMATION

Correspondence: Dr Andreeva, PhD, Nutritional Epidemiology Research Unit, (UREN), University of Paris XIII, 74, rue Marcel Cachin, Bobigny 93017, France (v.andreeva@uren.smbh.univ-paris13.fr).

Author Contributions: Dr Andreeva had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Andreeva and Cockburn. Acquisition of data: Andreeva. Analysis and interpretation of data: Andreeva and Cockburn. Drafting of the manuscript: Andreeva. Critical revision of the manuscript for important intellectual content: Cockburn. Study supervision: Cockburn. Data abstraction: Andreeva.

Financial Disclosure: None reported.

Funding/Support: This work was supported in part by Centers for Disease Control and Prevention grant 36 U55/CCU921930-02, National Institute of Environmental Health Sciences grant 5P3037 ES07048, and National Cancer Institute grant R01 CA121052 (Dr Cockburn) and by a doctoral dissertation fellowship from the Department of Preventive Medicine, Keck School of Medicine, University of Southern California (Dr Andreeva).

Role of the Sponsors: The sponsors had no role in the design or conduct of the study; in the collection, analysis, or interpretation of data; or in the preparation, review, or approval of the manuscript.

Galindo  GRMayer  JASlymen  D Sun sensitivity in 5 US ethnoracial groups. Cutis 2007;80 (1) 25- 30
PubMed
Crane  LAMokrohisky  STDellavalle  RP Melanocytic nevus development in Colorado children born in 1998: a longitudinal study. Arch Dermatol 2009;145 (2) 148- 156
PubMed
Andreeva  VAUnger  JBYaroch  ALCockburn  MGBaezconde-Garbanati  LReynolds  KD Acculturation and sun-safe behaviors among US Latinos: findings from the 2005 Health Information National Trends Survey. Am J Public Health 2009;99 (4) 734- 741
PubMed Link to Article
Surveillance Epidemiology and End Results Program, SEER cancer statistics review, 1975-2007.  Bethesda, MD National Cancer Institute2010;
Eide  MJWeinstock  MA Association of UV index, latitude, and melanoma incidence in nonwhite populations—US Surveillance, Epidemiology, and End Results (SEER) Program, 1992 to 2001. Arch Dermatol 2005;141 (4) 477- 481
PubMed
Pollitt  RAClarke  CASwetter  SMPeng  DHZadnick  JCockburn  M The expanding melanoma burden in California Hispanics: Importance of socioeconomic distribution, histologic subtype, and anatomic location. Cancer 2011;117 (1) 152- 161
PubMed Link to Article
Federal Register, Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity.  Washington, DC Office of Management and Budget1997;
Saraiya  MHall  HIThompson  T Skin cancer screening among U.S. adults from 1992, 1998, and 2000 National Health Interview Surveys. Prev Med 2004;39 (2) 308- 314
PubMed Link to Article
Risica  PMWeinstock  MARakowski  WKirtania  UMartin  RASmith  KJ Body satisfaction effect on thorough skin self-examination. Am J Prev Med 2008;35 (1) 68- 72
PubMed Link to Article
Rodriguez  GLMa  FFederman  DG Predictors of skin cancer screening practice and attitudes in primary care. J Am Acad Dermatol 2007;57 (5) 775- 781
PubMed Link to Article
Canto  MTDrury  TFHorowitz  AM Use of skin and oral cancer examinations in the United States, 1998. Prev Med 2003;37 (3) 278- 282
PubMed Link to Article
Pipitone  MRobinson  JKCamara  CChittineni  BFisher  SG Skin cancer awareness in suburban employees: a Hispanic perspective. J Am Acad Dermatol 2002;47 (1) 118- 123
PubMed Link to Article
Friedman  LCBruce  SWeinberg  ADCooper  HPYen  AHHill  M Early detection of skin cancer: racial/ethnic differences in behaviors and attitudes. J Cancer Educ 1994;9 (2) 105- 110
PubMed Link to Article
Robinson  JKRigel  DSAmonette  RA What promotes skin self-examination? J Am Acad Dermatol 1998;38 (5 Pt 1) 752- 757
PubMed Link to Article
Arnold  MRDeJong  W Skin self-examination practices in a convenience sample of U.S. university students. Prev Med 2005;40 (3) 268- 273
PubMed Link to Article
Federman  DGKravetz  JDHaskell  SGMa  FKirsner  RS Full-body skin examinations and the female veteran: prevalence and perspective. Arch Dermatol 2006;142 (3) 312- 316
PubMed
Robinson  JKJoshi  KMOrtiz  SKundu  RV Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology 2011;20 (3) 313- 320
PubMed Link to Article
Alexandrescu  DT Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages. Dermatol Online J 2009;15 (11) 1
PubMed
U.S. Census Bureau, Hispanics in the United States.  Washington, DC U.S. Census Bureau, Ethnicity and Ancestry Statistics Branch, Population Division2006;

Figures

Tables

Table Graphic Jump LocationTabel . Summary of Observational Epidemiologic Studies on Melanoma/Skin Cancer Screening Involving US Hispanics, 1992-2006

References

Galindo  GRMayer  JASlymen  D Sun sensitivity in 5 US ethnoracial groups. Cutis 2007;80 (1) 25- 30
PubMed
Crane  LAMokrohisky  STDellavalle  RP Melanocytic nevus development in Colorado children born in 1998: a longitudinal study. Arch Dermatol 2009;145 (2) 148- 156
PubMed
Andreeva  VAUnger  JBYaroch  ALCockburn  MGBaezconde-Garbanati  LReynolds  KD Acculturation and sun-safe behaviors among US Latinos: findings from the 2005 Health Information National Trends Survey. Am J Public Health 2009;99 (4) 734- 741
PubMed Link to Article
Surveillance Epidemiology and End Results Program, SEER cancer statistics review, 1975-2007.  Bethesda, MD National Cancer Institute2010;
Eide  MJWeinstock  MA Association of UV index, latitude, and melanoma incidence in nonwhite populations—US Surveillance, Epidemiology, and End Results (SEER) Program, 1992 to 2001. Arch Dermatol 2005;141 (4) 477- 481
PubMed
Pollitt  RAClarke  CASwetter  SMPeng  DHZadnick  JCockburn  M The expanding melanoma burden in California Hispanics: Importance of socioeconomic distribution, histologic subtype, and anatomic location. Cancer 2011;117 (1) 152- 161
PubMed Link to Article
Federal Register, Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity.  Washington, DC Office of Management and Budget1997;
Saraiya  MHall  HIThompson  T Skin cancer screening among U.S. adults from 1992, 1998, and 2000 National Health Interview Surveys. Prev Med 2004;39 (2) 308- 314
PubMed Link to Article
Risica  PMWeinstock  MARakowski  WKirtania  UMartin  RASmith  KJ Body satisfaction effect on thorough skin self-examination. Am J Prev Med 2008;35 (1) 68- 72
PubMed Link to Article
Rodriguez  GLMa  FFederman  DG Predictors of skin cancer screening practice and attitudes in primary care. J Am Acad Dermatol 2007;57 (5) 775- 781
PubMed Link to Article
Canto  MTDrury  TFHorowitz  AM Use of skin and oral cancer examinations in the United States, 1998. Prev Med 2003;37 (3) 278- 282
PubMed Link to Article
Pipitone  MRobinson  JKCamara  CChittineni  BFisher  SG Skin cancer awareness in suburban employees: a Hispanic perspective. J Am Acad Dermatol 2002;47 (1) 118- 123
PubMed Link to Article
Friedman  LCBruce  SWeinberg  ADCooper  HPYen  AHHill  M Early detection of skin cancer: racial/ethnic differences in behaviors and attitudes. J Cancer Educ 1994;9 (2) 105- 110
PubMed Link to Article
Robinson  JKRigel  DSAmonette  RA What promotes skin self-examination? J Am Acad Dermatol 1998;38 (5 Pt 1) 752- 757
PubMed Link to Article
Arnold  MRDeJong  W Skin self-examination practices in a convenience sample of U.S. university students. Prev Med 2005;40 (3) 268- 273
PubMed Link to Article
Federman  DGKravetz  JDHaskell  SGMa  FKirsner  RS Full-body skin examinations and the female veteran: prevalence and perspective. Arch Dermatol 2006;142 (3) 312- 316
PubMed
Robinson  JKJoshi  KMOrtiz  SKundu  RV Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology 2011;20 (3) 313- 320
PubMed Link to Article
Alexandrescu  DT Melanoma costs: a dynamic model comparing estimated overall costs of various clinical stages. Dermatol Online J 2009;15 (11) 1
PubMed
U.S. Census Bureau, Hispanics in the United States.  Washington, DC U.S. Census Bureau, Ethnicity and Ancestry Statistics Branch, Population Division2006;

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