Kim M, Boone SL, West DP, Rademaker AW, Liu D, Kundu RV. Perception of Skin Cancer Risk by Those With Ethnic Skin. Arch Dermatol. 2009;145(2):207–208. doi:10.1001/archdermatol.2008.566
Skin cancer is the most prevalent malignant neoplasm in the United States, outnumbering all other cancers combined. Mortality rates among whites decreased by 20% to 30% between 1969 and 1988, but the mortality rates for ethnic populations remained unchanged during the same period.1 The present study assessed skin cancer awareness, risk perception, and sun-protective behavior in ethnic populations.
One hundred subjects of African American, Asian, or Hispanic descent, 19 men and 81 women (aged 20-71 years), who attended the Northwestern Center for Ethnic Skin, Chicago, Illinois, between July 1, 2006, and August 1, 2006, were surveyed. Participants were administered an in-clinic survey concerning weekly sun exposure, sun-protective behavior (use of sunscreen, hats, and long-sleeved clothing), child sun exposure and sun protection, and risk for skin cancer. Additional questions included history of skin cancer, skin reaction to the sun, and the number of physician-conducted full-body skin examinations they had prior to the study. The survey used for this study was adapted from one used by Jungers et al,2 which focused on skin cancer knowledge and behavior in a primarily nonethnic, nonpatient population.
The results of our analysis are summarized in Table 1 and Table 2. Sixty-five percent of ethnic participants believed that they were not at risk for skin cancer (65 of 100), while 35% believed that they had some risk (35 of 100). Sixty-eight participants indicated that they participated in sun-exposing outdoor activity (41 with no perceived risk, 27 with some perceived risk). Seven percent of subjects who perceived risk for skin cancer (2 of 27) spent less than 2 hours in sun-exposing recreation per week (P = .01 compared with those who perceived no risk). Seventy-four percent of subjects who perceived risk for skin cancer (20 of 27) spent 2 to 5 hours in sun-exposing recreation per week (P = .01 compared with those who perceived no risk). These data are summarized in Table 2. No statistically significant association was found between the use of sunscreen or reaction to the sun and perception of risk for skin cancer in the ethnic population. No statistically significant association was found between ethnicity and perception of risk for skin cancer.
Twenty-two participants had children younger than 12 years who participated in sun-exposing recreation. Fifty-five percent used sunscreen sometimes or most of the time (n = 12) and 32% reported never using any form of sun protection (n = 7).
While 43% of the subjects in this pilot study of principally African American people reported the ability to sunburn (n = 43), 35% perceived some risk of developing skin cancer (n = 35). Thus, skin cancer risk perception is less than the risk that can be inferred from the biological reaction of experiencing sunburn. The relatively lower incidence of skin cancer in persons with skin phototypes III through VI and the belief that having increased pigmentation reduces the risk of skin cancer may contribute to this low risk perception.3 Although a trend was noted toward sun-protective behavior among persons with ethnic skin who believed themselves to be at risk, knowledge that sun exposure may increase the risk for skin cancer does not seem to affect sun-protective behavior. Despite 96% of children of ethnic skin subjects having reported sun exposure (n = 22), a third of children with ethnic skin never used sunscreen (n = 7). These findings support the notion that the ethnic-skin adult population perception and behavior patterns appear to be perpetuated in children as well, but larger population studies are necessary.
Correspondence: Dr Kundu, 550 First Ave, New York, NY 10016 (email@example.com).
Author Contributions:Study concept and design: Kim, Boone, and Kundu. Acquisition of data: Kim and Kundu. Analysis and interpretation of data: Kim, Boone, West, Rademaker, Liu, and Kundu. Drafting of the manuscript: Kim, Rademaker, and Kundu. Critical revision of the manuscript for important intellectual content: Kim, Boone, West, Rademaker, Liu, and Kundu. Statistical analysis: Rademaker and Liu. Administrative, technical, and material support: Boone and Kundu. Study supervision: Boone and Kundu.
Financial Disclosure: None reported.