Skin Cancer in Hispanics in the United States

Maritza I. Perez MD

Mount Sinai Icahn School of Medicine, New York, NY

Abstract

The Hispanic population has been the principal driver of U.S. demographic growth in the last two decades. In 2016, Hispanics accounted for 18% of the nationâ€™s population and were the second-largest racial or ethnic group behind whites making the people of Hispanic origin the nation's largest ethnic or racial minority. Non-melanoma skin cancer (NMSC) is the most common malignancy in the U.S. with over 3.5 million diagnosed in over 2 million people, incidence rising at about 2.6% per year. In Hispanics, Loh et al showed a retrospective 5-year one-institution study that revealed an incidence of 3% for NMSC, in a population that is younger and mainly females as compared to Caucasian and Asians. In the past two decades, melanomas incidence among Hispanics has risen by 20%. Hispanics are younger at diagnosis, present with thicker tumors (>1mm, 35% to 25%), regional involvement (12 to 8%), and distant metastasis (7 to 4%), having the worst survival rate as compared to whites. In general, even though increasing, the incidence of NMSC and MM is lower in Hispanics than Caucasians, however, the mortality is higher. The later stage at diagnosis and worse prognosis in Hispanics have been attributed to several factors: 1.) Less awareness of risks or symptoms leading to a lack of linguistically or culturally targeted screening efforts.20 2.) Decline in sun-safe behaviors because of increasing acculturation.21, 22 3.) Less access to health insurance-- more than 15% Hispanics in last census lack medical coverage causing delays in seeking treatment.23 Many of these factors may be associated with lower socioeconomic status (SES). 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. 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. J Drugs Dermatol. 2019;18(3 Suppl):s117-120.

INTRODUCTION

The Hispanic population in the United States has reached nearly 58 million in 2016 and has been the principal driver of U.S. demographic growth, accounting for half of national population growth since 2000. In 2016, Hispanics accounted for 18% of the nation’s population and were the second-largest racial or ethnic group behind whites making the people of Hispanic origin the nation's largest ethnic or racial minority.¹The projected Hispanic population of the United States is 119 million by 2060. According to this projection, the Hispanic population will constitute 28.6 percent of the nation’s population by that date.²Hispanics are the youngest major racial or ethnic group in the United States. About one-third, or 17.9 million, of the nation’s Hispanic population is younger than 18, and about a quarter, or 14.6 million, of all Hispanics are Millennials (ages 18 to 33 in 2014), according to a Pew Research Center analysis of U.S. Census Bureau data. The Hispanic population within the United States is younger than the Caucasian population. Fifty-seven percent of Hispanic married-couple households had children younger than 18 present in 2014, whereas for the nation it was 40.1 percent.³ This population is made of 64% born within the U.S. and 36% immigrants.1 Hispanics of Mexican origin account for 63.3% (36 million) of the nation’s Hispanic population in 2015, by far the largest share of any origin group, but down from a recent peak of 65.7% in 2008. Another 9.5% were of Puerto Rican background, 3.7% Cuban, 3.7% Salvadoran, 3.3% Dominican, and 2.4% Guatemalan.⁴ The five states that have the largest concentration of Hispanics are California, Texas, Florida, New York, and Illinois. Nearly half of all Hispanics live in California and Texas. Fifteen million live in California, 10.4 million in Texas, 4.2 million in Florida, 3.4 million in NY, and 2 million in Illinois.⁵