Study Finds Socioeconomic Factors May Impact Skin Cancer Knowledge

Socioeconomic factors such as a lower level of education and lack of health insurance may impact individuals' knowledge of the type of skin cancer with which they are diagnosed, according to an investigator at The Cancer Institute of New Jersey (CINJ), whose research on the subject appears in the current print edition of the Archives of Dermatology (Vol. 146, No. 10). As a result, these individuals may have a poor sense of the measures they need to take to reduce the risk of future skin cancers.

Nearly 800,000 Americans are living with a history of melanoma and 13 million are living with a history of non-melanoma skin cancer, typically diagnosed as basal cell carcinoma or squamous cell carcinoma (Altekruse et al., SEER Cancer Statistics Review, 1975-2007; Stern, Archives of Dermatology, 2010). Although less common, melanoma is more lethal than non-melanoma skin cancer. Previous research has identified discrepancies between the estimated number of melanoma cases as self-described by patients versus data documented in the Surveillance, Epidemiology, and End Results (SEER) cancer registry. This may be due to patients' lack of knowledge of their skin cancer diagnosis type.

This latest study, published as a research letter, examined the extent to which individuals who reported a skin cancer history were unable to identify whether they were diagnosed with melanoma or non-melanoma skin cancer.

The study, titled "Lack of Knowledge of Type of Skin Cancer Diagnosis," looked at 45,174 adults who took part in the 2007 and 2008 U.S. National Health Interview Surveys conducted by the National Center for Health Statistics. Participants indicated whether they had ever been told by a doctor or other health professional that they had cancer or a malignancy of any kind. Out of that number, 1,172 individuals who reported a diagnosis of melanoma, non-melanoma skin cancer, or a skin cancer for which they did not know the type were identified and included in the current study.

Nearly one in five (19 percent) of the 1,172 participants indicated they did not know their type of skin cancer, while 21 percent firmly reported having had melanoma and 64 percent non-melanoma skin cancer (the percentages sum to greater than 100 due to some participants reporting multiple types of skin cancer diagnosis). Lack of knowledge of the type of skin cancer diagnosis was more common among individuals with a lower level of education (29 percent among those with some or less than a high school education) or family income (26 percent among those earning less than $35,000 annually), those reporting their health as poor or fair (26 percent), and individuals without health insurance (33 percent). Participant gender, age, and length of time since cancer diagnosis were not associated with lack of knowledge of skin cancer type. The study participants were 50 percent female and 97 percent non-Hispanic Caucasian.

Elliot J. Coups, Ph.D., behavioral scientist at CINJ and associate professor of medicine at UMDNJ-Robert Wood Johnson Medical School, is the sole author of the study. "This study shows that a surprisingly large number of skin cancer patients are unaware of whether they were diagnosed with melanoma or nonmelanoma cancer," Coups noted. "It is of concern that individuals with a lower level of education or income are more likely to lack knowledge of their skin cancer diagnosis type, as they have a worse prognosis when diagnosed with melanoma. These findings suggest that these individuals may gain particular benefit from additional education from healthcare providers about their skin cancer diagnosis and treatment. Such information also could have a positive impact on the prevention and earlier detection of subsequent cases of skin cancer."

The study was supported by funding from a National Cancer Institute grant 1K07CA133100.

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