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A killer under the sun

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Esther Cepeda
April 3, 2011
— Did you know that Latinos, blacks and other dark-skinned people are as susceptible to skin cancer as those who are light skinned—and even likelier to die from it? If you did, then you’re smarter than I am, because I learned the hard way.

And though it’s only been three years since a specialist surgically removed several suspicious-looking moles from my skin, I had to be reminded the hard way, too.


About a month ago, I noticed some odd changes on my long-forgotten scars and experienced the kind of dread that comes from knowing what I’d say when the doctor asked if I’d slathered myself with sunblock every single time I’d been out in the sun. Looking back, I knew I hadn’t.


My health insurance plan dictated I had to go to my family doctor first and, despite my medical history, he halfheartedly investigated my concern and quickly declared me “fine.” At least he promised a referral if there were more changes.


This anecdote pretty much describes why skin cancer is so prevalent. Generally, we know we should protect our skin from the sun, but it’s difficult to remember 100 percent of the time.


For Hispanics and other minorities, it’s common to grow up believing the myth that their dark skin—inherited from ancestors reared in native lands where summer-like sunshine is a year-round companion—is itself a natural defense against sun-related skin diseases.


General practitioners are simply not trained to discern the endless variations of perfectly normal freckles, moles, beauty marks, scars and otherwise harmless growths from the ones that are potentially life-threatening.


And lastly, low-income, minority and female patients are the least likely patients to question a doctor’s diagnosis, volunteer additional information to nudge a medical professional to heed a concern, or ask for follow-up.


According to Dr. Roopal Kundu, director of the Ethnic Skin Center at Northwestern University’s Feinberg School of Medicine, a 2009 study of melanoma incidence and severity at diagnosis among whites, Hispanics and blacks found that Caucasians were 156 times more likely than blacks and 35 times more likely than Hispanics to be diagnosed with melanoma—but both Hispanics and blacks had significantly more advanced melanoma than white patients.


“Caucasians are … also more likely to have the least dangerous type (of melanoma) and be more aware of it,” Kundu told me. “Though all people are at risk of developing skin cancer, ethnic minorities are two or three times as likely to die from melanoma as Caucasians of the same age and sex. They’re the least likely to even perceive the risk of skin cancer—frequently, minorities don’t even know that melanoma is cancer. … It’s a great challenge to raise awareness both among minorities and the doctors who care for them.”


Kundu added that studies showed mortality rates among whites with skin cancer decreasing by 20 percent to 30 percent between 1969 and 1988, yet the mortality rates for ethnic populations remained unchanged during the same period.


But the most important thing to know is that regardless of your race, ethnicity, gender or age, skin cancer is not to be ignored or dismissed as a potential threat. It is the most common of all cancers—about half of all cases—and spreading.


Despite all the warnings about skin cancer, an alarming number of teenagers use indoor tanning. The American Journal of Public Health’s April issue features a study that reports 17 percent of teen girls and 3 percent of teen boys had used indoor tanning. Previous studies have found tanning-bed use increases risk of melanoma by 75 percent.


And though studies have consistently found that skin cancer is about twice as common in men than in women, a new report from researchers at the Cancer Prevention Institute of California found that rates of melanoma among young white women have more than doubled in the past three decades and that wealthier, more educated women appear to be at greatest risk.


The good news is that skin cancer is the most preventable of all cancers. Kundu says to coat yourself with sunblock, check your skin regularly to become familiar with your particular skin patterns and vigilantly look for changes. And take it from me: Don’t be shy about making your doctor pay attention to your skin concerns.


Esther Cepeda is a columnist for the Washington Post Writers Group. Her email address is estherjcepeda@washpost.com.

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