Skin Cancer Risk Factors Identified in Asian Americans

Suephy C. Chen, MD, MS

A recent cross-sectional study concluded that disaggregated comparisons among Asian Americans demonstrated differences in skin cancer risk factors that could be used to identify high-risk subgroups and inform culturally aware counseling.

Despite being the fastest growing racial group in the United States, Asian Americans have remained underrepresented in health disparities research.

However, previous data observed lower rates of sunscreen use among Asian Americans in general compared with non-Hispanic White individuals.

Suephy C. Chen, MD, MS, Department of Dermatology, Duke University School of Medicine, Durnham, North Carolina, and fellow investigators aimed to examine the prevalence of sunburns, indoor tanning, sun-protective behaviors, and total body skin examinations (TBSEs) among Asian Americans compared with non-Hispanic White individuals in addition to examining potential differences among subgroups of Asian Americans.

The Methods

Chen and colleagues utilized an annual cross-sectional survey of health conditions, behaviors, access, and utilization called the National Health Interview Survey to collect data on respondents 18 years and older who were pooled in 2000, 2005, 2010, and 2015.

Self-reported Asian Indian, Chinese, Filipino, and Other Asian participants were included in the study, while non-Hispanic White participants were included as a reference group. The most populous subgroup, Chinese Americans, was used as the reference for subgroup comparisons.

Outcomes for participants included any sunburn during the last 12 months, sun-protective behaviors performed always or most of the time, any indoor tanning in the last 12 months, and any TBSE during a participant’s lifetime.

Prevalence estimates incorporated survey weights to produce nationally representative estimates, and all met a reliability threshold with coefficients of variation at less than 30%. Outcomes were compared by race using Rao-Scott χ2 tests. Multivariable logistic regression models additionally adjusted for survey year, sociodemographic variables, cancer-related health behaviors, skin phototype, and personal history of skin cancer.

The Findings

From 2000 to 2016, investigators pooled a total of 124,631 respondents, 5694 of whom (weighted prevalence, 4.7%) identified as Asian American and 78 336 (weighted prevalence, 69.6%) who identified as non- Hispanic White.

Of the 5694 Asian American individuals, 1073 (21.0%) identified as Asian Indian, 1165 (19.4%) as Chinese, 1312 (23.5%) as Filipino, and 2144 (36.1%) as Other Asian. Lifetime prevalence of skin cancer was 3.7% among non-Hispanic White individuals compared with 0% among Asian Indian, 0.1% among Chinese, 0.8% among Filipino, and 0.1% among Other Asian individuals.

Sunburn prevalence in the past year was 12.4% among Asian Indian, 20.2% among Chinese, 24.2% among Filipino, and 19.0% among Other Asian individuals, while frequent use of at least 1 sun-protective behavior was 62.9% among Asian Indian, 65.7% among Chinese, 70.7% among Filipino, and 66.1% among Other Asian individuals.

Investigators also noted that 1.8% of Asian Indian, 3.1% of Chinese, 3.5% of Filipino, and 3.4% of Other Asian individuals tanned indoors, and that lifetime prevalence of TBSE was 6.5% for Asian Indian, 8.9% for Chinese, 11.5% for Filipino, and 7.4% for Other Asian individuals.

In multivariable models adjusting for sociodemographic variables, health behaviors, photosensitivity, and skin cancer history, all Asian American subgroups were less likely than non-Hispanic White individuals to sunburn, apply sunscreen, tan indoors, and receive TBS.

“Oversampling of Asian American subgroups in future dermatologic studies may facilitate further disaggregated analyses to evaluate for potential masked health disparities,” the team wrote.