Skin Cancer Determinants

Problem Definition: The incidence of skin cancer in the white adolescent population (age 16-21) has increased over the past decade in the United States.


Over the years, skin cancer has been a cancer that is frequently ignored because non-fatal basal cell and sqaumous cell carcinomas make up 90% of cases and melanoma only about 10% of cases.  Statistics from the past decade indicate a steep rise especially in the adolescent population.  In fact, melanoma has become the second most common cancer for 15 to 29 year-olds in the United States (2).  American adolescents have the lowest skin protection rates of all age groups and skin cancer currently accounts for 11.5% of all cancers in this age group (4, 2).


Identifying key determinants will help to answer why the adolescent population is at such high risk and hopefully point toward interventions to reverse the problem.  Biological determinants refer to the anatomic, physical, or medical/clinical reasons a problem might exist.  Some of the biological determinants of skin cancer include genetic factors, gender, and medical problems like compromised immune system.  Genetic factors make some people more susceptible to skin cancer than others.  For example, melanin--produced by melanocytes-- is a genetic factor that determines an individual's capacity to protect against UV exposure (5).  People with eumelanin can absorb UV radiation and transform energy into heat, thus preventing DNA damage.  This is why there is a lower incidence in darker-skinned populations.  Other people have pheomelanin.  These are the fair-skinned, freckled people whose melanin cannot absorb UV radiation like those with eumelanin resulting in less natural sun protection.  This can help explain why people with personal or family history of melanoma often develop skin cancer (2).  Gender differences are not as paramount, however, research has found that young men are less likely to sunbathe, but also less likely to use sun protection; young females are also more likely to indoor tan (1).


Some social and cultural determinants include normative beliefs regarding sunbathing and the use of sunscreen and also self-efficacy (4).  Most people do not follow sun protection recommendations because American society associates tanned appearance with beauty and people have reported feeling more confident with a tan (1).  In addition to having a tan, there is little social support for using sun protection.  This is often referred to as the 'bikini effect' (2).  There are not been much evidence found for ethnic differences, but whites are most susceptible to skin cancer because of fair skin (1).  


The most obvious environmental determinant is UV light exposure; the intensity of UV radiation tend to increase approaching the equator (1, 2, 4).  Economically,  people of higher socio-economic status are usually more aware of long term risks of sun exposure than lower socio-economic groups (1).  However, wealthier people also have easier access to indoor tanning.  There are not many political determinants to this problem except the lack of national investment in promoting the prevention of skin cancer (6).


In addition, there are also behavioral determinants of skin cancer.  For example, children who grow up in families that do not use sunscreen are less likely to use sunscreen themselves (4).  Also, indoor tanning behavior before age 35 increases risk of melanoma by 75 percent.    


References:
1.http://http://heapro.oxfordjournals.org/content/early/2012/04/11/heapro.das015.long
2. http://www.tandfonline.com/doi/full/10.1080/07448481.2011.596872
3. http://www.sciencedirect.com/science/article/pii/S1054139X11002825
4. http://www.ncbi.nlm.nih.gov/pubmed/22251761
5.http://www.ncbi.nlm.nih.gov/pubmed/22123420
6. http://www.ncbi.nlm.nih.gov/pubmed/22018060