Skin cancer risk: The hidden factors beyond sunburn

Skin cancer stands as the most frequently diagnosed cancer in the United States, bringing about millions of non-melanoma cases and tens of thousands of melanomas yearly. 

In addition, treating skin cancer costs the nation roughly $8.9 billion annually. Individuals with fair skin, a history of sun exposure or tanning bed use, and a genetic predisposition bear higher risks. 

Yet, barriers like insufficient public awareness, cultural ideals favoring tanned skin, and limited access to sun protection tools underscore the ongoing challenges in prevention.

A new study led by researchers at Florida Atlantic University (FAU) sheds light on how sunburn patterns and protective habits vary with different sociodemographic backgrounds. 

According to the American Academy of Dermatology, experiencing over five blistering sunburns between ages 15 and 20 increases melanoma risk by 80 percent and nonmelanoma skin cancer risk by 68 percent.

Perceived risk of skin cancer 

The research drew from the U.S. National Cancer Institute’s 2022 Health Information National Trends Survey 6 (HINTS 6), focusing on participants’ confidence in their own health, perceived risk of cancer, and anxiety about potential diagnoses. 

Additionally, respondents noted whether they had experienced sunburn within the last year. The study examined how age, gender, occupation, marital status, education, Hispanic origin, race, and income shaped these responses, recognizing each of these factors could influence skin cancer risk.

Among 6,252 participants surveyed, 44% felt “very confident” they could care for their health, while 27.3% said they were “completely confident.” 

Although few reported being “extremely worried” about skin cancer (9.1%), a quarter felt moderately concerned. On sunburns, the study found 67.6% reported none in the past year and 30.3% said they had between one and five. 

In addition, 6.4% acknowledged drinking alcohol while already sunburned – something the authors associated with heightened exposure and additional sunburns. Activities such as drinking, working outdoors, or swimming commonly coincided with sunburn incidents.

Surprising trends in sunburn prevalence

Using multinomial regression, the team found multiple factors tied strongly to sunburn likelihood. Adults over 40 emerged with lower sunburn risks, and women also tended to have fewer. 

People who were disabled, unemployed, or employed in multiple jobs saw fewer sunburns, while those who were married or partnered experienced more. In contrast, being divorced or single corresponded with fewer sunburns. 

Also, higher education and being Hispanic, Black, Asian, or of mixed race correlated with fewer incidents. Income was found to be a striking predictor: higher income individuals had significantly higher risks of sunburns, with the highest income group being over four times more likely to report sunburns.

“Social determinants such as race/ethnicity, sex, income and employment status are closely linked to sunburn and skin cancer risk,” said Lea Sacca, senior author and an assistant professor in the Department of Population Health and Social Medicine at FAU. 

“While Hispanics and Black Americans generally report lower rates of sunburn, Hispanics often perceive greater benefits of UV exposure, which increases their risk. Factors such as sex, education, and income also influence sunscreen use, with lower use observed among Black Americans and Hispanic Americans.” 

“However, within these groups, women with higher education and income are more likely to use sunscreen. Interestingly, higher income is associated with more frequent sunburns.”

The basics of skin cancer

There are three primary types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. 

Basal cell carcinoma is the most prevalent but typically the least severe, emerging as pearly bumps on sun-exposed areas. 

Squamous cell carcinoma often takes the form of red, scaly patches or open sores and can spread if untreated. 

Melanoma, the most dangerous type, can appear as new or changing moles and spreads quickly if not caught early.

Why sociodemographics matter

“Understanding perceptions of skin cancer risk and the prevalence of protective behaviors is vital to reducing the likelihood of developing skin cancer, particularly among vulnerable groups,” said first author Madison Etzel, a second-year medical student at FAU. 

“Our study underscores the importance of raising awareness about skin cancer susceptibility as we found that all sociodemographic factors were significantly linked to the number of reported sunburns in the past year.”

“Future research should explore how additional social determinants of health influence sunburn incidence and prevention behaviors. A deeper understanding of these factors is critical to addressing the widespread harms of skin cancer in U.S. adults.”

Preventing skin cancer

According to health authorities like the American Cancer Society, several effective strategies can prevent skin cancer. 

Key recommendations include regularly applying a broad-spectrum sunscreen (SPF 30 or higher) when outdoors, avoiding peak UV radiation times (10 a.m. to 4 p.m.), wearing protective clothing (such as long sleeves, hats, and sunglasses), and steering clear of tanning beds. 

Self-exams and professional check-ups can help detect any unusual skin changes early on, improving treatment outcomes.

Growing awareness and targeted interventions 

The study’s findings show that comprehending public attitudes and behaviors – especially among high-risk populations – is essential to driving down skin cancer prevalence. 

By considering how age, race, income, and education intersect with sun exposure, health officials and policymakers can better hone campaigns to encourage healthy habits. 

Ultimately, growing awareness and targeted interventions may lead to fewer sunburns, lower healthcare costs, and improved public health across the U.S.

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