Lower income may be associated with greater odds of nonmelanoma skin cancer (NMSC) diagnosis, suggests study data published in the Journal of the American Academy of Dermatology. In a large cohort study of participants in the American Academy of Dermatology’s (AAD) SPOT skin cancer® screening program, patients in lower income quartiles had elevated odds of suspected skin cancer diagnoses. These findings challenge results from European studies, which have found higher incidence rates of NMSC among patients of higher socioeconomic status (SES).
Investigators extracted screening data from the SPOT skin cancer screening program, a nationwide public health program which provides free screenings to residents in the United States. Data from the years 2015 through 2019 were included. The primary outcome was a screening result of suspected NMSC, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Patient income was reported on screening forms or estimated using US Census Bureau income data for the patient’s zip code of residence. Multivariable logistic regression was used to assess the relationship between income and suspected skin cancer diagnosis. Models were adjusted for age, sex, race/ethnicity, and skin cancer history.
Complete screening data were collected from 324,813 patient forms. Median age was 56 years; 62.4% were women; and 86.5% were White. Patient income was divided into the following quartiles: $10,714–$54,785; $54,786–$69,885; $69,886–$91,624; and $91,624-$250,000. Suspected BCCs, SCCs, and melanomas were described in 6.9%, 2.6%, and 1.3% patients, respectively. In regression models, income per $10,000 was inversely associated with suspected BCC (adjusted odds ratio [OR], 0.99; 95% confidence interval [CI], 0.99-0.99) and 0.SCC (aOR, 0.98; 95% CI, 0.98-0.99) (both P <.001). No association between income and melanoma was identified.
These data suggest to the investigators that patients of lower income may be at increased risk for skin cancer. Although myriad reasons are likely behind this association, investigators hypothesized that patients in lower-income zip codes may be more likely to work outdoors, thus increasing their sun exposure. Further, lower-income patients often have limited access to healthcare and may instead seek care through the free SPOT screening program rather than through a traditional dermatology clinic.
As a study limitation, investigators noted the use of suspected skin cancer diagnoses, rather than biopsy-confirmed diagnoses. Despite this, the study authors wrote, “findings suggest that greater efforts by organizers of the SPOT program to promote screening events and encourage volunteer dermatologists to screen in lower income communities may improve yield for suspected NMSC without diminishing melanoma yield.”
Beaulieu D, Gao DX, Swetter SM, Hawryluk EB, Geller AC. Association between income and suspected non-melanoma and melanoma skin cancers among participants of the American Academy of Dermatology’s SPOT Skin Cancer® screening program – a cross-sectional analysis. J Am Acad Dermatol. Published online June 2, 2021. doi: 10.1016/j.jaad.2021.05.048