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Why Does Hawaii Have the Lowest Skin Cancer Rate In the U.S.?

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Photo: blvdone / Shutterstock

Whenever a health organization reveals the states with the highest incidences of skin cancer, it's no big surprise when a tropical, year-round sunny destination lands in or near the top spot. (Hi, Florida.) What is surprising, though, is seeing such a state at the very bottom of the list. But it happened: In the latest Health of America report from the Blue Cross Blue Shield Association (BCBSA), Hawaii has secured the coveted spot of fewest skin cancer diagnoses.

According to the report, which reviewed how many Blue Cross and Blue Shield members have been diagnosed with skin cancer, a mere 1.8 percent of Hawaiians had been diagnosed. These include basal cell carcinoma and squamous cell carcinoma, two of the most common forms of skin cancer, and melanoma, the most deadly form, according to the American Academy of Dermatology (AAD).

For comparison, Florida had the highest number of diagnoses with 7.1 percent.

What gives? Shannon Watkins, M.D., a New York City–based dermatologist who grew up in Hawaii, says lifestyle plays a big factor. "I like to think that, living in a sunny environment all year long, Hawaiians know the importance of sun protection and sunscreen and are better able to prevent sunburns," she says. "Growing up in Hawaii, sunscreen and sun protective clothing was a part of everyday life for me, my family, and friends." (PS: Hawaii is banning chemical sunscreens that harm its coral reefs.)

But surely Florida residents are aware of their sun exposure, too. So why are the two states ranking on each end of the spectrum? Ethnicity is a possibility, says Dr. Watkins. "There are many Asians and Pacific Islanders in Hawaii, and melanin, which gives pigment to the skin, can act as a built-in sunscreen," she explains.

Just because someone has more melanin doesn't mean they're safe from skin cancer, though. In fact, the AAD reports that in patients with a darker skin color, skin cancer is often diagnosed in its later stages, making it more difficult to treat. Research has also shown that these patients are less likely than Caucasians to survive melanoma. And a 2014 report from the Centers for Disease Control and Prevention says the Aloha State had more reported cases of new melanoma than the national average.

Sadly, one reason skin cancer rates are so low simply could be that Hawaiians aren't getting screened as much, because they think they're at less risk. "I would believe that the rate of office visits to the dermatologist for annual, preventative skin checks is low compared to the mainland areas of the country [that have] a higher predominance for lighter skin types," says Jeanine Downie, M.D., a New Jersey–based dermatologist and contributing medical expert to Zwivel. "This could skew the numbers."

Regardless of where you live and how many cases of skin cancer there actually are, it's clear that two things matter: sunscreen and regular skin cancer screenings. Remember, skin cancer is the most common cancer in the United States, with nearly 9,500 people being diagnosed every day, according to the AAD. But if it's caught early, basal cell and squamous cell carcinomas are highly curable, and the five-year survival rate for early-detection melanoma (before it spreads to the lymph nodes) is 99 percent.

If you don't have health insurance—or a regular dermatologist to perform a scan—you can also look for companies that offer free services. The Skin Cancer Foundation, for example, has partnered with Walgreens for their Destination: Healthy Skin campaign, hosting mobile pop-ups across the U.S. that offer free screenings from a dermatologist. And don't forget about routine self-checks—here's a step-by-step tutorial of how to do one properly, courtesy of the Skin Cancer Foundation.

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