Lifestyle behaviors and sun exposure among individuals diagnosed with skin cancer: a cross-sectional analysis of 2018 BRFSS data



With the continued increase in skin cancer incidence rates, the population of skin cancer survivors continues to grow. Understanding skin cancer survivors’ lifestyle behaviors, including ultraviolet radiation exposure, is important in reducing skin cancer recurrences and improving health outcomes. The objective of this study is to compare the differences in lifestyle behaviors among skin cancer survivors or individuals who currently have skin cancer versus individuals who have never had a skin cancer diagnosis.


To investigate these lifestyle behaviors, we performed a cross-sectional analysis comparing lifestyle behaviors in persons diagnosed with skin cancer and those without a history of skin cancer among US citizens using publicly available data from the 2018 Behavior Risk Factor Surveillance System (BRFSS).


In total, there were 437,436 respondents. No significant difference existed between the two cohorts in sunburn frequency, use of sun protection, or indoor tanning; in fact, males were more likely to be afflicted with sunburns following diagnosis. Skin cancer survivors were less likely to be current smokers and sedentary. Female survivors were more likely to binge and heavily drink alcohol.


Our findings highlight important areas for reducing risk factors, which could reduce the recurrence of skin malignancies in skin cancer survivors.

Implications for Cancer Survivors

Our study provides insight to lifestyle behaviors among skin cancer survivors. Being aware of these behaviors has the potential to reduce skin cancer recurrence.

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  1. 1.

    Skin cancer. Accessed February 28, 2020.

  2. 2.

    WHO | Skin cancers. Published online October 16, 2017. Accessed February 28, 2020.

  3. 3.

    Akdeniz M, Hahnel E, Ulrich C, Blume-Peytavi U, Kottner J. Prevalence and associated factors of skin cancer in aged nursing home residents: a multicenter prevalence study. PLoS One. 2019;14(4):e0215379.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069–80.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Erdmann F, Lortet-Tieulent J, Schüz J, Zeeb H, Greinert R, Breitbart EW, et al. International trends in the incidence of malignant melanoma 1953-2008--are recent generations at higher or lower risk? Int J Cancer. 2013;132(2):385–400.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Armstrong BK, Kricker A. The epidemiology of UV induced skin cancer. J Photochem Photobiol B. 2001;63(1-3):8–18.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    US Department of Health, Human Services. Skin cancer as a major public health problem. Office of the Surgeon General (US); 2014.

  8. 8.

    Cancer Facts & Figures 2019 | American Cancer Society. Accessed February 29, 2020.

  9. 9.

    Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat Clin Pract Oncol. 2007;4(8):462–9.

    PubMed  Article  PubMed Central  Google Scholar 

  10. 10.

    Radiotis G, Roberts N, Czajkowska Z, Khanna M, Körner A. Nonmelanoma skin cancer: disease-specific quality-of-life concerns and distress. Oncol Nurs Forum. 2014;41(1):57–65.

    PubMed  Article  Google Scholar 

  11. 11.

    Burdon-Jones D, Thomas P, Baker R. Quality of life issues in nonmetastatic skin cancer. Br J Dermatol. 2010;162(1):147–51.

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Guy GP Jr, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. Am J Prev Med. 2015;48(2):183–7.

    PubMed  Article  Google Scholar 

  13. 13.

    Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363–85.

    Article  Google Scholar 

  14. 14.

    Skin Cancer (Non-Melanoma) - Statistics. Cancer.Net. Published June 25, 2012. Accessed February 29, 2020.

  15. 15.

    Skin Cancer | CDC. Published September 18, 2019. Accessed February 29, 2020.

  16. 16.

    Skin Cancer | Skin Cancer Facts | Common skin cancer types. Accessed February 29, 2020.

  17. 17.

    Rhee JS, Davis-Malesevich M, Logan BR, Neuburg M, Burzynski M, Nattinger AB. Behavior modification and risk perception in patients with nonmelanoma skin cancer. WMJ. 2008;107(2):62–8.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Mowls DS, Brame LS, Martinez SA, Beebe LA. Lifestyle behaviors among US cancer survivors. J Cancer Surviv. 2016;10(4):692–8.

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Blanchard CM, Stein KD, Baker F, et al. Association between current lifestyle behaviors and health-related quality of life in breast, colorectal, and prostate cancer survivors. Psychol Health. 2004;19(1):1–13.

    Article  Google Scholar 

  20. 20.

    CDC. 2018 BRFSS Overview. Accessed February 28, 2020.

  21. 21.

    Norton EC, Miller MM, Kleinman LC. Computing adjusted risk ratios and risk differences in Stata. Stata J. 2013;13(3):492–509.

    Article  Google Scholar 

  22. 22.

    Rundek T, Brown DL. Socioeconomic status and subclinical atherosclerosis: are we closing disparity gaps? Stroke. 2014;45(4):948–9.

    PubMed  Article  PubMed Central  Google Scholar 

  23. 23.

    Levine RS, Kilbourne BA, Rust GS, Langston MA, Husaini BA, Gittner LS, et al. Social determinants and the classification of disease: descriptive epidemiology of selected socially mediated disease constellations. PLoS One. 2014;9(11):e110271.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  24. 24.

    Maty SC, Everson-Rose SA, Haan MN, Raghunathan TE, Kaplan GA. Education, income, occupation, and the 34-year incidence (1965-99) of Type 2 diabetes in the Alameda County Study. Int J Epidemiol. 2005;34(6):1274–81.

    PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Squire I. Socioeconomic status and outcomes in heart failure with reduced ejection fraction. Heart. 2018;104(12):966–7.

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Kouzes E. Effects of regional average sunny days and other risk factors on the prevalence of skin cancer: a United States nationwide population-based study. of regional average sunny days and other risk factors on the prevalence of skin cancer.pdf. Accessed 3 March 2019.

  27. 27.

    Ghissassi FE, El Ghissassi F, Baan R, et al. A review of human carcinogens—Part D: radiation. Lancet Oncol. 2009;10(8):751–2.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Moan J, Grigalavicius M, Baturaite Z, Dahlback A, Juzeniene A. The relationship between UV exposure and incidence of skin cancer. Photodermatol Photoimmunol Photomed. 2015;31(1):26–35.

    PubMed  Article  PubMed Central  Google Scholar 

  29. 29.

    Mancebo SE, Wang SQ. Skin cancer: role of ultraviolet radiation in carcinogenesis. Rev Environ Health. 2014;29(3):265–73.

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Veierød MB, Couto E, Lund E, Adami H-O, Weiderpass E. Host characteristics, sun exposure, indoor tanning and risk of squamous cell carcinoma of the skin. Int J Cancer. 2014;135(2):413–22.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol. 2012;67(4):552–62.

    PubMed  Article  Google Scholar 

  32. 32.

    Islami F, Goding Sauer A, Miller KD, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2018;68(1):31–54.

    PubMed  Article  Google Scholar 

  33. 33.

    Pérez LL, Bashline B. Skin cancer: prevention. FP Essent. 2019;481:28–31.

    PubMed  Google Scholar 

  34. 34.

    Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011;29(3):257–63.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Odenbro A, Bellocco R, Boffetta P, Lindelöf B, Adami J. Tobacco smoking, snuff dipping and the risk of cutaneous squamous cell carcinoma: a nationwide cohort study in Sweden. Br J Cancer. 2005;92(7):1326–8.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    De Hertog SAE, Wensveen CAH, Bastiaens MT, et al. Relation between smoking and skin cancer. J Clin Oncol. 2001;19(1):231–8.

    PubMed  Article  Google Scholar 

  37. 37.

    Ortiz A, Grando SA. Smoking and the skin. Int J Dermatol. 2012;51(3):250–62.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Green A, McCredie M, MacKie R, Giles G, Young P, Morton C, et al. A case-control study of melanomas of the soles and palms (Australia and Scotland). Cancer Causes Control. 1999;10(1):21–5.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.

    PubMed  Article  Google Scholar 

  40. 40.

    Sergentanis TN, Antoniadis AG, Gogas HJ, Antonopoulos CN, Adami HO, Ekbom A, et al. Obesity and risk of malignant melanoma: a meta-analysis of cohort and case-control studies. Eur J Cancer. 2013;49(3):642–57.

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    Pothiawala S, Qureshi AA, Li Y, Han J. Obesity and the incidence of skin cancer in US Caucasians. Cancer Causes Control. 2012;23(5):717–26.

    PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    LoConte NK, Gershenwald JE, Thomson CA, Crane TE, Harmon GE, Rechis R. Lifestyle modifications and policy implications for primary and secondary cancer prevention: diet, exercise, sun safety, and alcohol reduction. Am Soc Clin Oncol Educ Book. 2018;38:88–100.

    PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Rota M. Evidence for an association between alcohol intake and an increased risk of nonmelanoma skin cancer. Br J Dermatol. 2017;177(3):611–2.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  44. 44.

    Rota M, Pasquali E, Bellocco R, Bagnardi V, Scotti L, Islami F, et al. Alcohol drinking and cutaneous melanoma risk: a systematic review and dose--risk meta-analysis. Br J Dermatol. 2014;170(5):1021–8.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Kurtze N, Eikemo TA, Kamphuis CBM. Educational inequalities in general and mental health: differential contribution of physical activity, smoking, alcohol consumption and diet. Eur J Pub Health. 2013;23(2):223–9.

    Article  Google Scholar 

  46. 46.

    Mukamal KJ. Alcohol consumption and self-reported sunburn: a cross-sectional, population-based survey. J Am Acad Dermatol. 2006;55(4):584–9.

    PubMed  Article  PubMed Central  Google Scholar 

  47. 47.

    van der Pols JC. Alcoholic drinks and skin cancer—boozing on the beach and beyond. Br J Dermatol. 2014;171(6):1295–6.

    PubMed  Article  PubMed Central  Google Scholar 

  48. 48.

    Karmen Hanson AG. Indoor tanning restrictions for minors | a state-by-state comparison. Accessed March 14, 2020.

  49. 49.

    Tripp MK, Gershenwald JE, Davies MA, Garcia J, Gritz ER, Hawk ET, et al. Assessment of compliance with Texas Legislation banning indoor UV tanning by minors. JAMA Dermatol. 2017;153(2):228–9.

    PubMed  PubMed Central  Article  Google Scholar 

  50. 50.

    Williams MS, Buhalog B, Blumenthal L, Stratman EJ. Tanning salon compliance rates in states with legislation to protect youth access to UV tanning. JAMA Dermatol. 2018;154(1):67–72.

    PubMed  Article  Google Scholar 

  51. 51.

    Henrikson NB, Morrison CC, Blasi PR, Nguyen M, Shibuya KC, Patnode CD. Behavioral counseling for skin cancer prevention: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319(11):1143–57.

    PubMed  Article  Google Scholar 

  52. 52.

    Buller DB, Heckman CJ, Manne SL. The potential of behavioral counseling to prevent skin cancer. JAMA Dermatol. 2018;154(5):519–21.

    PubMed  Article  Google Scholar 

  53. 53.

    Manne SL, Coups EJ, Kashy DA. Relationship factors and couples’ engagement in sun protection. Health Educ Res. 2016;31(4):542–54.

    CAS  PubMed  Article  Google Scholar 

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Correspondence to Ryan Ottwell.

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Ottwell, R., Cook, C., Greiner, B. et al. Lifestyle behaviors and sun exposure among individuals diagnosed with skin cancer: a cross-sectional analysis of 2018 BRFSS data. J Cancer Surviv (2020).

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  • Skin neoplasm
  • Skin cancer
  • Melanoma
  • General dermatology
  • Skin cancer survivors
  • Lifestyle behaviors
  • Lifestyle modifications
  • Public health
  • Sun protection
  • Ultraviolet radiation