Discussion: Environmental and Genetic Factors That Influence Health

“Genetic epidemiology is the approach to determine whether and how variation in the genetic material interacts with environmental factors to increase (or decrease) risk of disease” (Friis & Sellers, p. 524). For this discussion I have chosen to research skin cancer including keratinocyte carcinoma, melanoma, cutaneous T-cell lymphoma, Merkel cell carcinoma, sebaceous carcinoma (Sweeney, 2020), and Xeroderma Pigmentosum (Xeroderma Pigmentosum: Rare disease causes an extreme sensitivity to sunlight, n.d.).

      Environmental Agent and Genetic Factor

Everyone around the world is exposed to the damaging UV rays of the sun. Until recently, sunscreens and the encouragement to wear protective clothing when exposed to direct sunlight for hours at a time were not developed, nor was public education regarding the dangers of severe sunburns given or the dangers of using tanning beds had not yet been studied. Research of genetic predisposition to skin cancers had not yet been completed. Several generations of people world-wide suffered and some died from skin cancers that migrated to internal organ systems.

Significance of Protection from Sunburn and Skin Cancers

Blistering sunburns before the age of 18 predispose people to basal and squamous cell skin cancers (Sun exposure and skin cancer, n.d.). Typically, these lesions must be surgically removed and frequent examinations by a dermatologist is highly recommended. Melanoma is the fifth most common cancer among men and women in the US (Melanoma: Statistics, 2021). It is 20 times more common in Caucasians. People who have had more than one occurrence of melanoma are 9 times more likely to experience recurrence and 90% have a survival rate of at least 5 years post initial diagnosis (Melanoma, n.d.). Increased morbidity and mortality from skin cancer in people of color is due to lack of education, diagnosis late in development of disease, and socioeconomic barriers to accessing adequate healthcare on a regular basis (Gupta, 2016). However, a genetic connection has been discovered through an autosomal dominant pattern causing altered genes to increase the risk of developing melanoma (Melanoma, n.d.). Informal observational studies have been conducted by family physicians and dermatologists who treat more than one member in a family. Jaykumar C. Patel, MD, plastic surgeon affiliated with Lower Bucks Hospital and Jefferson Health Northeast is one of these non-published skin cancer specialists. In one family that he treated, correlations between a grand-aunt who suffered from Xeroderma pigmentosum (Ngan, 2002), multiple basal, squamous, and melanoma lesions in niece, multiple basal and squamous lesions in daughter of niece, and several squamous lesions in son of daughter. While Dr. Patel did not conduct formal genetic studies, the similarities of the lesions encouraged him to determine causal genetic predisposition to environmental exposure to UV rays resulting in cancers in several family members.

The annual cost of treating skin cancer in the US is estimated to be $4.8 billion for nonmelanomas and $3.3 billion for melanoma treatment (Skin Cancer Facts and Statistics, n.d.). While it is the most common cancer in the world, the average death rate in the US in 2 people per hour, twice as many from squamous cell carcinoma than melanoma.

Health Disparities in Global Populations

Environmental locations, cultural practices, employment locations, and recreation activities contribute to UV ray exposure. As ozone

levels deplete, the atmosphere loses its protective filter and more solar UV radiation reaches the Earth’s surface (Radiation: Ultraviolent (UV) radiation and skin cancer, 2017). People with pale skin, blue eyes and red or blonde hair appear to be more susceptible to exposure to damaging UV rays even when that exposure is not experienced on a daily basis. Geography plays a major role in skin cancer development as studies have found that malignant melanoma morbidity increases as latitude decreases (Radiation: Ultraviolent (UV) radiation and skin cancer, 2017). While basal cell and squamous cancers were identified and received early treatment in Caucasian patients, people of color were not as apt to seek medical attention for skin lesions since their melanin pigmentation often disguises early detection signs (Skin Pigmentation Disorders, n.d.). Rigorous public health information must be developed for all populations and early detection/treatment plans must be put in place for accessibility.

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 References

Friis, R.H., & Sellers, T. A. (2021). Epidemiology for public health practice (6^th ed.). Jones &

Bartlett.

Gupta, A. K., Bharadwaj, M., & Mehrotra, R. (2016). Skin Cancer Concerns in People of Color:

Risk Factors and Prevention. (2016). PubMed.gov, 17(12), 5257-5264. https://pubmed.ncbi.nlm.nih.gov/28125871/

Melanoma: Statistics. (2021). Cancer.Net. Retrieved from https://www.cancer.net/cancer-

types/melanoma/statistics

Melanoma. (n.d.). In MedlinePlus. Retrieved from https://medlineplus.gov/melanoma.html

Ngan, V. (2002). Xeroderma pigmentosum. DermNet NZ.

https://dermnetnz.org/topics/xeroderma-pigmentosum

Radiation: Ultraviolet (UV) radiation and skin cancer. (2017). WHO. https://www.who.int/news-

room/questions-and-answers/item/radiation-ultraviolet-(uv)-radiation-and-skin-cancer

Sweeney, M. (2020). Can Genetics Increase Your Risk of Skin Cancer? Healthline. Retrieved

from  https://www.healthline.com/health/is-skin-cancer-genetic#types-of-skin-cancer

Sun exposure and skin cancer. (n.d.). Cleveland Clinic. Retrieved from

https://my.clevelandclinic.org/health/diseases/10985-sun-exposure-and-skin-cancer

Skin cancer facts and statistics. (n.d.). In Skin Cancer Foundation.

https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/

Skin Pigmentation Disorders. (n.d.). Medline Plus. https://vsearch.nlm.nih.gov/vivisimo/cgi-

bin/query-meta?v%3Aproject=medlineplus&v%3Asources=medlineplus-bundle&query=Skin+Pigmentation+Disorders&_ga=2.170523682.347967202.1640819403-537530771.1640819403

Xeroderma Pigmentosum: Rare disease causes an extreme sensitivity to sunlight. (n.d.). In AAD.

Retrieved from https://www.aad.org/public/diseases/a-z/xeroderma-pigmentosum-sensitivity-to-sunligh

Week 5 Initial Discussion Post – Roni Ferrenberg

            “Environmental epidemiology refers to the study of the relationship between environmental factors (e.g., exposures) and adverse health outcomes that occur in the population” (Friis & Sellers, 2021, p. 480).  The exposures are generally outside of the individual or populations control and considered involuntary (Friis & Sellers, 2021).  I’ll be looking at environmental factors in pediatric asthma.

Environmental Agent or Genetic Factor

            15% to 18% of children in the United States live with some form of chronic illness with asthma being the most common (Hines, 2011).  There are many environmental factors or triggers that can exacerbate and be irritants for pediatric asthma patients (Woodley, 2019).  Some of the major environmental factors are emotional stress, smoking, poor outdoor air quality, and buildings in disrepair which lead to higher levels of allergens such as mold, dust, cockroaches, and rodents (Woodley, 2019).  These environmental agents increase the severity of the patient’s asthma, especially for the disadvantaged child and those children living in urban areas (Woodley, 2019).

Significance

            The cost to society for the pediatric asthmatic patient is great.  The costs of exacerbations result in increased emergency department visits and hospitalizations (Woodley, 2019).  Low annual income households are more at risk for the environmental factors and often cannot afford their child’s asthma medications (Woodley, 2019).

            With the economic burden of asthma exceeding a cost of $19 billion per year, there have been many health policies enacted in the United States to help mitigate some of the cost for the pediatric asthma patient such as the Health People 2020, the Affordable Care Act of 2010, and Asthmatic-School-Children’s Treatment and Health Management Act (Hines, 2011).  Most of these policies included goals and looked at environmental factors in pediatric patients (Hines, 2011).  Healthy People 2030 is currently bring created to identify future national health priorities and ways to meet these priorities (Hines, 2011).  The Asthmatic-School-Children’s Treatment and Health Management Act made it possible for children to self-medicate with their inhalers at school, impacting asthma is a positive way (Hines, 2011).

Health Disparities

            One of the ethnic groups with the highest prevalence of pediatric asthma is African Americans (Hines, 2011).  The African American child had an overall asthma rate of 8%,  compared to 5% rate among white children (Hines, 2011).  A high percentage of African Americans reside in urban areas where there is not as much open, green space and poor air quality related to traffic and businesses (Woodley, 2019).  In addition to the urban setting, there is a large proportion of African American children in low annual income families (Hines, 2011).  Many families are not able to afford to purchase their children’s medication, which creates a more sensitive asthmatic that is reactive to triggers, resulting in increased hospital visits through the emergency department (Hines, 2011).

            Pediatric asthma continues to not only be a national concern, but a worldwide concern (Woodley, 2019).  Nurses can be transformative in this patient population by understanding racial disparity and working together to help this population receive the education and health care needed (Woodley, 2019).

References

Baker Hines, A. (2011). Asthma: a health disparity among African American children. The impact and implications for peditric nurses. Journal of Pediatric Nursing, 26, 25–33.

Friis, R. H., & Sellers, T. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett Learning, LLC.

Woodley, L. K. (2019). Reducing health disparities in pediatric asthma. Pediatric Nursing, 45(4), 191–198.