Preface Contents Executive Summary Background Paper   I. Incidence, mortality, and impact on society   II. Skin cancer   III. Contributing and causative factors   IV. Prevention   V. Cancer prevention and information services that impact the skin cancer problem   VI. Barriers to early detection and treatment of skin cancer in Texas   VII. Policy initiatives that would affect skin cancer awareness and prevention   VIII. Professional practice regarding skin cancer prevention, detection, and treatment   IX. Prevention and information models Action Plan   Goal I Initiate data collection and analysis Goal II Develop prevention information and services to increase public awareness Goal III Enhance professional education and practice Goal IV Improve access to prevention, detection, and treatment Bibliography Appendix   i. Melanoma of the Skin Incidence and Mortality Rates, 1988-1992 ii. Five-Year Relative Survival Rates, by Site 1986-1992 iii. Average Years of Live Lost per Person Dying of Cancer, 1993 iv. Demographic Characteristics of Patients Diagnosed with Malignant Melanoma of the Skin v. Counties Reporting Health Care Availability as an Issue vi. Federally Designated Medically Underserved Areas vii. Additional Texas Cancer Council Initiatives
		VI. Barriers to early detection and treatment of skin cancer in Texas
		A. Geographic barriers The Texas Community Futures Forum, a survey project of the Texas Agricultural Extension Service at Texas A&M University, found that 48 of 254 counties in Texas reported health care availability as a problem. (Appendix v) This included availability of prevention and wellness programs, and programs for both the very young and the very old. Of the 48 counties several were in close proximity to major metropolitan areas. [ 20 ] The Federal Government's definition of medically underserved areas, even metropolitan areas, includes "percentage of population 65 and over, the poverty rate, the infant mortality rate, and the ratio of number of primary care physicians to the area's population." Only 29 counties in all of Texas are not designated by the Federal Government to be medically underserved. (Appendix vi) [ 24 ] B . Fiscal barriers The U.S. Census Bureau estimates that there are 44 million individuals without insurance in the United States today, and 20% of this number live in the South and Southwest. [ 25 ] In Texas, 24.5% of the population is uninsured, compared to a national average of 16.1%. Demographically, they are "young adults in the 18-24 yrs. age group, people with lower levels of education, people of Hispanic origin, those who work part time, and people born in another country." [ 27 ] The cost of MM care, has been found to be higher in community settings than in metropolitan centers, due to the increased costs involved in the traditional referral pattern in community settings, versus the "coordinated multidisciplinary" approach found in medical centers. [ 28 ] These factors compound the already serious problem of a lack of insurance. Prevention and detection are less likely to be a priority for a population that seeks medical care only for emergency situations.