Teresita’s Story: The generational impact of sun damage
Parkland leader shares family’s skin cancer journey
Growing up in Costa Rica, Teresita Oaks’ mother Tita never wore sunscreen or had any awareness about skin cancer. It was normal to spend endless hours on the beach and walk everywhere, and no one thought anything of it.
When a small spot showed up on Tita’s face underneath her wide-rimmed glasses, she didn’t pay it much attention because as her daughter recalls, in the Hispanic community, “We always had spots. In our population, we’re likely to do landscaping and construction; my dad is a good example of that. Other people’s skin in our community looks just like ours.”
It wasn’t until one day when Tita took off her glasses that her daughter noticed the spot. Teresita thought it was just a scratch at first, but when Tita said it came up out of nowhere, the family quickly grew concerned and took her to a dermatologist. While that spot was small and seemingly innocent on the surface, it turned out to be a very deep skin cancer lesion that required an invasive removal surgery and a 15-inch incision across Tita’s cheek.
Teresita Oaks, Director of Community Health Programs at Parkland Health, leads the execution and implementation of the Community Health Needs Assessment (CHNA) conducted every three years. Part of this work focuses on what the data from the CHNA means for people’s lives in the community. The 2022 CHNA found that cancer is the second leading cause of death in Dallas County and that 40% of Parkland’s patients with cancer are Hispanic.
Teresita’s own story and her family’s experience with cancer, particularly skin cancer, drives home that statistics represent much more than just numbers. Each data point is a life and a story giving a much deeper context to the numbers. In Teresita’s words, “to me, what’s important about this story is that we don’t understand how our actions or inactions today are going to impact us later. Sun safety is not something my mom and dad grew up with, so they couldn’t understand how it would impact them and our entire family later in life.”
Teresita’s father, Jorge, is from Ecuador and her mother, who Teresita is named after, is from Costa Rica, but the family lovingly refers to them as Tito and Tita. The couple raised a family of nine children and growing up Teresita says, “We spent endless hours on the beach and walked everywhere. We were all fine and never really used sunscreen.” They raised their children the same as generations before.
It wasn’t until much later in life that spots started to show up on Tito’s and Tita’s skin and these precancerous lesions had to be routinely removed. Tito has been through multiple surgeries, including one most recently to remove a section of his ear. Five years ago when doctors discovered the cancerous lesion on Tita’s cheek which required invasive surgery. “It’s very difficult to watch because the surgery my mom had was very close to her eye and close to important nerves. Seeing her so stressed about it and how my father is affected by his skin cancer at age 90 is hard. With his age, all these surgeries are putting additional stress on his health. It’s very risky,” said Teresita. Watching their loved ones go through these challenges has changed the entire family’s perception about sun safety and skin cancer. Teresita said when Tita came out of surgery, “We were overwhelmed to see how her face looked...you could see on everyone’s faces that they realized this was really serious.”
It is estimated that one in five Americans will develop skin cancer in their lifetime; however, the dangers of inadequate sun safety don’t always feel urgent because the negative consequences are distanced from when the actual damage takes place.
While Tito and Tita were the only ones in both of their families to have skin cancer, four of their nine children have also had skin cancer lesions, including Teresita. It started when she was with her sister trying on dresses for an upcoming wedding and her sister pointed out an odd spot on her back and suggested that she should get it checked out. Teresita’s primary care doctor referred her to a dermatologist who immediately removed the lesion, but since then, Teresita has had three additional skin cancer lesions removed.
Her perception began to change well before spots showed up on her skin though. She lived in Arizona for 18 years, and 11 of them were spent working for the state health department. When she heard that they were hosting a skin cancer fair, it opened her eyes to the idea that skin cancer prevention should be like any other regular screening, like checking your blood pressure or well-woman exams. The behaviors of others around Teresita began affecting not just her views but also her own habits. “I saw women my age who were more conscious of sunscreen and that rubbed off on me. They would reinforce it with their kids and make them get out of the pool to reapply sunscreen. That’s really where my education came from,” said Teresita, adding that her daughter who still lives in Arizona is mindful of skin cancer, always uses sunscreen and models healthy behaviors for Teresita’s granddaughter.
Teresita stresses the importance of viewing your skin as an organ, just the way you view protecting your internal organs. She firmly believes that we need to normalize skin cancer screenings and says that as it becomes more normal “you become more aware. I now feel more comfortable telling someone I know that a spot they have looks concerning and recommending they have a doctor check it out to see if it’s okay or not. You might think, ‘I’ve always had this spot,’ but spots change. It might have always been there, but how does it look? Have the edges changed? Why is the color changing? That’s the piece where people struggle because by the time they notice it, it’s often much more advanced.”
This awareness is crucial for everyone of all ages and all skin types. While Teresita’s father’s side of the family has lighter skin and lighter eyes, her mother’s side has a darker complexion, therefore wearing sunscreen and taking measures to protect your skin is necessary no matter your age or your skin color. “It’s not just people with fair skin who need to be careful. It’s everyone,” she said. “In the Hispanic culture, we love the barbeques at the park. Some days we pack the park doing barbeques and hanging out there all day! But do we wear sunscreen? Usually no.”
Teresita said the biggest takeaway she wants others to learn from her own family’s story is that “Skin cancer is real. We aren’t conscious of how it can quickly turn into something serious. We need to be mindful and learn about it. You must pay attention and educate yourself on how your skin reacts in the sun and what’s normal for your body. As we learn about it, we start to understand what’s different.”
Teresita’s final word of advice is that “Skin cancer is rarely talked about, but if you were to ask, you’re always going to know somebody... Ask, ‘do you know someone who had skin cancer? What was their experience?’ Hearing these stories makes it real versus something that feels not real because you won’t experience the effects for 20 years.”
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