‘Siesta’ protects Southern Europeans from skin cancer

Elderly Portugese taking a siesta. [Pedro Ribeiro Simões/Flickr]

Despite being less exposed to the sun, Northern Europeans face a higher risk of skin cancer than their southern neighbours, a new study has found.

According to the report, published on Wednesday (13 July), skin cancer is more common in developed countries. Thanks to adequate health care spending, mortality rates remain low.

Derma.plus, a website which publishes dermatological advice from leading physicians, conducted an international study on skin cancer, focusing on the geographical and socio-economic factors that offer a fertile ground for skin cancer to appear.

Dietrick Abeck, Chief Medical Advisor for Derma.plus stressed that on a global level, more than 3 million non-melanoma skin cancers and 150,000 melanoma skin cancers were diagnosed each year.

“One in every three cancers diagnosed is a skin cancer,” he noted, adding that both non-melanoma and melanoma skin cancers have increased dramatically over the past decades.

The report’s first section, the Skin Cancer Susceptibility Index, analyses the ultraviolet (UV) factor, the average population skin tone, and the rate of incidences from a range of countries to geographically identify where the highest rates of skin cancer are most likely to occur.

The second section the Socioeconomic Treatment Index, focuses on national spending on healthcare, access to treatment, and individual income, as measured against death rates.

UV exposure and light skin

According to the study, developed countries like New Zealand and Australia have the highest incidence and likelihood of melanoma per capita due to a combination high level of UV exposure and lighter skin tone.

Seven out the top ten countries in this list lie in Central and Northern Europe.

Switzerland has 2,484 melanoma cases annually, Sweden 2,911, the Netherlands 4,804, Germany 16,884 and the UK 14,445.

On the contrary, this is not the case for Europe’s “sunny” south.

The study indicated that in Cyprus 52, annual melanoma cases are reported, in Greece 472, in Italy 5,124, in Spain 5,004 and in Portugal 464.

Health spending

The report emphasised that these countries have high levels of healthcare spending, which results in decreased death rates from skin cancer.

Referring to World Bank data, the study noted that health care spending in New Zealand and Australia was high enough to result in the world’s lowest mortality rates from skin cancer. In addition to strong health systems, the report cited equality in terms of life quality as a second factor.

EU member states such as Sweden, Switzerland, and Italy invest a lot in healthcare systems and have low death rates with 17%, 15%, and 14% respectively.

But countries with low healthcare budget face high mortality rates from skin cancer incidents.

“For example, Bangladesh is the country with the lowest skin cancer prevalence per capita, however, the amount spent on 300 skin cancer patients here is equal to the amount spent on one case in Norway,” the report reads.

“Smart” southern Europe

Dr. Swen Malte John, Chairman of the Media and Public Relations Committee of the European Academy of Dermatology and Venereology, told euractiv.com that southern Europeans have a smart approach to sun exposure.

“With the Italian siesta and other similar customs in southern European countries, the most UV-prone time of the day is being avoided: 80% of daily UV is between 11:00 AM and 02:00 PM. This is when southern Europeans tend to stay away from the sun,” the professor stressed.

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Referring to the northern hemisphere, Malte John noted that due to the cold climate, people prefer to expose themselves in the warmest time of the day, which is also between 11.00 AM and 02.00 PM.

“So then they will get the maximum of UV exposure. It may be the case that the daily UV exposure in northern countries is much higher than in southern countries due to this special pattern of behavior,” he emphasised.

He added that people in northern countries are particularly prone to develop all sorts of skin cancer also because by nature many of them “have virtually no sun protection […] obviously this refers to blond blue-eyed or red haired individuals with freckles”.

He continued, saying that these individuals usually know that they will not get tanned but rather sunburnt right away. “Sunburn is a sign of particular damage to the upper skin cells from which over the years skin cancer may arise.”

The professor also stressed that Africans rarely get skin cancer as they are well protected against the carcinogenic UV by nature, which partly explains the low skin cancer rates in “dark skinned southern Europe” compared to the north.

Preventing skin cancer

The European Commission believes that the rise of skin cancer is a warning sign for public health systems, and recommends that member states to take immediate preventive measures.

In an effort to tackle the absence of effective intervention, through the Health Programme (2007-2013) the executive has helped promote awareness of the issue.

The European Code Against Cancer recommends that “Care must be taken to avoid excessive sun exposure. It is specifically important to protect children and adolescents. For individuals who have a tendency to burn in the sun active protective measures must be taken throughout life”.

EUROSUN is a programme aiming at measuring the exposure of individuals and populations in Europe to UV radiation by using the data of meteorological satellites.

Map of the averaged daily UV irradiation (in J/cm2) in Europe for the month of July averaged over the period 2003-2007.

Map of the averaged daily UV irradiation (in J/cm2) in Europe for the month of July averaged over the period 2003-2007. [EuroSun]

Another project is EPIDERM (European Prevention Initiative for Dermatological Malignancies) whose main goal is to share knowledge on skin cancers relating to their occurrence, risk factors, treatments, and costs of illness to develop prevention.

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