A month ago I showed you my public comment on the Surgeon General’s anticipated statement on ultraviolet light (UV) and skin cancer. I made the argument that UV has both positive and negative effects on health. These effects depend upon skin color in that, compared to those with darker skin, those with lighter skin have the benefit of much higher vitamin D levels and the risk of much higher rates of skin cancer. Given the diversity of skin colors in the U.S., I suggested public health policy should address the needs of people of all skin colors rather than addressing the needs of light-skinned people while ignoring the vitamin D needs of people of color.
My statement included 23 references, but since then another study has been published and noted on our website here that would have fit right in with the others cited in my comment:
Brondum-Jacobsen P, Nordestgaard BG, Nielsen SF, Benn M. Skin cancer as a marker of sun exposure associates with myocardial infarction, hip fracture and death from any cause. Int J Epidemiol. Sep 13 2013.
This study looks at the health effects of high-levels of UV exposure by using skin-cancer itself as the marker for high UV exposure. The study used hip fractures, heart attacks, and death from any cause as outcome measures. The idea was to test the hypothesis that those with higher levels of UV exposure, as determined by a skin cancer event, would have lower levels of heart attacks, hip fractures, and deaths from any cause. Relationships between these outcomes using vitamin D status as the marker for UV exposure have been reported previously in the literature. Using skin cancer itself as the marker for UV exposure, however, concentrates the mind on both the negative and positive health impacts of UV.
The researchers had access to a magnificent data set – the entire population of Denmark above 40 years of age from 1980 through 2006. To create the data set the researchers combined data from:
- the Danish Civil Registration System, which included births, deaths, and moves into or out of the country
- the Danish Cancer Registry, which included information on 98% of the cancer cases in Denmark
- the Danish Patient Registry and the Danish Causes of Death Registry, which included data on hip fractures, heart attacks, and death from any cause
- and Statistics Denmark, which provided demographic information.
The cancer data included codes to separate basal cell and squamous cell carcinoma (non-melanoma skin cancer), which typically do not result in death, from melanoma, which, untreated, typically does. “Constant and prolonged sun exposure patterns cause non-melanoma skin cancer, whereas overexposure as a child and high intensity intermittent sun exposure primarily cause cutaneous malignant melanoma,” the researchers say.
Overall, the data set included 4.4 million individuals, 1.6 million deaths, 328,000 diagnoses of heart attacks, 129,000 of hip fractures, 129,000 of non-melanoma skin cancers, and 22,000 of melanoma.
The researchers analyzed the data several different ways, but the results were similar in all cases. Figure 1 shows the cumulative incidence of hip fractures, heart attacks, and death as a function of age in individuals who also had a diagnosis of non-melanoma skin cancer. As you can see in the graphs, those who were diagnosed with non-melanoma skin cancer also had fewer hip fractures, fewer heart attacks, and lived longer.
While the researchers were very careful to limit the implications of their data (“Causal conclusions cannot be made from our data. A beneficial effect of sun exposure per se needs to be examined in other studies.”), what we’re talking about here is whether it is ethical to continue existing global health policy recommendations that people of all skin colors should limit UV exposure.
According to the American Cancer Society, in the U.S. skin cancer deaths make up just 2% of all cancer deaths. In this data set, a heart attack is about 15 times more likely than melanoma. The policy experts who insist that UV should be limited have no evidence showing that limiting UV is beneficial to health in any way other than reducing skin cancer. Meanwhile, here we have a study that shows that even in a population where 90% of the individuals have a light skin color, and even among individuals who have had skin cancer, increased levels of UV exposure are related to better health.
This certainly strong evidence of the benefits of sun exposure. What I found strange about the study was the extremely high (8%) mortality from non-melanoma skin cancers while the MM mortality was just 1.4%. As noted, in the U.S, all skin cancer deaths are just 2%. Looking for an answer I found this interesting site:
in which I found this:
Which shows very low non-MM incidence and death rates.
Hi Richard – I can’t figure out where you’re getting the 8% and 1.4% mortality figures – I assume it must be a different article. All the relevant information I can find in this one is related to death from any cause and I don’t see anything here about death from skin cancers. If I’m missing it, let me know what part of the paper it’s in.
In the U.S., the American Cancer Society’s Cancer Facts and Figures 2013 doesn’t have any informaiton on the incidence or prevelance of non-melanoma skin cancer, apparently because there is no requirement in the U.S. that these cancers be reported. So although the American Cancer Society report talks about skin cancer being one of the most prevalent types of cancers, it doesn’t include any hard data on anything but melanoma.
Whoops …on anything but melanoma, which is one of the least common types of cancer. – Tom
Oops, my mistake. I was looking at the at the diagnosis #s (e.g. “129,000 of hip fractures”) as deaths as it was preceded with “1.6 million deaths” and I guess I missed “diagnosis”. Anyway, that makes the non-MM incidence 2.9% and MM rate 0.5% which seem reasonable.
Given the database that they seemed to have available, and the research that shows that many cancers are probably affected by D levels, it seems strange that they didn’t also look at correlations with at least Breast and Prostate cancers.
Richard – Agreed. This appears to be an amazing data set for this kind of analysis. We can hope they saved it for a second article. – Tom
When the ACS talks about skin cancer being the most prevalent it is inpart because data is skewed. One person might have 100 skin cancers and statistics are raised by 100, not 1 for instance. They also combine melanoma and nonmelanoma to purposely increase numbers. The reason why you don’t see skin cancer deaths on most charts is because there are so few deaths compared to other reasons that they don’t make it onto the chart. http://en.wikipedia.org/wiki/List_of_causes_of_death_by_rate
death by skin cancer is on the third page according to incidents.