Attitudes towards skin cancer: when “she’ll be right” isn’t enough

By Katie Stone

Reading time: 13 minutes

Summer in New Zealand really brings out our Kiwi-ness. Backyard cricket, fish ‘n chips on the beach, jandals, pōhutukawa trees, sunshine.

And skin cancer.

We may be the Land of the Long White Cloud, but the sun is Kiwis’ worst enemy. Along with Australia, New Zealand has the highest rates of skin cancer in the world. More Kiwis die from skin cancer than on the road.

By Katie Stone

Reading time: 13 minutes

Summer in New Zealand really brings out our Kiwi-ness. Backyard cricket, fish ‘n chips on the beach, jandals, pōhutukawa trees, sunshine.

And skin cancer.

We may be the Land of the Long White Cloud, but the sun is Kiwis’ worst enemy. Along with Australia, New Zealand has the highest rates of skin cancer in the world. More Kiwis die from skin cancer than on the road.

There are two main types of skin cancer: melanoma and non-melanoma. Melanoma is the deadliest form and the third most common cancer in New Zealand. Around 4,000 Kiwis are diagnosed every year, and nearly 80% of all skin cancer deaths are due to melanoma. That’s more than 350 people.

It hasn’t always been this bad. Those who grew up in the ‘60s or ‘70s may recall days spent in the glaring sun without so much as a lick of sunscreen and getting no more than a ‘nice healthy tan’.

Today, however, most of us are all too familiar with sunburn. We know the searing pain, the burning heat, the unsightly strap marks, the garish peeling. But despite the discomfort, and the ready availability of sunscreens, and even the “slip, slop, slap” message that’s been drilled into us for over 25 years, we keep letting ourselves burn. And the numbers keep increasing.

The serious case of sunburn.

You’ve probably heard about burn time – the number of minutes you can spend in the sun before your skin roasts. The burn time concept has actually been superseded by the UV Index (UVI): a measure of the intensity of UV radiation. The higher the number, the more intense the UV. That means the greater the potential for damage to the skin and eyes, and the less time it takes for that damage to occur. For example, a UV Index of 12 equates to a burn time of about 12 minutes. An index of six equates to a burn time of 24 minutes, and so on.

In countries close to the equator, and throughout the Altiplano region of Peru, Chile, and Argentina, the UVI can be as high as 20, while countries in northern latitudes may only reach a maximum of eight.

In New Zealand, the maximum UV Index is usually around 12, but it can surpass 13 in the far North. One study found that peak UVI values in New Zealand are about 40% higher than in countries of similar latitudes in northern America.

So, why is it so bad in New Zealand?

There are a few reasons. First of all, geography. The earth’s elliptical orbit means that the sun is closer to New Zealand during our summer than it is to countries in the Northern Hemisphere in their summertime.

Then there’s the ozone hole. This ‘hole’ is actually a section of the protective ozone layer that is thinner than it should be, allowing harmful UV radiation through. During our summer, this ozone-depleted air moves over from Antarctica to New Zealand, bringing those cancer-causing rays with it.

And while there’s every reason to be proud of our “clean, green” image, our relative lack of pollution allows this UV radiation to pass through our atmosphere more easily than it might in other countries.

But most shocking is the recent discovery that our sunscreens don’t always measure up. In a study by Consumer NZ, 20 sunscreens were tested against the Australia/New Zealand standard for broad-spectrum protection. Only nine were true to their SPF label claim and their ability to protect the skin from UV rays. These included ‘natural’ sunscreens which, although appealing to today’s chemical-conscious market, may provide much lower levels of protection than their users are led to believe.

Unfortunately, the sunscreen standard is voluntary in New Zealand, which means sunscreens can be sold here without being tested.

But the final nail in the coffin can’t be blamed on the planet, manufacturing, or marketing. It’s our attitude.

When “she’ll be right” isn’t enough.

According to research published in the New Zealand Medical Journal, many Kiwis just aren’t as consistent with slip-slop-slapping as we should be. Only 4.3% of us cover up with protective clothing, and around 10.7% stick to the shade.

Compared to a previous study in 2016, more of us are now going topless and barefoot when we’re around water. We’re also less likely to wear sun-protective hats and sunglasses.

Worst of all, many Kiwis simply don’t apply enough sunscreen to achieve the advertised SPF. The internationally accepted standard for testing sunscreen involves a thickness of 2mg/cm², while the average thickness of sunscreen used by consumers is approximately 0.39–1.0mg/cm².

Not surprisingly, it’s this lax attitude – coupled with the rising UV Index – that’s contributing to our susceptibility to skin cancer.

And, as it turns out, we aren’t the only nation guilty of neglecting our skin.

Globally, skin cancer ranks as the 19th most common cancer. But experts predict that by 2040, melanoma rates will climb to become the second most common cancer overall. Population growth aside, some of the main reasons for this increase are excessive exposure to UV radiation and dwindling respect for the harm it can cause.

But it’s not just the sun that’s killing us.

After Australia and New Zealand, the countries with the highest rates of skin cancer include Norway, Denmark, the Netherlands, and Sweden. That’s right: the countries with the most sun-deprived climates and the longest winters.

So how are they following us so closely with so much less sun?

Here’s a hint: it’s not the sun.

Incredibly, the Scandinavian love of solariums is almost as bad as the effects of our depleted ozone layer. Sunbed use prevalence is highest in northern countries with low levels of sunshine (excluding Italy and Spain). And despite advocates for indoor tanning claim that sunbeds allow for ‘safer’ ultraviolet light, studies show that this is just not true.

Solariums increase the risk of melanoma by around 20%. For those under 35, the risk is around 59% greater. Frequent use pushes the risk higher still. And no wonder: solariums emit UV levels up to six times more powerful than peak sunshine. On top of burning, sunbed sessions can also cause eye damage, skin irritation and inflammation.

In Norway, 29.6 people per 100,000 are diagnosed with skin cancer every year. That’s more than 2000 men and women. Researchers have linked these increasing rates to two major factors: more hours of solarium exposure, and the way people expose themselves to the sun.

According to The Cancer Registry of Norway, melanoma is a disease “linked to a high standard of living, to high socioeconomic status”. In other words, those who are wealthy and can afford to buy beach houses on the coast, take long holidays abroad, and spend time in tropical destinations are more likely to suffer from skin cancer.

Those most likely to have a sunbed addiction are single women, possibly because tanned skin is associated with being more attractive. Norway has seen sunbed use by those under 18, but the rates continue to climb.

The situation is no better in Sweden. Sweden is described as a “nation of sun-worshippers”, and, as a relatively affluent country, most can afford to go abroad during summer and winter. Swedes are also a fan of the sunbed, especially during the freezing winter months. According to researchers, Swedes are well informed about the dangers of UV radiation – but the desire for warmth and the appeal of a tan appear to outweigh the risks.

The US has also seen a rapid increase in skin cancer rates over the past decade, but this is not just about sunbeds. Data from the Centres for Disease Control and Prevention (CDC) show that people who live in states not known for sunny weather are actually at greater risk of developing skin cancer. States with the highest rates of skin cancer include Utah, Delaware, Vermont, Idaho, and Minnesota, which have considerably fewer hours of sunshine than Florida, California, and Texas. Oncologists say that this is partly down to a lack of awareness. Those who are not used to regular sun exposure are at a higher risk of burning simply because they’re not used to it. Living in less sunny places means they don’t expect to get burnt as easily, so they don’t prepare for it. They’re also more likely to head out into the bright light of day when they do get fine weather.

But there’s another demographic taking the skin cancer crown. Men.

In nearly every country around the world, melanoma is more common in men than women overall. Males have disproportionately higher rates of skin cancer and also usually experience worse outcomes following a skin cancer diagnosis. Again, it’s about attitude.

Surveys show that men are a bit less stringent on sun protection. They tend to apply sunscreen less frequently than women and are less likely to wear sun-protective clothing.

And it’s not necessarily due to a lack of knowledge about the risks of skin cancer. Further research shows that men continue to be lax on sun smart practices even after a melanoma diagnosis.

Experts predict that by 2040, melanoma will be the most common cancer among men.

Are we heading into a sunburned future?

With the abundance of information about skin cancer, few of us have any excuse to be ignorant. But the outlook for future generations may not be so bright, either.

A recent survey of 1,500 US millennials found that although 70% say they are “concerned” about the sun damaging their skin, only 14% use sunscreen every day. Four out of ten said they only use sunscreen when they expected to be in the sun.

Like their parental generations, this is a less-than-healthy attitude for life on a planet so catastrophically affected by ozone-depleting forces.

So. The choice is ours. We can shield our precious, vulnerable skin by slathering ourselves in the right sunscreen (look for the “broad-spectrum” label) and wearing a good ol’ broad-brimmed hat. We can keep out of the sun during peak UV hours (usually between 10am-4pm) and we can stick to the shade as much as possible.

Or, we can bare our bodies to merciless UV rays and bake ourselves into wrinkled, toxic (but tanned) oblivion.

It’s time to change our attitude about the sun.

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