N.S. and P.E.I. have higher rates of skin cancer than national average. Here's why

Some parts of the Maritimes are seeing higher skin cancer rates than the national average, according to a new study out of McGill University in Montreal.

Nova Scotia and Prince Edward Island in particular have higher rates, even when compared to neighbouring New Brunswick.

Dr. Ivan Litvinov, the chair of the dermatology department at McGill, led the research for the study.

He spoke with Maritime Noon guest host David Burke. Their conversation has been edited for length and clarity. 

What did your research uncover when it comes to skin cancer rates in the Maritimes? 

The skin cancer rates are not uniform. Particular areas of P.E.I. and Nova Scotia, especially the ones that are closer to the coastlines, have higher risk of melanoma, a deadly skin cancer, compared to some other parts of the country and in particular neighbouring New Brunswick. Newfoundland and Labrador had much lower rates than with ones that we're seeing in P.E.I. and Nova Scotia.

Why do Nova Scotia and P.E.I. have higher skin cancer rates than New Brunswick and Newfoundland?

It's a complex question. In part it relates to where you are, the weather patterns where you are, and the other thing is behaviours and the norms of the communities where we live.

Our research has shown that annual average temperatures — so just how pleasant it is in the area that you are — will drive melanoma rates. If you increase annual pleasant temperature by 2½ degrees, you increase melanoma rates by 21 per cent.

Also, UVR index, that's very important. If you increase UVR index by one standard deviation, you increase melanoma rates by about 14 per cent.

How much vegetation there is in the area where you are, that may drive you to go out more, as opposed to if you're living in a desert or in a very cold area where there's no trees. So if you increase greenery in the area, you increase melanoma rates by about 15 per cent.

On the other hand, heat events, highest annual temperature and rain events drive melanoma rates down based on weather, so when the temperature becomes more than 27 degrees, folks are less likely to go out and enjoy the outdoors.

The other thing is behaviour. We have found, surprisingly, that in Prince Edward Island and Nova Scotia, people had higher awareness of risk of sun exposure. They had more likelihood of having a family member with melanoma. They were using more sun protection than New Brunswick or Newfoundland. But on the other hand, they had much higher rates of sun exposure, higher rates of sunburns, which translate ultimately into more likely developing skin cancer.

So what are the rates exactly? How do we compare?

Before in Canada — about 2010, let's say — the annual rate was 12 cases per 100,000. Now the rates have increased everywhere. Now the rate of melanoma is 20 cases per 100,000, so almost double, and when you look at Nova Scotia and P.E.I., the provincial rates are actually about 30 cases per 100,000. In contrast to that, New Brunswick is about 20 cases per 100,000 and Newfoundland and Labrador are even lower. They're sitting at about 16 cases per 100,000.

Why did you want to break down these rates by province? How is that helpful? 

There were many campaigns before that tried a one-size fits-all approach saying, "Oh, just protect yourself from the sun, et cetera," and they have all failed. We don't have a community of concern like they do in Australia and other parts of the world.

People are still enjoying the sun and we get very, very short summers, so of course everybody's trying to soak up that vitamin D. We understand now that we need to tailor the message and understand the community needs and to lower skin cancer.

For instance, they're finding that while recreational sun exposure is not as high in Newfoundland, they have a much higher tanning bed use than folks in Nova Scotia and P.E.I., so this is something that we need to identify and educate people about.

When we look at people by income, we see that people in higher socioeconomic status, so wealthier people, are much more likely to have recreational sun exposure. They're going to take vacations to sunny climates and get a sunburn, or they're going to rent a cottage and get a sunburn, and they're more likely to use certain measures of some protection but not others.

On the other hand, folks who earn less than $50,000 are reporting much higher rate of sun exposure from their work: they have to be outdoors, in the sun during construction or other work outdoors. So again, education and targeting would be very different.

We also see big differences between men and women. Men, for instance, are more skeptical about sunscreen and sun protection than women are. Men are reporting more recreational and occupational sun exposure, while women are reporting more tanning bed use.

Ultimately, the way you need to speak to a mother of three children who lives next to the coast somewhere in P.E.I. is very different than the way you need to speak about sun protection to a young guy in Fort McMurray working in oilfields. We understand that. We're trying to understand individual communities, what drives them, what's important for them, in order to develop a message that would resonate with the people.

How far along has that tailored messaging gotten for those really specific groups?

Yeah, we're really getting patient involvement, community involvement. We've done focus groups in 22 communities across Atlantic Canada. The folks in Nova Scotia and P.E.I. are really highlighting that they are outdoors people, they are nature people and trying to mess with that, trying to send messaging around going indoors, will just not work. Clearly, we need to encourage people to be outdoors and to enjoy, but not get a suntan or a burn — celebrate natural skin colour — so the messages will be focused on that.

They are more likely to accept messages showing scars or tumours, describing how horrible melanoma can be.

On the other hand, folks in Newfoundland and Labrador, they have different identifications. They are more likely to accept activities indoors, it's more congruent with their culture, and the focus there would be more on tanning bed use, and they told us they wouldn't want to see any of the gruesome images of skin cancer, that would just turn them off, so clearly the approach is going to be different.

Is there anything the government can do to protect people from the sun?

Yeah, absolutely. Melanoma is really a public health issue. In 2004, we spent $532 million treating melanoma. By 2030 we're projecting to spend about a billion dollars.

We just need to look outside of Canada. For instance, California, New York, Virginia, Texas, Maryland, Florida, New Zealand, the United Kingdom, Australia, they have all eliminated taxes on sunscreen and sun protection items, or a physician can prescribe a sunscreen and it will not be taxed. This is not the case in Canada.

There is no benefit to employers to buy sun protection items for their employees. This needs to change. We are arguing that we need to remove tax on sunscreens. We need to make it the corporate tax deduction to buy some protection items, and so then, hopefully, maybe as a society, as a government, as a public, we will not be paying twice for treatment of melanoma a few years down the road, as we will encourage more people to protect themselves and develop less of this deadly cancer.

What advice do you have for people who want to get out and enjoy the outdoors?

It's very important. First of all, get out, enjoy the outdoors. The summers are short. We are nature people. We are Canadians, we love our country, our natural landscapes. Do all of that. Just do that without getting a tan, so getting a tan is not a good thing.

The best way to protect yourself is really a rash guard, long sleeve shirt, those surfer pants — some protective clothing and a wide-brim hat, those are the best ways to go. And then put sunscreen on areas that are not otherwise covered, so put it on the face, on the hands, et cetera, and reapply frequently if you sweat or if you're planning to swim.

That would be my top recommendation, the switch from just relying on sunscreen to sun protective clothing for you and your entire family.