I'd like to tell you a story of skin cancer, wealth, poverty and, I'm afraid, journalism done badly.
My morality tale starts this Monday with the announcement of a study in this month's British Journal of Dermatology: a report by scientists in Belfast, who had tracked and analyzed skin cancer rates in Northern Ireland over 12 years.
Their primary finding, based on data from 1993 to 2004, echoed what many researchers have been saying: melanoma and other skin cancers are increasing alarmingly fast worldwide. Even in Ireland -- hardly a sun-blistered climate -- doctors report a 62 percent increase in skin cancer samples sent to laboratories and a 20 percent increase in patients.
There has been much speculation about the global rise in skin cancer, ranging from heavy use of tanning salons, to overexposure on beaches, to thinning of the planet's ozone layer, which famously blocks the worst of the ultraviolet radiation that bombards our atmosphere.
But news coverage of this study didn't look for answers to such questions. Rather, they focused on a fact highlighted in the press release -- that the sharpest increase, at least among the largely fair-skinned people of Northern Ireland, is among those who live in affluence. Melanoma is two-and-a-half times more common in people who live in moneyed neighborhoods, according to the analysis, and the less lethal skin cancers, such as basal cell carcinoma, were 41 percent more likely to occur.
I must first admit to a middle-class moment, brought on by a seriously annoying week of being bombarded with stories about Paris Hilton as she dodged around the Los Angeles criminal justice system, of thinking "serves them right." Let the over-compensated suffer for those hours they spend lounging around on some Caribbean isle while my life stays illuminated mostly by the screen of my laptop.
But once my better self triumphed -- or so I hope -- I began to wonder about those statistics. It's not as if any of us, rich or poor, escape the sun. And melanoma is not a cancer I would wish on anyone. So why should the prosperous Irish be so cursed? In fact, the media speculation that arose from the report focused -- albeit less bitterly -- on my initial speculation, on the risks of an expensive lifestyle. "Holidays blamed for rising Northern Ireland skin cancer," announced one report.
There's a logical point here -- increased sun exposure increases the risk of skin cancer. There are also logical countermeasures -- wear a good sunblock, a hat and, as my dermatologist is forever telling me, cover up at the beach when you're not in the water. The study does emphasize the need for "safe sun measures" on holiday and at home. It does acknowledge a long-standing association between affluence and melanoma, which has been generally linked to leisure time in the sun.
But as opposed to the news coverage, the report is not particularly obsessed with the wealthy. In fact, if you read the study, rather than the press release, there's a sense of genuine concern about the poorer patients. The researchers real focus is on underestimating skin cancer among the poor. Or to quote directly, "It is possible that patients from lower socioeconomic groups do not present for medical care," leading to under-reporting of skin cancers, emphasizing an underlying worry that the numbers are missing some very sick people.
This is far from just politically correct angst. Study after study, in country after country, shows exactly that disparity. In the United States, it happens to be a worsening problem. A 2003 report by the National Cancer Institute analyzed "socioeconomic variations in U.S. cancer incidence" between 1975 and 1999. It found that people in poor neighborhoods are far more likely to have their cancers diagnosed late rather than early. Which means, not surprisingly, that they're far more likely to be killed by those cancers.
So that in 1975, the rate of U.S. cancer deaths was two percent higher for men living in poverty than those in affluent neighborhoods. Twenty-five years later, mortality was 13 percent higher for poor men. A similar trend showed for women. And if one took melanoma as an example -- poor people were twice as likely to have their cancer diagnosed when it had already reached a metastatic stage. Meaning that the higher death rate should be no surprise -- and reminding us of what's actually important in discussions of health disparities between rich and poor.
It's not an image as media-sexy as toasted bodies on a beach. But it is one that can't be changed unless we do see it, over and over until we get it right. And, although it's not obvious from the reporting thus far, it is one of the most important points in the Irish study. And that, readers, is the moral that makes the story worth telling.