Evidence-based medicine shows sun avoidance may actually be just as dangerous as smoking

The western world's restrictive guidance against sun exposure over the past four decades may be particularly ill advised. Pelle Lindqvist, MD, of Karolinska University Hospital in Huddinge, Sweden, and his colleagues recently found that women who seek out the sun were generally at lower risk for cardiovascular disease (CVD) and non-cancer/non-CVD diseases such as diabetes, multiple sclerosis, and pulmonary diseases, than those who avoided sun exposure. And one of the strengths of the study was that results were dose-specific — sunshine benefits went up with amount of exposure. The researchers acknowledge that longer life expectancy for sunbathers seems paradoxical to the common thinking that sun exposure increases risk for skin cancer. They found an increased risk of skin cancer. However, the skin cancers that occurred in those exposing themselves to the sun had better prognosis.

Age and Smoking Habits

The researchers studied sun exposure as a risk factor for all-cause mortality for 29,518 women with no history of malignancy in a prospective 20-year follow-up of the Melanoma in Southern Sweden cohort. The women were recruited from 1990 to 1992 when they were 25 to 64 years old. Detailed information was available at baseline on sun-exposure habits and potential confounders such as marital status, education level, smoking, alcohol consumption, and number of births. When smoking was factored in, even smokers at approximately 60 years of age with the most active sun-exposure habits had a 2-year longer life expectancy during the study period compared with smokers who avoided sun exposure, the researchers note. The authors do, however, acknowledge some major limitations. Among them, it was impossible to differentiate between active sun-exposure habits and a healthy lifestyle, and they did not have access to exercise data.

UV radiation and melanoma

There can be no doubt that a relation exists between UV radiation and melanoma of the skin. Also, there is no doubt that UV radiation is a form of electromagnetic radiation that is capable of damaging cells in different ways. The depletion of the ozone layer over the last decades has become a cause for concern regarding skin and eye melanoma. But no strong increase in UV radiation due to ozone depletion was noticed as early as 1955. I wrote a sentinel paper on the increasing level of malignant melanoma on the period 1950-1985 back in the Mayo Clinic in 1989. Consequently, there must be something else that suddenly accelerated the transformation of damaged cells into skin cancer.

Role of FM/TV broadcasting networks

Research by Örjan Hallberg and Olle Johansson shows no evidence that increased travel is the main cause of increased mortality in malignant melanoma since 1955. We found, however, a strong connection between the start of FM broadcasting and increased mortality from malignant melanoma of the skin in all investigated countries. The fact that melanoma mortality starts to increase earlier than the incidence implies that an environmental factor other than sunshine affects the survival probability of melanoma patients. This is further underscored by the fact that melanoma deaths can show peaks of the kind noticed in France during 1968.

Role of Vitamin D Still in Question

The results add to the longstanding debate on the role of vitamin D in health and the amount of it people need, but this study doesn't resolve the question. Whether the positive effect of sun exposure demonstrated in this observational study is mediated by vitamin D, another mechanism related to ultraviolet radiation such as the release of nitrous oxide, or by unmeasured bias cannot be determined.

Life expectancy for Australian men goes over 80 years old for first time ever – but why do they live so much longer than Britons?

Adam Withnall writing in the Independent recently posed this question as Australia has for the first time entered an exclusive club of countries where men can expect to live to more than 80 years old. Australia now joins Switzerland, Japan and Iceland in being able to boast that both its men and women can expect to reach an 80th birthday or beyond. That compares to around 78.9 for baby boys born today in the UK. While women in the country have had a life expectancy of around 84 for a couple of years, the figure for men has continued to soar, and broke through the 80 mark for the first time in 2014, according to a release from the Australian Bureau of Statistics (ABS). The author concluded that the OECD, the organization committed to the development of some of the world’s 34 richest countries has provided an explanation and it essentially boils down to an outstanding health system. They even said “Australia’s universal health care system is one of the best in the world,” the organization says, with an above-average £2,400 spent on healthcare per person in 2010.

Really ! It is really as simple as that !

I have worked in Australia for three years and agree it has an enviable system of health. Australia has also seen a sharp decline in tobacco consumption, which the OECD says contributes to chronic diseases – and therefore lower life expectancies – across its countries: physicians attribute this to public awareness campaigns, advertising bans and increased taxation. Facts show that life expectancy is not simply down to the average wealth of a nation: the US is one of the richest countries in the world, yet ranks around 40th in the world for how long its citizens can expect to live.

But could there be another uncited reason? What about the sun?

The results of a recent study, conducted by researchers at the Karolinska Institute in Sweden, followed nearly 30,000 women over 20 years showed that patients who avoided sunbathing during the summer were twice as likely to die than those who sunbathe every day. They found that the results “showed that mortality was about double in women who avoided sun exposure compared to the highest exposure group”. Experts behind the study say that wearing sunscreen and staying out of the sun could lead to a deficiency in vitamin D, which has been linked to more aggressive forms of skin cancer. Nonsmokers who stayed out of the sun had a life expectancy similar to smokers who soaked up the most rays, according to researchers who studied nearly 30,000 Swedish women over 20 years. Pelle Lindqvist, MD, of Karolinska University Hospital in Huddinge, Sweden, and colleagues found that women who seek out the sun were generally at lower risk for cardiovascular disease (CVD) and noncancer/non-CVD diseases such as diabetes, multiple sclerosis, and pulmonary diseases, than those who avoided sun exposure. And one of the strengths of the study was that results were dose-specific — sunshine benefits went up with amount of exposure.

This indicates that avoiding the sun "is a risk factor for death of a similar magnitude as smoking," write the authors of the article, published March 21 in the Journal of Internal Medicine. Compared with those with the highest sun exposure, life expectancy for those who avoided sun dropped by 0.6 to 2.1 years.

2.1 years! - isn't that the exact same difference in time that Aussies get to enjoy the planet more than their British counterparts?! Food for thought!

This study was supported by the Clintec at the Karolinska Institute; ALF (Faculty of Medicine, Lund University, Region Skane); the Swedish Cancer Society; and the Swedish Medical Research Council. Funding was also received from Lund University Hospital; the Gustav V Jubilee Fund; the Gunnar Nilsson Foundation; the Kamprad Foundation; and the European Research Council. The authors declared no relevant financial relationships.