Four types of cancer are illustrated using a new atlas


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  • Moussy sourd

    Data journalist

  • Sander Zorhaki

    Healthcare Editor

  • Moussy sourd

    Data journalist

  • Sander Zorhaki

    Healthcare Editor

The cancer atlas of the Comprehensive Cancer Center Netherlands (IKNL) shows for the first time geographically where forms of cancer occur to a greater or lesser degree than the national average, corrected for population and age in the region. The atlas confirms existing knowledge but also reveals new insights. In this article we focus on cervical cancer, melanoma, lung cancer and asbestos cancer.

Cervical cancer is less common in the eastern and southeastern Netherlands than in the Randstad and the North. Why this is still somewhat of a mystery and reason for further investigation.

The inventor of the atlas, Professor and Principal Investigator at IKNL Valerie Lemmens, suspects that preventive screening is an important factor. Women between the ages of 30 and 60 can often find out if they are at increased risk for this disease through a Pap smear at their GP. Then relatively simple measures are enough to prevent cancer.

“We know that women in the east of the country often participate in population screening,” Lemmens says.

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Map showing the number of cervical cancer diagnoses by zip code area.

Gynecologist Jacqueline Lovers from Diakonisenhuis in Utrecht specializes in cervical cancer and supports the importance of population screening. But whether it explains the sharp division between the West and the East of the Netherlands as a whole is still a question.

For example, according to Louwers, who is also an expert on behalf of the Professional Association of Gynecologists, risk is also determined by the number of sexual partners. After all, this cancer is caused by the human papillomavirus (HPV), a virus that you can only contract through sexual contact. “In big cities where many students live, there is more free sexual intercourse than in other parts of the country, which also affects HPV infection.”

Caroline Kruidenberg, a gynecologist at St Jansdal in Harderwijk, also wonders if smoking plays a role. “Most people get HPV in their lifetime. Often the body clears this virus on its own. Sometimes it doesn’t and then you can get cancer. And one of the factors that increases the risk that your body won’t get rid of HPV itself is smoking.”

Do you want to know for yourself what is the situation in your place of residence? You can do so via this link or in the interactive map below:

Lowers also notes that more women with immigrant backgrounds are living in big cities. “They find their way less easily into our health care system and it is probably taboo to do a smear test. This is also often the case with other Dutch women. So it is an uncomfortable examination, with your legs spread wide for a Pap smear. Nationwide, about 50 percent of women show up for population screening. That’s unfortunately low.”

HPV self-tests are now possible, but the total number of tests remains virtually unchanged.

Therefore, the best way to prevent cervical cancer is vaccination. Girls have been able to get this shot for years, boys since last year. Women who have turned 30 this year have had the opportunity for this vaccination. Although not everyone did. And older women never had that opportunity.

This is why Louwers stresses the importance of participating in population screening. “We still have cases where women have to have their uterus removed when this could have been avoided if they had gotten a vaccine or a Pap smear.”

Research starting points

In addition to a lot of information, as with cervical cancer, the new atlas also raises questions. This also applies to two types of skin cancer: melanoma and squamous cell carcinoma. Both types of cancer are caused by exposure to ultraviolet light on the skin, but they are still different. Melanoma often arises due to a person getting burned at a young age, and squamous cell carcinoma is an “accumulation” of sunlight.

Newly calculated data show that melanomas are common in northern Holland, and few on the Zeeland coast. The picture is the exact opposite of the other type of skin cancer: this form of the disease is relatively common in the southern coastal regions. “We can’t properly explain why that is,” Lemmens says.

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Other types of skin cancer have been detected in different parts of the Netherlands.

“It could be because the genetic makeup of people who live in an area makes their skin types look similar,” suggests the professor. “We know in general that if people don’t study, many of them will continue to live in a particular area their entire lives.”

Over the past decade, both types of skin cancer have been diagnosed approximately 17,000 times a year. Squamous cell carcinoma was diagnosed more often (10,583 times) than melanoma (6,116 times).

social and economic environment

The environment matters when it comes to how much a person’s risk of developing a particular type of cancer is. For skin cancer, the sun-shaped nature is an important environmental factor. Lung cancer, one of the deadliest and most common types of cancer, is often determined by the socioeconomic environment.

In the case of lung cancer, the atlas shows clear boundaries between slums and affluent neighborhoods. Sometimes only separated by water or railways, the differences can be seen at a glance.

Take, for example, Amersfoort’s working-class neighborhood, Soesterkwartier. In the past 10 years, lung cancer was 60 percent more common there than the national average. The affluent neighborhood on the other side of the railway, Amersfoortse Berg, is 21 percent lower than the national average. big difference.

  • NOS/Chord Moisey

    The neighborhoods Soesterkwartier and De Berg in Amersfoort differ greatly in numbers on lung cancer.
  • NOS/Chord Moisey

    Map showing the number of lung cancer diagnoses by zip code area.

“It is very important that we do not point fingers at people who live and smoke in such a neighborhood,” Lemmens stresses. “There is more than just an individual choice to start smoking. Environmental factors therefore play an important role. If people live in certain neighbourhoods, they have less chances of getting a good education, less chances of getting a well-paying job, and having a hard life so there is a chance “Greater for stress. In an environment where smoking is normal, it is also difficult to stop this addiction. They resort to cigarettes to relax and as a result live less healthy.”

Lemmens argues that policy makers should take the lead in addressing such an unhealthy living environment. Research by the UMC Center in Amsterdam shows that there are disproportionately many tobacco outlets in poorer neighborhoods of medium-sized cities. Many of these tobacconists are located within walking distance of schools, which increases the risk of smoking from a young age.

“These are environmental factors that only governments can address,” Lemmens said. “Just like increasing excise duties on tobacco, alcohol and sugary products is a government monopoly. It’s a public measure, but we know from studies that it really helps reduce smoking in poor groups.”

There is no cancer without exposure

The case of asbestos cancer (mesothelioma) also clearly shows that the environment in which people work and live largely determines their risk of developing the disease. For example, the atlas shows that mesothelioma actually only occurs in areas where there used to be a lot of industries working with asbestos. Think shipyards.

The notion that an unhealthy environment greatly increases the risk of cancer becomes even more acute when only women with mesothelioma are considered.

  • NOS/Chord Moisey

    Map showing the number of asbestos cancer diagnoses in all people, by zip code area.
  • NOS/Chord Moisey

    Map showing the number of asbestos cancer diagnoses in women, by zip code area.

“Nationally, you see that men in particular got this disease, because they were the ones who worked with asbestos. So, women were protected from it,” Lemmens says. “But not in Twente, as there was a large asbestos factory in Goor. The men took home all kinds of semi-finished products containing asbestos, for example to build a shed. Then their women were also exposed to asbestos. That is why you note that mesothelioma among Women just happen to be in Twenty.”

Cancer related to mesothelioma is expected to occur less and less in the Netherlands. After all, with the ban on asbestos, exposure goes away. “Another example of how critical government intervention can be.”

But in Twente, according to Mens, it will still be visible for a few more generations. “The workers’ children are also exposed: Work clothes containing asbestos have been washed in the house. It could be decades before people get sick.”

Kim Pot participated in population screening for cervical cancer in 2020. The investigation saved her life, she says:

Kim: Without examining the population, I wouldn’t be able to tell this story

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