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Cancer is a bigger killer in developing countries than tuberculosis, malaria and AIDS combined and a “tsunami” of the disease threatens to overwhelm the nations worst equipped to cope, experts said Tuesday.

While only about 5 percent of global resources for cancer are spent in developing countries, the burden of the disease is far greater there, they said, with 60 percent of last year’s 7.6 million cancer deaths occurring in poorer nations.

Women-specific cancers like breast and cervical cancer, which account for more than a quarter of all female deaths worldwide, could be dramatically cut in low and middle-income nations by improving awareness and detection, they said.

“There are tens of millions of people living with cancer or at risk of cancer in low and middle-income countries who do not benefit from all these advances,” said Anne Reeler, who launched a report on cancer in poorer countries at the ECCO-ESMO European cancer congress in Berlin.

Reeler noted that while experts gathered in Berlin to discuss ground-breaking and often highly expensive medical advances that may help cancer sufferers in the rich world, poorer nations have almost no access to even the most basic treatments.

“In Ethiopia, for instance, what we often find is that by the time women come to a clinic they literally have a tumor protruding through the breast,” she said. “They’ve spent two years going to see traditional healers and using holy water, and when they come to clinics it’s too late to do anything for them.

“So awareness — getting rid of the myth that cancer kills and you can do nothing about it — is really important.”

Oncology experts expect a doubling of cancer cases across the world in the next 20 years and estimate that more than half of the 12.4 million new cases in 2008 occurred in low and middle income countries, a pattern predicted to continue.

David Kerr, a contributor to the report by a international cancer working group called CanTreat, and a professor of cancer medicine at Britain’s Oxford University, said this was “wake-up call” for those concerned about the developing world.

“If there is a coming tsunami of cancer, and there surely is, then now is when we need to start working together to develop new models of cancer care so that we are prepared for it in the developing world,” he told Reuters.

“We are facing a huge increase in cancer burden, and that burden will fall predominantly in those countries which are least well-equipped to deal with it — no infrastructure, no training, no docs, no nurses, no gadgets, no nothing.”

The CanTreat experts said in their report that changing lifestyles, aging populations, urbanization and infections all played a part in the rise in cancer.

The CanTreat report called on governments in developed nations to work with pharmaceutical and healthcare industries on new ideas for improving access to cancer medicines and diagnostics, including deals to cut drug prices.

The experts also urged health authorities in low and middle-income countries to improve education to encourage women to recognize possible signs of the disease and act quickly and without fear of stigma if they suspect they are ill.

CanTreat authors compared the current threat to that posed by AIDS in developing countries and by cancer in richer nations several decades ago.

“Cancer in developing countries now is like cancer in rich countries 30 years ago — there was little that could be done, and people were dying stigmatized,” said Joseph Saba, another CanTreat member. “The difference is that now we know what to do. Then we didn’t.”

Very light-skinned children who tan in the sun develop significantly more moles than their peers who stay pale in the sun, new research shows.

The number of moles a person has is among the strongest risk factors for developing melanoma, the most deadly form of skin cancer, so the findings suggest that parents of these children should take extra care to protect them from the sun’s rays, Dr. Lori A. Crane of the University of Colorado in Denver and her colleagues conclude in a report in the Archives of Dermatology.

While sunburns are known to increase melanoma risk, Crane and her team note in the report, the effect of tanning on skin cancer risk isn’t clear; in fact, some studies suggest it’s protective.

To investigate, they looked at 131 very-light-skinned children and 444 darker-skinned white kids born in Colorado in 1998. All underwent full-body mole counts at age 6, 7 and 8 years.

The researchers gauged their skin color using a device called a colorimeter. To determine whether or not the children tanned, they used the device to compare the color of their skin at the inside of their upper arm to the color of the skin on the outside of their lower arm.

At age 6, the average number of moles for the minimally tanned light-skinned children was 14.8, compared to 21.2 for the more darkly tanned children. At age 7, the paler kids had 18.8 moles, on average, while the tanned kids had 27.9 moles. By age 8, the untanned children had 22.3 moles, compared to 31.9 for the tanned kids.

But among the darker-skinned children, whether or not they were tanned made no difference in the number of moles they had on their bodies.

The current study didn’t determine whether the untanned children were simply unable to tan, or had been protected from the sun, Crane told Reuters Health. No matter what, she added, the findings suggest “there should be more careful protection of those children, which is probably not very surprising.”

And parents shouldn’t rely on sunscreen alone for shielding kids from the sun, the researcher added; while it can protect against sunburn, it doesn’t do a good job of preventing tanning.

Also, she added, parents may let their children stay out in the sun longer when they wear sunscreen, which could be harmful. Crane suggests protecting kids with lightweight, loose clothing, including hats, and avoiding the strong mid-day sun.

Binge drinking can weaken the body’s ability to fight infections for at least 24 hours, say U.S. researchers.

Binge drinking is defined as consuming large amounts of alcohol over a short period of time to deliberately get drunk.

In experiments with mice, the researchers found that binge drinking affects toll-like receptor 4 (TLR4), a protein that plays an important role in immune system activation. Specifically, heavy drinking suppresses TLR4’s ability to send signals that activate production of inflammatory cytokines — signaling molecules that begin the inflammatory response to infection.

The researchers also determined that binge drinking inhibits NF-B, a protein complex that controls DNA transcription and expression of some of the cytokines inhibited by alcohol.

“The time frame [after binge drinking] during which the risk of infection is increased might be at least 24 hours,” study author Stephen Pruett, of the College of Veterinary Medicine at Mississippi State University, said in a news release. “A persistent effect of ethanol on cells is indicated, such that inhibition of the response of some cytokines occurs even after the ethanol is cleared” from the body.

Fatigue isn’t the only contributor to medical errors among medical residents. A new study finds that financial woes, family concerns and other elements of distress also play a major role in potentially fatal mistakes.

Fatigue and distress among doctors are known causes of medical errors, but Mayo Clinic researchers say that theirs is the first study to show how each contributes to mistakes. And they recommend that distress be considered independently of fatigue when new training guidelines are considered.

“Changes to the process of physician training should address both resident fatigue and distress to improve resident and patient safety as both factors independently increase the risk of self-reported major medical errors,” said lead researcher Dr. Colin P. West, a internist at the Mayo Clinic in Rochester, Minn.

Fatigue, along with lower quality of life, burnout, depressive symptoms and other signs of distress, independently led to increased rates of self-reported major medical errors among internal medicine residents, West said.

“In fact, common levels of fatigue and distress are associated with double or triple the risk of these errors,” he said.

This is an important distinction, West said, because most current efforts to reform medical training that are intended to promote resident and patient safety have focused on fatigue.

“Our results support this, but suggest that specific attention to promoting resident well-being is needed as well,” he said. “We don’t know enough about effective ways to promote physician well-being, however, and further research is needed to answer this question.”

The report is in the Sept. 23/30 issue of the Journal of the American Medical Association.

Medical mistakes are a serious issue. Nearly 100,000 people in the United States die each year from preventable medical errors, according to a report in 1999 from the Institute of Medicine.

West’s team used data from 430 internal medicine residents, who were surveyed quarterly from 2003 through 2008. The survey asked about their medical errors, if any, as well as quality of life, fatigue, burnout, depression and sleepiness.

Among the 378 doctors who answered questions about medical errors, 39 percent said they had made at least one major error.

West’s group found a connection between these errors and fatigue. For every point increase in the fatigue score, doctors were 14 percent more likely to make a medical error. In addition, for every point increase in the sleepiness score, doctors were 10 percent more likely to err.

Medical errors were also linked to burnout, depression and overall quality of life, the researchers found.

Changes in how doctors are trained are making things better for doctors and safer for patients, said Dr. David J. Birnbach, a professor and vice provost of the University of Miami and associate dean and director of the UM-Jackson Memorial Hospital Center for Patient Safety at the Miller School of Medicine.

“We’ve known for a long time that fatigue in anyone is bad, and medical personnel who are very fatigued tend to make more errors,” he said. “We in the United States have made a dramatic change in the way we train residents to limit the number of hours they work. That’s regulated at a federal level.”

But more needs to be done, Birnbach said. “If you are distressed or fatigued, either of them will impact on your ability to function optimally,” he said. “At the end of the day, you are going to make more mistakes. Medical errors kill people.”

Birnbach said he’s concerned that, although residents are working shorter hours, no system exists to monitor whether they are tired or whether the hospital is complying with current regulations.

Also, he said, no mechanism is in place to deal with distress and fatigue among older practicing doctors, who make up the bulk of physicians. “We have not regulated the group that is most sensitive to sleep deprivation,” he said. “We have no rules for the 65- or 70-year-old practitioner.”

Regulating the hours residents can work in training is “a good start,” he said, “but eventually, we are going need to regulate everybody’s hours in medicine to increase the safety.”

In another report in the same issue of JAMA, doctors who participated in a program that included meditation, self-awareness exercises and stories of “meaningful clinical experiences” improved their well-being, had more empathy toward patients and were less “emotionally exhausted” or burned out, the researchers found.

The study demonstrated that primary care physicians participating in a continuing medical education program that focused on self-awareness experienced improved personal well-being, including burnout and improved mood, the researchers wrote.

“They also experienced positive changes in empathy and psychosocial beliefs, both indicators of a patient-centered orientation to medical care,” they said. Such changes are associated with positive patient associations, such as taking a patient’s experience of illness into account and promoting patients’ participation in care, the study concluded.