Skin cancer in Australia

Over 2,000 Australians die each year from skin cancer, with more than 750,000 diagnosed and treated.[1] Tanning has been imbedded in Australian culture, and is still proving to be a controversial issue, with a large amount of data correlating tanning with increased risk of developing melanoma but continuing to maintain popularity amongst teens and solariums users.[2] Australia has experienced relative success through skin cancer prevention campaigns started in the 1980s, and continues to invest and promote awareness through a variety of government funded mass media strategies.[3] Although Australia still has one of the highest international rates of skin cancer, it has experienced a relative stabilisation of mortality trends in melanoma.[4]

Tanning and skin cancer

sun bed tanning

Australia has long culturally identified with the "bronzed Aussie" stereotype, viewing it as a healthy desirable image associated with recreational sporting and exercise orientated life styles. With over 90% of melanomas derived through contact with the sun,[4] skin cancer preventative initiatives in Australia are striving to change this perception.

Solariums and tanning salons are widely used and available throughout Australia. Tanning has been a phenomenon since the 1800s, with medical use of phototherapy, emerging popularity of sunbathing, and in the 1970s, with tanning salons and solariums becoming increasingly popular, had developed into a worldwide tanning industry.[5] Although the tanning industry in Australia is relatively small by international standards, it has quadrupled in size since 1992.[6] The tanning industry promotes tanning as a process to stimulate higher levels of vitamin D, associating it with reduced likelihood of sunburn and skin cancer, with increased well being and feelings of happiness.[5]

Solarium regulation in Australia

In Australia, the solarium industry is regulated on a state by state basis. The first states to regulate solarium use were Victoria, South Australia and Western Australia in 2008 following the death of skin cancer victim Clare Oliver.[7][8][9][10] The 2008 regulations cited that solarium operators must be licensed, unsupervised solariums were banned and health warnings must be displayed. In Victoria, those under the age of 16 and people with fair skin were banned from using solariums and those aged 16 and 17 were required to have parental consent whereas in South Australia and Western Australia, an outright ban for the under 18s was applied.[7]

In February 2009, the Victorian Government introduced further changes to the management licence for tanning units, including applying a ban for the under 18s, consistent with the revised Australian standard, released in January 2009. Victorian solarium legalisation was revised in late 2010, strengthening some controls around sighting evidence of age documents in relation to excluding persons under 18.[11][12][13][14]

The Australian standard requires that operators must:[12] (a) ban people under 18 years of age from using their solarium, (b) cite evidence-of-age documents for clients who may be under 18, (c) ban people with very fair skin (skin type I) from using their solarium, (d) display mandatory health warnings, (e) provide a consent form outlining the risks of solarium use for customers to read and sign, (f) complete a skin assessment of all clients, (g) ensure all staff have completed training in carrying out skin assessments and determining exposure times, and (h) ensure clients wear protective eyewear.

New South Wales, Queensland, ACT and Tasmania introduced legislation applying these standards in 2009 and 2010.[15][16][17][18] In 2011, the New South Wales government called for public submissions in relation to a proposal to extend the age ban from using solariums to those under 30. In February 2012 the New South Wales Government announced its intention to ban tanning beds, starting in 2014.[19] In October 2013, the Victorian parliament passed an official ban on solariums, which will take effect by 2015.[20]


Ultraviolet radiation and skin cancer

Melanoma, basal cell carcinomas and squamous cell carcinomas are predominantly caused by exposure to ultra violet radiation (UVR), and both UVA and UVB radiation has internationally been categorised as carcinogenic, by medical experts.[6] Artificial UVR primarily used in tanning salons and sunbeds, has generated concern amongst health officials and in a 2006 review it was observed to considerably heighten the risk of developing cutaneous malignant melanoma.[6] An Australian study in 2010, found that there was strong eveidence supporting association between indoor tanning salon use and increased risk of developing melanoma.[2] The study demonstrated strong correlations between increased risk of melanomas and carcinogenic ultraviolet radiation related outcomes.[2] These increased risks were specifically associated with participants of younger ages,[2] with tanning and solarium use relatively popular amongst teens and young adults. An increase of 59% in risk of developing melanoma was associated with people who used sun beds before they were 35.[21]

Skin cancer awareness in Australia

Australia accompanied by New Zealand, has the highest rates of skin cancer in the world.[22] Some factors for elevated skin cancer rates include the large percentage of the population with fair skin prone to skin cancers and the high levels of UV radiation prominent in Australia.[3] In order to maintain effective prevention and national awareness Australia has used a variety of campaigns and initiatives since the early 1980s.[3] The Slip, Slop, Slap campaign was initiated in 1981. Hugely successful, it introduced a seagull singing a catchy jingle “Slip on a shirt! Slop on some sunscreen! and Slap on a hat!”, promoted awareness and stuck into the psyche of Australian culture.[3] It was so successful that it still remains part of the SunSmart slogan today, which has been updated to, Slip, Slop, Slap, Slide (on sun glasses), Seek (shaded areas).[23]SunSmart began in 1987, an Australian foundation focused on promoting skin cancer awareness. Social education, challenging societal and cultural ideals, still remains part of SunSmart's methods for promoting awareness and through its many successes now functions throughout all of Australia, under state Cancer Councils.[3]

The first government funded mass media skin cancer initiative was released in Australia during 2006.[3] Its confronting, challenging and informative skin cancer awareness message was delivered to the Australian public through radio, television and printed mediums.[3]

Australians soaking up the sun at a beach in Byron Bay N.S.W.

Media promotion and education remains a vital and effective tool in Australian skin cancer awareness strategy. Although its largely effective there are still members of the public who remain indifferent or unaware of the risks caused by inefficient sun protection and skin care.[24] Preventative campaigns in the media require constant ongoing investment and commitment to maintain beneficial outcomes of skin cancer awareness.[3]

Skin cancer mortality in Australia

Metastatic melanoma cells

Skin cancer has three main forms: basal cell carcinoma, squamous cell carcinoma and melanoma.[22] Non-melanoma carcinomas (basal cell and squamous cell carcinoma) are the most prevalent form of skin cancers diagnosed throughout Australia.[22] Although generally non-melanoma carcinomas have lower associations with mortality than melanomas, fatalities still do occur with 534 reported deaths in 2011.[25] 434,000 Australians in 2008 underwent treatment for non-melanoma carcinomas.[25] Melanomas have the highest correlation with mortality, with 1,544 deaths recorded in Australia in 2011.[25] Australia shares with New Zealand, the highest diagnosis of melanoma throughout the world and also has the highest work wide diagnosis of non-melanoma carcinomas.[22]

Trends in Australian melanoma mortality

Skin cancer prevalence on an international scale. Yellow indicating the least and red indicating the highest prevalence.

Australia has recorded increased mortality rates of melanoma from the 1950s, continuing to rise till the late 1980s, and beginning to steady from 1990 onwards.[4] Although there has been stabilising and a decreasing trend in melanoma fatality, Australia still has some of the highest melanoma related fatalities in the world and double the mortality rates of south and central Europe.[4] Notably the introduction of preventative campaigns correlate with the beginning of transitioning to stability and decreases in melanoma mortality. Sun protection, other forms of primary protection, early detection and increased public awareness have had the most effective outcomes on melanoma mortality prevention.[4]

Prevention

Awareness and early detection are the most efficient tools for avoiding skin cancer, and are the basis of many effective prevention campaigns in Australia. Prevention initiatives such as SunSmart promote awareness by advocating effective sun protective methods, sun risk awareness and are an integral part of skin cancer prevention. SunSmart recommends wearing protective clothing,[26] hats,[27] sunscreen,[23] seeking shade[28] from the sun and wearing UV protective eye ware.[29] SunSmart also provides a wide range of recommendations on how to choose the right protective clothing, hats, sunscreen and eye ware for UV protection.[26] Having regular skin checks is also an important step in the prevention of skin cancer.

Currently the standard for skin cancer screening in Australia is that of self-assessment and occasional clinic screening.[30] Consistent with Australian guidelines for public skin cancer screening, the Cancer Council Australia doesn’t recommend annual or regular skin assessment on the basis, low national melanoma occurrences don’t financially justify national public screening, non-melanoma carcinomas relatively low mortality and GP screening accuracy is varied.[30] In 2003 a study analysing the effectiveness of skin cancer screening was implemented in northern Germany.[30] Doctors in the study were provided with 8 hours of training and over a year screened 19% of Schleswig-Holstein’s population.[30] Initially there was an increase of 34% in melanoma detection and after 5 years the population experienced over 50% decrease in melanoma mortality demonstrating the positive outcomes of public screening.[30]

Economic implications of prevention campaigns

Australia spends more than $2 Billion on treating cancer every year,[31] with skin cancer being the most costly cancer, on average $300 million spent annually over the last decade, and with $512.3 million spent in 2010 on diagnosis, treatment and pathology related costs of non melanoma carcinomas[21] costs are continuing to rise. Prevention initiatives make up an important part of financial expenditure for skin cancer funding and investments. Prevention programs are a productive tool, as they beneficially influence attitudes and behaviours towards skin cancer, but also deliver positive growth on investments.[3] Evaluating the economic benefits of prevention programs such as SunSmart was recently analysed in an Australian study.[32] It was observed that SunSmart prevented 103,000 skin cancers and more than 1000 related fatalities from 1988-2003.[32] SunSmart demonstrated positive growths in health, was seen to be cost effective and during the Victoria-based program returned $3.60 for every $1 invested.[32] The study concluded there was strong evidence that continued investment and support for SunSmart was economically sound and presented beneficial outcomes for Australia.[32]

See also

References

  1. ↑ "Skin cancer facts & stats - SunSmart". Skin cancer facts & stats - SunSmart. Retrieved 2015-08-30.
  2. 1 2 3 4 Cust, Anne E.; Armstrong, Bruce K.; Goumas, Chris; Jenkins, Mark A.; Schmid, Helen; Hopper, John L.; Kefford, Richard F.; Giles, Graham G.; Aitken, Joanne F. (2010-01-01). "Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma". International Journal of Cancer 128 (10). doi:10.1002/ijc.25576. PMC 2993823. PMID 20669232.
  3. 1 2 3 4 5 6 7 8 9 Sinclair, C.; Foley, P. (2009-11-01). "Skin cancer prevention in Australia". British Journal of Dermatology 161: 116–123. doi:10.1111/j.1365-2133.2009.09459.x. ISSN 1365-2133.
  4. 1 2 3 4 5 Baade, Peter; Coory, Michael (2005-08-01). "Trends in melanoma mortality in Australia: 1950–2002 and their implications for melanoma control". Australian and New Zealand Journal of Public Health 29 (4): 383–386. doi:10.1111/j.1467-842X.2005.tb00211.x. ISSN 1753-6405.
  5. 1 2 Levine, Jody A.; Sorace, Michael; Spencer, James; Siegel, Daniel M. (2005-01-01). "The indoor UV tanning industry: A review of skin cancer risk, health benefit claims, and regulation". Journal of the American Academy of Dermatology 53 (6). doi:10.1016/j.jaad.2005.07.066.
  6. 1 2 3 Hirst, Nicholas; Gordon, Louisa; Gies, Peter; Green, Adèle C. (2009-01-01). "Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia". Health Policy 89 (3). doi:10.1016/j.healthpol.2008.07.003.
  7. 1 2 Victorian Government. Radiation (Tanning Units Amendment) interim regulations 2007 Under section 139 of the Radiation Act 2005. Vol. STATUTORY RULE No. 148/2007, 2007.
  8. ↑ South Australia. Radiation protection and control (cosmetic tanning units) regulations 2008 under the Radiation protection and control act 1982, 2008.
  9. ↑ Radiation Safety Act 1975 Radiation Safety (General) Regulations 1983. Western Australia, 2008.
  10. ↑ Makin J, Dobbinson SJ. Changes in solarium numbers in Australia following negative media and legislation. Australian & New Zealand Journal of Public Health 2009; 33 (5): 491-494.
  11. ↑ Victorian Government. Radiation Amendment (Tanning Units and Fees) Regulations 2008 Under section 139 of the Radiation Act 2005. Vol. STATUTORY RULE No. 167/2008, 2008.
  12. 1 2 Standards Australia/Standards New Zealand. Australian/New Zealand Standard AS/NZS 2635 (Solaria for cosmetic purposes): Standards Australia/Standards New Zealand, 2008.
  13. ↑ Gies P, Javorniczky J, Henderson S, McLennan A, Roy C, Lock J, Lynga C, Melbourne A, Gordon L. UVR emissions from solaria in Australia and implications for the regulation process Photochemistry and Photobiology 2011; 87 (1): 184-190.
  14. ↑ Department of Health. Management licence conditions for the possession of a commercial tanning unit. Melbourne: Victorian Government, 2011.
  15. ↑ New South Wales Government. Radiation control regulation 2003 made under the Radiation Control Act 1990, as at 29 May 2009. Reg 615 of 2003. Part 4A - Tanning units, 2009.
  16. ↑ Queensland Health. Section 47A, Radiation Safety Act 1999, 2009.
  17. ↑ Australian Capital Territory. Radiation Protection (Tanning Units) Amendment Regulation 2010 (No 1) made under Radiation Protection Act 2006. Subordinate Law SL2010-29, 2010.
  18. ↑ Department of Health and Human Services Tasmania. Guidelines for the operation of solaria in Tasmania. Public Health Act 1997. Population Health, ed. Hobart, Australia: Department of Health and Human Services Tasmania, 2009.
  19. ↑ "Solariums banned across NSW". ABC News (Australia). 4 February 2012. Retrieved 4 February 2012.
  20. ↑ "Tan ban passes Vic parliament". News.com.au. 2013-10-15. Retrieved 2013-10-15.
  21. 1 2 "Skin cancer facts & stats - SunSmart". Skin cancer facts & stats - SunSmart. Retrieved 2015-08-29.
  22. 1 2 3 4 Girschik, J.; Fritschi, Lin; Threlfall, T.; Slevin, T. (2008-04-02). "Deaths from non-melanoma skin cancer in Western Australia". Cancer Causes & Control 19 (8): 879–885. doi:10.1007/s10552-008-9150-9. ISSN 0957-5243.
  23. 1 2 "Sunscreen - SunSmart". Sunscreen - SunSmart. Retrieved 2015-08-30.
  24. ↑ Turner, Jessica. "Despite one of the worst skin-cancer rates in the world, and a beach bag full of awareness campaigns over the years, [online]".
  25. 1 2 3 Australia, Cancer Council. "Non-melanoma - Cancer Council Australia". www.cancer.org.au. Retrieved 2015-08-27.
  26. 1 2 "Sun protective clothing - SunSmart". Sun protective clothing - SunSmart. Retrieved 2015-08-30.
  27. ↑ "Sun protective hats - SunSmart". Sun protective hats - SunSmart. Retrieved 2015-08-30.
  28. ↑ "Shade - SunSmart". Shade - SunSmart. Retrieved 2015-08-30.
  29. ↑ "Sunglasses - SunSmart". Sunglasses - SunSmart. Retrieved 2015-08-30.
  30. 1 2 3 4 5 Sinclair, Rodney (2012). [http://search.informit.com.au.ipacez.nd.edu.au/documentSummary;dn=581077450891977;res=IELHEA> "Skin Checks"]. Australian Family Physician.
  31. ↑ "Cancer Statistics Australia | ACRF". ACRF. Retrieved 2015-08-29.
  32. 1 2 3 4 Shih, Sophy Ting-Fang; Carter, Rob; Sinclair, Craig; Mihalopoulos, Cathrine; Vos, Theo (2009-01-01). "Economic evaluation of skin cancer prevention in Australia". Preventive Medicine 49 (5). doi:10.1016/j.ypmed.2009.09.008.
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