Impact: UV and cancer

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Impact: UV and cancer


Skin cancer accounts for over 80% of all new cases of cancer diagnosed in Australia each year[1]. Melanoma and non-melanoma skin cancer (NMSC) account for 44% of the cancers managed by general practitioners[2].

In 2016, skin cancer was the 19th most common cause of death in Australia[3]. A 2015 Australian study estimated that 7,220 melanomas and all NMSC occurring in Australia in 2010 could be attributed to UV radiation exposure[4].


Melanoma

Incidence and mortality

Australia has the highest incidence of melanoma in the world. Melanoma is rare in populations of non-European origin[5].

Excluding non-melanoma skin cancer, melanoma is the fourth most common cancer diagnosed in Australia; the third most common in Australian men (after prostate cancer and bowel cancer) and third most common in Australian women (after breast cancer and bowel cancer)[6].

Overall, melanoma incidence now exceeds that of lung cancer[6]. In Australia in 2013, 12,744 people were diagnosed with melanoma (7,513 men and 5,232 women)[7].

In Australia the lifetime risk (to age 75 years) of developing melanoma is one in 22 for men and one in 33 for women[7].

The survival rate of melanoma is among the highest of all cancers in Australia. In the period from 2007 to 2011, those diagnosed with melanoma had a 90% chance of surviving for at least five years compared with the general population[8]. Females tend to have higher survival than males: five-year survival in females is 94% compared with 88% for males[8].

There were 1,467 deaths from melanoma (988 men and 479 women) in Australia in 2014[7].


Trends

The incidence of melanoma in Australia increased by 151% in males and 46% in females from 1982 to 2007, however some of this increase may be due to improved detection methods over this time period[9]. From 2007 to 2020, a further increase in the incidence of melanoma is expected; 30% males and 18% females[9].

Mortality from melanoma rose steadily from 1931 to 1985, with rates increasing annually by 6% in men and 3% in women[10]. Since 1990 melanoma death rates in Australia have been relatively stable, but remain twice as high for men compared with women[11].

Among younger age groups (<25), melanoma incidence is stable[2]. This is believed to be due to a change in sun protection behaviours as a result of public education programs, although it may be partly related to a change in the racial mix in Australia’s population.


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Non-melanoma skin cancer

Incidence and mortality

NMSC is the most common cancer in Australia[12]. The most common types of NMSC are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

While BCC and SCC cases are not routinely reported to cancer registries, it is estimated that almost 434,000 Australians (equivalent to 2% of the population) were treated for one or more NMSCs in 2008: 296,000 for BCC and 138,000 for SCC[12].

NMSC is more commonly diagnosed in men than women, 253,000 males were treated for NMSCs in 2008, compared with 180,000 females[12].

In Australia in 2014, there were 600 deaths from NMSC (391 men and 209 females)[7]. Because NMSC cases are not reported to cancer registries, five-year survival data is not available.


Trends

The total number of NMSC treatments increased by 86% in the period between 1997 and 2010, from 412,493 to 767,347[13]. The number of treatments is estimated to increase by a further 22% between 2010 and 2015, to almost 939,000[13].

The estimated annual number of general practice encounters for NMSC increased by 14% over the seven-year period from 1998-2000 to 2005-2007, from 836,500 GP encounters to 950,000 GP encounters[12].

Although NMSC incidence has been increasing, NMSC excision rates declined significantly among men and women younger than 45 years in the period from 2000-2011, suggesting incidence rates are decreasing in young Australians[14].

Between 1968 and 2005 there was a slight overall decline in NMSC mortality rates, however from 1998 to 2005 the NMSC mortality rate was stable[12]. An increase in NMSC deaths among men from the mid-1980s to the mid-1990s is thought to be related to HIV/AIDS[10].


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Economic impact

NMSC is Australia’s second most expensive cancer[15]. In 2010, an estimated $511 million was spent on the diagnosis and treatment of NMSC[13]. This cost is expected to rise to $703.0 million by 2015[13]. The majority of NMSCs are treated by GPs; in 2014, 959,243 ($127.6 million) Medicare benefits claims were paid for NMSCs[8]. These figures do not include the cost of NMSCs treated in public hospitals or costs borne by individuals.

In 2007-08 it was estimated that health expenditure on NMSC comprised $225 million on hospital admitted patients, $133 million on out-of-hospital costs and almost $10 million on prescription pharmaceuticals[15]. This accounted for 8% of all cancer expenditure in Australia[15].

In 2014, nearly $9.4 million of Medicare benefits were paid for services related to melanoma[8].


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References

  1. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2006. Canberra: AIHW; 2007. Report No.: Cancer series no. 37. Cat. no. CAN 32. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454559.
  2. 2.0 2.1 Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia 2001. Canberra: AIHW; 2004 Dec. Report No.: Cancer series no. 28. Cat. no. CAN 23. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454484.
  3. Australian Bureau of Statistics. Causes of Death. [homepage on the internet] Canberra: ABS; 2017 Sep Available from: http://www.abs.gov.au/ausstats/abs@.nsf/0/47E19CA15036B04BCA2577570014668B?Opendocument.
  4. Olsen CM, Wilson LF, Green AC, Bain CJ, Fritschi L, Neale RE, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. Aust N Z J Public Health 2015 Oct;39(5):471-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437734.
  5. Severi G, English DR. Descriptive epidemiology of skin cancer. In: Hill D, Elwood JM, English DR. Prevention of Skin Cancer. Dordrecht, Netherlands: Kluwer Academic Publishers; 2004. p. 73-88.
  6. 6.0 6.1 Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2012. Canberra: AIHW; 2012. Report No.: Cancer series no. 74. Cat. no. CAN 70.
  7. 7.0 7.1 7.2 7.3 Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. [homepage on the internet] Canberra: AIHW; 2017 Feb 3 Available from: http://www.aihw.gov.au/acim-books/.
  8. 8.0 8.1 8.2 8.3 Australian Institute of Health and Welfare. Skin cancer in Australia. Canberra: AIHW; 2016 Jul. Report No.: Cat. no. CAN 96. Available from: https://www.aihw.gov.au/getmedia/0368fb8b-10ef-4631-aa14-cb6d55043e4b/18197.pdf.aspx?inline=true.
  9. 9.0 9.1 Australian Institute of Health and Welfare. Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW; 2012.
  10. 10.0 10.1 Giles G, Thursfield V. Trends in Cancer Mortality, Australia 1910–1999. Carlton: Cancer Epidemiology Centre, Anti-Cancer Council of Victoria; 2001. Report No.: 33. Available from: http://www.cancervic.org.au/downloads/cec/CanStats/33-Aus-cancer-mortality.pdf.
  11. Australian Institute of Health and Welfare.. ACIM (Australian Cancer Incidence and Mortality) books. Canberra: AIHW; 2015 Jan 8 Available from: http://www.aihw.gov.au/acim-books/.
  12. 12.0 12.1 12.2 12.3 12.4 Australian Institute of Health and Welfare, Cancer Australia. Non-melanoma skin cancer general practice consultations, hospitalisation and mortality. Canberra: AIHW; 2008 Sep. Report No.: Cancer series no. 43. Cat. no. CAN 39. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454591.
  13. 13.0 13.1 13.2 13.3 Fransen M, Karahalios A, Sharma N, English DR, Giles GG, Sinclair RD. Non-melanoma skin cancer in Australia. Med J Aust 2012 Nov 19;197(10):565-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23163687.
  14. Olsen CM, Williams PF, Whiteman DC. Turning the tide? Changes in treatment rates for keratinocyte cancers in Australia 2000 through 2011. J Am Acad Dermatol 2014 Mar 28 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24685358.
  15. 15.0 15.1 15.2 Australian Institute of Health and Welfare. Health system expenditure on cancer and other neoplasms in Australia 2008-09. Canberra: AIHW; 2013 Dec 16. Report No.: Cancer series 81. Cat. no. CAN 78. Available from: http://aihw.gov.au/publication-detail/?id=60129545611.

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