Impact

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Impact


UV exposure is responsible for 4.3% of Australia’s cancer burden, primarily due to melanoma and keratinocyte cancers (KCs) [1]. It is estimated that incidence of melanoma accounts for 10% of all cancers diagnosed in 2016[2]. Keratinocyte cancers (KCs) were estimated to be the most common form of cancer diagnosed in Australia in 2002 (most recent data available), with more KCs diagnosed each year than all cancers combined [3].

In 2016, skin cancer was the 19th most common cause of death in Australia[4]. An Australian study estimated that 7,220 melanomas and almost all KCs occurring in Australia in 2010 could be attributed to UV radiation exposure[5].

Melanoma

Incidence and mortality

Australia has the one of the world’s highest incidence of melanoma [6]. In 2015, melanoma was the third most common cancer diagnosed in both Australian men (after prostate cancer and bowel cancer) and women (after breast cancer and bowel cancer) [7] In 2015, 13,694 people were diagnosed with melanoma (7,990 men and 5,704 women)[7].

The survival rate of melanoma is among the highest of all cancers in Australia. In the period from 2011 to 2015, those diagnosed with melanoma had a 91% chance of surviving for at least five years. Five-year relative survival was higher for women compared with men (94% vs 89%) [7].

In 2016, there were 1,281 deaths from melanoma (863 men and 418 women) in Australia[8].

Trends

The age-standardised incidence rate for melanoma increased by 93% between 1982 and 2015 from 27 cases per 100,000 persons to 52 cases per 100,000 persons [7], however some of this increase may be due to improved detection methods over this time period[9].

Mortality from melanoma rose steadily from 1931 to 1985, with rates increasing annually by 6% in men and 3% in women[10]. Between 1990 and 2016, mortality rates for men almost doubled, whereas for women it has remained relatively stable [7].

Among people under 40, melanoma incidence is declining[2]. This is believed to be due to a change in sun protection behaviours as a result of public education programs [11][12].

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Keratinocyte cancers

Incidence and mortality

Keratinocyte cancers (KCs) is the most common cancer in Australia, however data on incidence are not routinely collected[13]. The most common types of KC are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The estimated age-standardised rate for BCC and SCC were 770 per 100,000 and 270 per 100,000 person-years respectively [14]. In 2016, there were 679 deaths from KC in Australia (AIHW 2019). In 2011-2015, individuals diagnosed with KC had a 71% relative chance of surviving at least 5 years [7].

While BCC and SCC cases are not routinely reported to cancer registries, it is estimated that almost 434,000 Australians were diagnosed with one or more KCs in 2008; 296,000 for BCC and 138,000 for SCC[13].KC is more commonly diagnosed in men than women; in 2008, 253,000 males compared with 180,000 females [13].

Trends

The total number of treatments for KCs increased by 86% between 1997 and 2010, from 412,493 to 767,347[15].

The majority of KCs are treated by general practitioners. In 2014, 40,179 Medicare benefits claims were paid for 959,243 procedures for non-melanoma skin cancer [2].

Although KC incidence has been increasing, KC 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[16].

Between 1968 and 2005 there was a slight overall decline in KC mortality rates, however from 1998 to 2015 the KC mortality rate was stable(ACIM 2017). An increase in KC 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

The cost burden of treatment for melanoma in Australia has increased from an estimated $30 million in 2001 to $272 million in 2017. [17] In 2015-16, pharmacotherapies cost the Australian government $92.3 million for an estimated 1,100 new annual cases of advanced melanoma.[18] The mean cost of treatment per patient with melanoma was $10,716 and increased to an estimated mean cost of $14,606 three years post-diagnosis[17].

Due to the high number of KCs treated each year, KCs are one of the most expensive cancers in Australia.. In New South Wales alone, KC costs accounted for 68% ($365 million) of total lifetime economic costs in 2010, and 90% of total direct costs - $347 million ($2,336 per case). [19] During the same period, the total MBS benefit for KC treatments was $93.5 million.[15]

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References

  1. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Canberra: AIHW; 2019 [cited 2019 Jul 25]. Report No.: Australian Burden of Disease series no. 19. Cat. no. BOD 22. Available from: https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true.
  2. 2.0 2.1 2.2 Australian Institute of Health and Welfare. Skin cancer in Australia. Canberra: AIHW; 2020 [cited 2020 Sep 10] Available from: https://www.aihw.gov.au/reports/cancer/skin-cancer-in-australia/summary.
  3. National Cancer Control Initiative Skin Cancer Working Group. The 2002 national non-melanoma skin cancer survey. Melbourne: NCCI; 2003 [cited 2020 Sep 10].
  4. 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.
  5. 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.
  6. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today. [homepage on the internet] Lyon, France: International Agency for Research on Cancer; 2018 [cited 2019]. Available from: https://gco.iarc.fr/today.
  7. 7.0 7.1 7.2 7.3 7.4 7.5 Australian Institute of Health and Welfare. Cancer data in Australia. Canberra: AIHW; 2020 [cited 2020 Sep 10]. Report No.: Cat no. CAN 122. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/acim-books.
  8. Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. [homepage on the internet] Canberra: AIHW; 2017 Available from: http://www.aihw.gov.au/acim-books/.
  9. 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. Whiteman DC, Green AC, Olsen CM. The Growing Burden of Invasive Melanoma: Projections of Incidence Rates and Numbers of New Cases in Six Susceptible Populations through 2031. J Invest Dermatol 2016 Jun;136(6):1161-1171 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26902923.
  12. Aitken JF, Youlden DR, Baade PD, Soyer HP, Green AC, Smithers BM. Generational shift in melanoma incidence and mortality in Queensland, Australia, 1995-2014. Int J Cancer 2018 Apr 15;142(8):1528-1535 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29105744.
  13. 13.0 13.1 13.2 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.
  14. Pandeya N, Olsen CM, Whiteman DC. The incidence and multiplicity rates of keratinocyte cancers in Australia. Med J Aust 2017 Oct 16;207(8):339-343 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29020905.
  15. 15.0 15.1 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.
  16. 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.
  17. 17.0 17.1 Elliott TM, Whiteman DC, Olsen CM, Gordon LG. Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis. Appl Health Econ Health Policy 2017 Dec;15(6):805-816 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28756584.
  18. Department of Human Services. Pharmaceutical Benefits Schedule Item Reports. [homepage on the internet] Canberra: Commonwealth of Australia; 2020 Aug 28 [cited 2020 Oct 22]. Available from: http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp.
  19. Doran CM, Ling R, Byrnes J, Crane M, Searles A, Perez D, et al. Estimating the economic costs of skin cancer in New South Wales, Australia. BMC Public Health 2015 Sep 23;15:952 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26400024.

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