Ultraviolet (UV) radiation is both the major cause of skin cancer and the best natural source of vitamin D. Australia has one of the world’s highest skin cancer rates, with 1,857 people dying in 2008 from melanoma and non-melanoma skin cancer (NMSC) combined – more than the national road toll. The cost to the health system is enormous – NMSC alone incurs the second highest health expenditure of any cancer type in Australia, costing over $367 million annually. Yet most skin cancers are preventable through appropriate protection from UV radiation.
Skin cancer includes cutaneous melanoma and NMSC, namely basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). From as early as the 1950s and '60s, concern over high skin cancer rates led to limited community education campaigns in Victoria and Queensland. These campaigns aimed to raise public awareness about skin cancer and to increase health professionals’ early detection of skin cancer.
Since the 1980s, more extensive public health programs aimed at preventing excessive exposure to UV radiation have been implemented across Australia by non-government cancer organisations and government health services. The ‘Slip! Slop! Slap!’ and SunSmart slogans, developed in 1980 and 1987 by Cancer Council Victoria, have been the themes of many campaigns and are well recognised by Australians in relation to sun protection.
Today the key sun protection messages have expanded to ensure a focus on individual and environmental strategies, including slip on sun-protective clothing, slop on sunscreen with a rating of SPF30 or higher, slap on a hat, seek shade and slide on sunglasses. The focus of these skin cancer prevention programs has been on reducing the potential harm of skin cancer by decreasing exposure to UV radiation and increasing early detection and effective treatment. In more recent years Cancer Council has also taken a leadership role in promoting a balance between the benefits and harms of UV radiation exposure, in the context of the links between UV exposure and vitamin D.
Despite the challenges of evaluating programs aimed at changing sun protection behaviour, evidence of the effectiveness and cost-efficiency of programs in Australia and overseas is accumulating. It is estimated that the maintenance of the SunSmart program at $0.24 per capita per annum will yield a $2.32 saving in return for every dollar spent on the program. Research is increasingly linking public health programs that encourage behaviour change to reductions in incidence and mortality.
Investment in skin cancer prevention over three decades has produced a body of evidence, collected largely by Cancer Councils, showing the effectiveness of such health promotion programs. Research shows that such programs have led to increased awareness of skin cancer prevention and improved sun protective behaviours. Skin cancer rates would be expected to decline as a result.
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