High burden of skin cancer continues to rise

Morgan Liotta

11/03/2022 4:09:57 PM

Around two in three Australians will develop skin cancers in their lifetime − and that rate is steadily increasing according to fresh research.

Picture of an Australian beach
Over the past 30 years, Australia’s skin cancer rates have increased by up to 6% a year, with older men more at risk.

Australia’s sunshine has a dark side, with the climate also causing one of the world’s highest rates of skin cancer.
Now new research has reported an annual rise in non-melanoma skin cancers of around 2–6% over the past 30 years, highlighting the need for continued investment in education and prevention.
Non-melanoma skin cancers, known as keratinocyte cancers, are the most common cancers in Australia, with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) the two main types.
BCC accounts for around 70% of keratinocyte cancers, with rates higher in males.
Although mortality from keratinocyte cancers is relatively low in Australia, morbidity rates are significant.
The research, published this week in the Public Health Research & Practice journal, estimates that 69% of Australians (73% of men and 65% of women) will have at least one excision for histologically confirmed keratinocyte cancer in their lifetime.
The study suggests the increase has been highest among people aged 55 years and older, and that the rate is likely to rise further as the population ages.
RACGP Specific Interests Dermatology Chair Dr Jeremy Hudson is ‘not at all’ surprised by these findings, particularly for the older population.
‘Generation X is coming of age,’ he told newsGP.
‘They didn’t grow up with “Slip Slop Slap”, and we are planning to see a spike of skin cancers in 10 years’ time unless very robust education and preventive action is taken.’
The study reviewed the most recent population-based estimates of keratinocyte cancer incidence in Australia from 2001−2021. It revealed trends over time and calculated the lifetime risk of developing these cancers by adopting methods used by Cancer Research UK, which adjust for the competing risk of death.
Dr Hudson said the research is an important reminder of general practice’s place in the early detection and prevention of skin cancers through education.
‘Australian GPs are quite skilled at detecting skin cancers and are not only picking them up at increasing rates, but also diagnosing them at an earlier stage,’ he said.
‘GPs have an absolutely key role and continue to diagnose and manage the vast majority of skin cancers in Australia, particularly in rural, remote and low [socio-economic] areas.
‘We are seen as having the gold standard internationally and can be very proud of this.
‘General practice-based prevention, screening and management is incredibly effective for patient outcomes and saves the government millions of dollars annually.’
However, Dr Hudson believes that more investment is needed in general practice for this standard to continue.
‘GPs need far more recognition and remuneration for their work, and I have nothing but awe and respect for GPs who manage a busy workload in a bulk-billed practice and are expected to opportunistically screen for skin cancers as well,’ he said.
‘It is as clear as day that if we want a quality health system − including effective management of skin cancers − there needs to be more support for all GPs educationally and financially.’ 
Unlike melanomas, data on keratinocyte cancers is not recorded in state and territory cancer registries except in Tasmania, despite causing ‘substantial morbidity and treatment costs’ according to the study authors. 
As a result, they believe the data is out of date, of moderate quality and not routinely available, despite indications of very high rates of keratinocyte cancer in Australia.
‘This high and increasing burden of skin cancer emphasises the need for continued investment in skin cancer education and prevention,’ the authors write.
They recommend that population-based cancer registries work towards statutory notification and routine reporting of all keratinocyte cancers to monitor trends by obtaining accurate and up-to-date statistics across all jurisdictions.
Having reliable estimates of disease incidence is ‘fundamental’ to inform preventive measures, monitor their success, and plan for future healthcare services, the authors conclude.
Measures include support for national mass-media campaigns about the need for sun protection to prevent sunburn and skin cancer, implementation of additional regulatory measures to protect children and workers from the harms of overexposure to sun, and the provision of shade in public and spectator settings.
Dr Hudson agrees.
‘[Population-based cancer registries and routine reporting] would give much better data than Medicare,’ he said.
‘[Promoting] modifiable risk factors are also very important, and we are already developing some written management plans for GPs as part of a broader support rollout. 
‘UV exposure is still a big issue, and effective management of this alone could probably achieve another 30% reduction in cancers.’
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keratinocyte cancers lifetime risk non-melanoma cancers skin cancer

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