Omari Gates
Australia has the highest skin cancer rates in the world, with around 37 cases of melanoma per 100,000 people in 2020. The country's proximity to the equator, high ultra-violet (UV) radiation levels, and a predominantly fair-skinned population are key factors contributing to this. It is estimated that over 750,000 people are diagnosed and treated for skin cancer in Australia annually, with more than 2,000 deaths each year.
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What You'll Learn
Skin cancer prevention campaigns
Skin cancer is a pressing health issue in Australia, with the country recording the highest skin cancer rates worldwide. The combination of a high percentage of fair-skinned individuals in the population and high ambient UV radiation levels are key factors in this high prevalence. As a result, various skin cancer prevention campaigns have been launched to address this issue.
One notable campaign is SunSmart, which has been in operation since the 1980s. SunSmart aims to promote awareness and provide education about sun protection and sun risk. It recommends protective measures such as wearing suitable clothing, hats, and sunscreen, seeking shade, and using UV-protective eyewear. SunSmart has been successful in reaching the general community as well as high-risk groups, including outdoor workers, schoolchildren, and youths.
Another campaign, "No Tan Is Worth Dying For," has also been implemented to encourage people to avoid sun exposure and the pursuit of tanned skin. This campaign targets individuals who may actively seek a tan, aiming to shift their attitudes and behaviours towards sun protection.
The Australian government has also conducted mass-media campaigns to raise awareness about skin cancer prevention and early detection. These campaigns have utilised radio, television, print, social media, and smartphone apps to reach a wide audience. The messages and content of these campaigns have evolved over time to match current media trends and target specific audiences, including both the general community and hard-to-reach groups.
In addition to these national campaigns, state-specific initiatives have also been undertaken. For example, the Cancer Institute NSW has delivered public education campaigns since 2005 to reduce skin cancer rates in the state. One such campaign, "Change Your Routine," aimed to alter people's attitudes towards sun safety.
These skin cancer prevention campaigns have contributed to a decrease in melanoma mortality rates and a reduction in the incidence of skin cancer, particularly among young people. However, sustained and long-lasting behaviour changes remain a challenge, requiring continuous public health efforts to maintain sun protection awareness and early detection practices.
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Skin cancer treatment costs
Skin cancer is the most common cancer in Australia, with nearly one in three Australians living with cancer in 2017-18 having skin cancer. It is estimated that over 750,000 people are diagnosed and treated for skin cancer in Australia each year, with around 2,000 deaths from the disease annually. The high incidence of skin cancer in Australia is attributed to a combination of factors, including the country's proximity to the equator, resulting in higher intensity ultraviolet radiation (UVR), and the high percentage of fair-skinned individuals in the population, who are more prone to skin cancer.
The economic impact of skin cancer in Australia is significant, with annual treatment costs of around A$1.9 billion. The cost of skin cancer can be categorised into direct and indirect costs. Direct costs include expenses related to the management of skin cancer, such as diagnosis, treatment, and follow-up care, utilising healthcare resources like hospitals, medical services, and allied health care services. Indirect costs are associated with lost productivity due to an individual's inability to work, including morbidity costs such as sick leave and early retirement, as well as premature mortality, defined as death before the age of 65 in Australia.
In New South Wales (NSW), a review of 150,000 skin cancer patients in 2010 revealed a total lifetime cost estimation of AU$536 million, with 72% related to direct costs and 28% to indirect costs. The direct costs were higher for females, while indirect costs were higher for males.
The mean 12-month cost per person for keratinocyte carcinoma was A$525, while for melanoma, it was A$11,787. The cost of skin checks and subsequent treatments also varies, with skin checks billed as general practitioner (GP) consultations ranging from A$58 without subsequent healthcare to up to A$595 for melanoma excisions.
The Australian government subsidises the diagnosis and treatment of skin cancers, including keratinocyte carcinomas, through Medicare. Prevention initiatives and campaigns, such as SunSmart, also play a crucial role in reducing the financial burden of skin cancer by promoting sun protection, early detection, and public awareness.
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Melanoma mortality rates
Australia has the highest melanoma rates in the world, with the disease often referred to as "Australia's national cancer". The country has recorded increased mortality rates from the 1950s, which continued to rise until the late 1980s and began to stabilise from 1990 onwards. In 1982, 596 people died from melanoma in Australia, with the number increasing to 1,411 in 2022. The age-standardised mortality rate, however, remained similar over this period, at 5.6 deaths per 100,000 persons in 1982 and 5.5 deaths per 100,000 in 2022.
In 2016, it was estimated that 1,770 people would die from melanoma in Australia, with the age-standardised mortality rate at 6.2 deaths per 100,000. In 2022, melanoma was the tenth most common cause of cancer death in the country, with 1,411 deaths (982 males and 429 females). It is estimated that in 2024, there will be 1,340 deaths (892 males and 448 females), and a person will have a 1 in 272 (or 0.4%) risk of dying from melanoma by the age of 85.
Mortality rates vary across different areas of Australia. During the period 2015-2019, Inner Regional areas had the highest mortality rates, with 5.8 deaths per 100,000, followed by Outer Regional (5.5), Remote (5.1), and Very Remote (34.9). Major Cities had the lowest mortality rate, with 4.4 deaths per 100,000 people.
The risk of mortality from skin cancer is higher for men, with 66% of Australians who die from the disease being male. The introduction of preventive campaigns has correlated with the transition to decreases in melanoma mortality, with sun protection, early detection, and increased public awareness having the greatest impact. The five-year relative survival rate for melanoma has increased over time, rising from 90.0% between 1991-1995 and 2016-2020 to 94.1% in the latter period.
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Non-melanoma skin cancers
Skin cancer is primarily caused by skin cell damage due to overexposure to ultraviolet (UV) radiation from the sun. Indeed, between 95% and 99% of skin cancers in Australia are sun-induced. The risk factors for skin cancer include having an increased number of unusual moles, fair skin, a tendency to burn rather than tan, freckles, light eye colour, and light or red hair colour.
In 2021, Medicare recorded approximately 890,000 histologically confirmed NMSCs removed from Australians, and this number is increasing by about 2% annually. Additionally, Medicare data reveals over 1,100,000 paid Medicare services for non-melanoma skin cancers each year, translating to more than 3,000 treatments daily. According to estimates, at least two in three Australians will be diagnosed with skin cancer at some point in their lives, with a higher risk for men than women.
The treatment options for non-melanoma skin cancers depend on the type, size, and location of the cancer. Typically, a biopsy is performed to determine the stage of the cancer. In cases of SCC, lymph nodes may be examined to check for cancer spread. While non-melanoma carcinomas generally have lower mortality associations than melanomas, deaths from NMSC are on the rise, increasing from 143 to 765 between 1971 and 2021.
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Skin cancer risk factors
Australia has the highest skin cancer rates in the world. At least two in three Australians will be diagnosed with skin cancer in their lifetime. The risk is higher for men than for women.
Ultraviolet (UV) Radiation Exposure
Ultraviolet radiation exposure is a significant risk factor for skin cancer. The sun is the primary source of UV rays, but tanning beds and sun lamps are also sources. UV rays account for a tiny fraction of the sun's rays but are responsible for the sun's damaging effects on the skin. They damage DNA (genes) inside skin cells, and skin cancers can develop when this damage affects genes controlling skin cell growth. The pattern and timing of UV exposure may also play a role in melanoma development. For example, melanoma on the trunk and legs has been linked to frequent sunburns, especially during childhood.
Fair Skin Tone and European Ancestry
People with fair skin, particularly those of northern European heritage, are more susceptible to skin cancer. Australia has a high percentage of fair-skinned individuals due to the historical migration of Europeans. Similarly, New Zealand's high skin cancer rates are attributed to the Anglo-Celtic ancestry of many of its citizens, coupled with their outdoor lifestyle.
Personal and Family History of Skin Cancer
Those with a personal history of skin cancer or with a family history of frequent sun exposure are at increased risk. Additionally, certain gene mutations that run in families can elevate the risk. People who have previously had basal or squamous cell skin cancers are also at a higher risk of developing melanoma.
Moles Present at Birth (Congenital Nevi)
Congenital melanocytic nevi are moles present at birth. The lifetime risk of melanoma developing in these moles ranges from 0 to 5%, depending on their size. Larger congenital nevi carry a higher risk, and some may be surgically removed as a preventive measure.
Xeroderma Pigmentosum (XP)
XP is a rare, inherited condition that impairs the ability of skin cells to repair DNA damage. Individuals with XP have a significantly elevated risk of developing melanoma and other skin cancers at a young age, especially in sun-exposed areas of the body.
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Frequently asked questions
Skin cancer is one of Australia's most common cancers. In 2015, there were almost a million cases of skin cancer in the country.
It is estimated that by the end of 2018, there were 216,408 people in Australia living with melanoma who had been diagnosed between 1982 and 2018.
There are over 1,100,000 paid Medicare services for non-melanoma skin cancers each year in Australia, which is more than 3,000 treatments per day.
At least two in three Australians will be diagnosed with skin cancer in their lifetime.
In 2019, Queensland had the highest risk of developing melanoma, followed by Tasmania, Western Australia, New South Wales, Australian Capital Territory, Northern Territory, South Australia, and Victoria.
