Younger Australians are receiving less treatment for keratinocyte cancers despite an uptick in biopsy rates, MBS data show.

Researchers say the trend may partly reflect the success of ongoing “sun smart” public health interventions in the age group, although overall treatment rates continue to climb because of rising cases in older Australians.

The finding follows an analysis of Medicare claims data for items related to the diagnosis and treatment of BCCs and SCCs including excisions, Mohs surgery, surgical excisions of benign lesions, skin biopsies, and cryotherapy or serial curettage of premalignant and malignant lesions.

This revealed that, in the ten years to 2021, overall excision rates rose about 2% annually for both men and women, although there were small declines at the close of the study period coinciding with the COVID-19 pandemic.

But the increases were restricted to men aged 65 years or older and women aged 55 years or older, the researchers reported in the MJA (link here).

By contrast, BCC/SCC excision rates declined for men under 55 by between 1% and 3.4% per year over the study period and for women under 45 by between 1.7% and 2.3% annually.

“These declines were accompanied by rising biopsy rates in all age groups, including people under 55,” the authors wrote.

“These findings indicate that many more Australians are having skin lesions assessed, but fewer keratinocyte cancers are being detected; that is, we are looking more and finding less.”

“This strongly suggests that reported findings of declines in the incidence of keratinocyte cancers among younger people are robust.”

Besides the success of Australian primary prevention campaigns since the early 1980s, the positive finding was also likely linked to a general shift to more time spent indoors (including longer periods of screen time), according to the researchers.

Another possible explanation was demographic, with Australia’s population including greater numbers of migrants and their offspring who were physiologically at lower risk of skin cancer than Australians in earlier studies, they said.

Interestingly, the authors noted that a previous analysis of MBS data for excisions of histologically confirmed keratinocyte cancers indicated that the excision rate had increased during 2000–2011 by a mean of 2.2% per year for women and 3.3% for men.

“Future changes in skin cancer incidence will be determined by event rates in recent birth cohorts as they age; these people will probably have been exposed to less sunlight than earlier generations because of the combined effects of public health interventions and population-wide lifestyle changes related to technology use,” they concluded.

“They will also include a smaller proportion of people highly susceptible to skin cancer, given demographic changes in the Australian population.”

“We therefore predict continued reductions in the incidence of skin cancer among younger people. However, we also expect that these reductions will be more than offset by continued increases in skin cancer among older people, probably for the next two decades.”

“We advocate further quantification of the factors that contribute to reductions in skin cancer incidence and continued monitoring, with the aim of ensuring that future Australians enjoy relief from these preventable cancers.”