Rise in non-melanoma skin cancers shows need for register


Non-melanoma skin cancer is increasing in the Australian population, according to the latest review of the evidence.

According to an analysis of six population-based studies, most using Medicare data on excision rates, keratinocyte cancer is increasing at a rate of around 2–6% per year and especially in older age groups.

The research, published in the Public Health Research & Practice, estimated the lifetime risk of having at least one excision for a histologically confirmed keratinocyte cancer in 2014 was 69% (73% for men and 65% for women).

“Some data suggest differences by age, with declines seen over time in younger age groups but increases among those who are in their sixth decade or older,” the study said.

“The decline among younger people may reflect both the success of primary prevention campaigns that began in the 1980s (and were therefore most likely to benefit recent birth cohorts) and demographic changes (i.e. an increased proportion of the population of non-European ancestry and thus at lower inherent risk of skin cancer).”

Senior investigator and medical epidemiologist Professor David Whiteman told the limbic the estimated skin cancer rates were conservative.

“The data we have summarised here is largely based on histologically confirmed excision of skin cancers. And we know for a fact that not all skin cancers are sent for pathology. We also know for a fact that a lot of skin cancers are treated with liquid nitrogen or with creams and other methods so they are destroyed and not excised. We’re very confident that the incidence of non-melanoma skin cancers is underestimated.”

Professor Whiteman, from QIMR Berghofer Medical Research Institute, said it was probably time to start registering non-melanoma skin cancers.

“Now that we live in a digital age and we have the ability to house lots and lots of data, it’s not as hard as it used to be. We have national registration for all other cancers but not these non-melanoma skin cancers.”

And their impact was probably also underestimated.

“Most people get multiple cancers. They impose an economic toll, a health toll and a death toll and yet they are entirely preventable. We know that each year about 500-600 Australians die from these non-melanoma skin cancers. Unfortunately these are nasty cancers when they do get away and metastasise. They are very difficult to treat and they are usually very destructive.”

“This is a reminder that these are highly prevalent cancers that are preventable. We would prefer that they are prevented rather than treated.”

A Perspective article also published in the Journal said skin cancer – both melanoma and non-melanoma – costs Australia about $1.7 billion to treat each year.

“This is significantly more than any other cancer or disease group; skin cancer accounts for 12% of the total cancer-related health system expenditure, and about 1% of the total health system costs for all diseases.”

Yet Governments remained complacent about making a sustained investment to reduce the burden of this largely entirely preventable cancer, the authors said.

“Unlike efforts to reduce other health risk factors – like tobacco, alcohol or unhealthy food and drinks – skin cancer prevention faces minimal Australian industry opposition. The path to sustained investment is not challenged by industry but, seemingly, our own complacency.”

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