What I was really doing was setting the scene for the global burden of skin cancer and then wanting to look at the natural history, really, of the skin cancer problem, talking about both keratinocyte cancers, that is BCC and SCC, which, as most people know, are the most common cancers in the world, particularly in white skinned people, as well as melanoma. Then I wanted to look at the time trends and see what we could establish about how we were doing in terms of trying to control this problem in white-skinned populations.
Is this a problem that’s on the increase?
That’s a complex question and requires a little bit more; it’s not an easy answer because, in fact, it varies around the world. So I was giving a picture, attempting to give a picture globally and things are very different. There are different stages of evolution, really, in how the skin cancer problem is going and in countries where there have been long-established prevention and early detection campaigns we’re actually seeing glimmers of hope that the problem is getting better. Whereas in other countries which introduced control measures such as early detection and such as primary prevention campaigns, keeping out of the sun, much later then, and I’m thinking of Australia as being one of the most established countries for control programmes compared with, say, countries in Europe and some parts of the United States, then we can see that things are much delayed and, in fact, incidence is still climbing. There are some countries where there is still mortality climbing so you can see that it’s not a simple answer, really. And just behavioural practices varying around the world, whether young people are indulging in sunbeds, is also a new, relatively recent, exacerbation of the problem that we’ve got just with sunlight exposure. So all of these are in the mix for creating a different picture around the world.
In which countries is it getting worse?
What we’ve seen is where sunbeds are allowed to have proliferation and no restrictions, and that’s true of many states in the United States for example, where then we see that the young women’s rates are rising even though their mortality rates are dropping, so many of them are getting the disease that there’s actually quite a proportion of young people who are dying, particularly young women, from, we presume, this increased exposure because we’ve actually seen these time trends since the introduction. So that’s an outstanding example. The same is true for parts of Eastern Europe where there is, again, really uncontrolled and unrestricted access to solariums and sunbeds and there we see both increases in incidence and in mortality. So these are examples of countries where things aren’t looking good right now.
Are there global plans for tackling the problem, such as by the WHO?
They are really devolving the duties onto the various regions and, again, it really is in the hands of federal government because ultimately I’m afraid what this requires is investment, heavy investment, in firstly early detection. That’s something that could be achieved in today’s patients, the real problem is the amount of investment that’s required for long term control, definitive control, and that is primary prevention. That takes a lot of information to the community and to doctors to have a culture shift and you can imagine how much investment that requires. So this is something forward looking that a lot of people can only look at the near future and for real definitive skin cancer control we need to look generations in advance because we don’t see the good results of prevention campaigns for one or two decades later, into the next generation. But that’s who we’re looking after when we invest now.
Should governments be regulating sunbeds and implementing campaigns like the ones we see in Australia?
That’s correct and introducing campaigns is not an easy issue, again. That’s usually, it has been shown by many researchers, needs to be multidisciplinary, multi-pronged, if you like, so it’s not just mass media, it’s also social media now and advertising in the environment plus structures like shade structures and making sure that when people have got recreation exposure opportunities that there’s also protection opportunities and there’s a culture of protection. Again, this takes quite a long time to imbue into the population and then to see changes.