Preventing skin cancer worldwide and the impact of different regulatory and economic priorities

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Published: 11 Sep 2014
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Prof Darrell Rigel - New York University Medical Center, New York, USA

Prof Rigel talks to ecancertv at the XV World Congress on Cancers of the Skin in Edinburgh, UK, about the debate between whether emphasis should be put on primary or secondary prevention in terms of mortality and state regulation and spending.

I spoke about really an update on what’s happening with skin cancer prevention efforts in the US and in Canada. Skin cancer is a very serious problem worldwide and certainly we do see it in a large measure in the US and in Canada and we’ve worked on a variety of prevention efforts over the years to try to impact on the incidence and the mortality from skin cancer. We’ve been somewhat effective but there is lots of room for improvement.

What has been effective so far?

Probably the largest programme has been the efforts of the American Academy of Dermatology. The nationwide skin cancer screening programmes began in 1985, so it’s almost thirty years now, and over that period of time we’ve actually screened 2.5 million people. Each year about 4,000 dermatologists in the US, plus their staff, get involved in the effort. Tens of thousands of melanomas have been picked up and hundreds of thousands of non-melanoma skin cancers have been picked up so it has been quite effective in that sense, as a mass screening effort but also as an educational tool, to remind people of the importance of sun protection and, hopefully, changing their behaviours to lower their risk.

What’s the best way to educate the public?

The American Academy of Dermatology has been at the forefront of this too, along with the Skin Cancer Foundation in the US. Basically the idea is to get the word out to the public to protect themselves from the sun. It’s a tough message; the two things we focussed on in these primary prevention efforts have been regular use of sun screen and sun protection and also not going to tanning salons, not using tanning beds or, as I like to call them, tanning coffins because I think it gets the message across a little better.

Are sunbeds regulated in the US?

There is some regulation of tanning beds in the States, not as strong as it is in many other countries and certainly things are changing here in the UK as well as in Australia, but we’re working towards it. Each state has a separate set of rules within the US; there is a bill before Congress now to try to develop national regulations and there is some support for that and we’re working very strongly to push that.

Why do you think rates of skin cancer are on the rise despite increased knowledge of the causes?

When we talk about prevention we talk about really two kinds of prevention: primary prevention and secondary prevention. Primary prevention is changing behaviours, protecting yourself from ultraviolet radiation, and that impacts on the incidence of the cancer. Secondary prevention is early detection – if you have a spot come have it checked; that impacts on mortality. So there are two different approaches and there is also a debate that goes back and forth of where shall we spend our resources, on primary prevention, behavioural changes, or on secondary prevention or early detection? What I spoke about yesterday was primarily we need to do both because they both have value in the long run. If you look at the data in the US, despite everything we’re doing, mortality rates continue to rise. At the end of the day that’s what we care about, we want less people to die from melanoma. So there is room for this but really our focus right now is across both centres, both on the primary and the secondary prevention and hopefully that will make the biggest impact in the future.

Do you think we need more studies on primary versus secondary prevention in terms of the impact on mortality?

Yes, there are several studies looking at the value of screenings and primary prevention; certainly the German study that was done several years ago is a very powerful measure. The same types of studies are currently being undertaken in the US. The American Academy of Dermatology is developing a data registry to try to collect these kinds of data but it takes a while, you need 5-10 years of follow-up to even look to see what the impact might be.

Is there anything you’d like to add?

It’s important that we understand that skin cancer is a worldwide problem. A meeting like this is very helpful because we really can share ideas and there are synergies that occur and hopefully make even a greater impact on cancer in the future.