Benefits of investing in skin cancer prevention

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Published: 11 Sep 2014
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Craig Sinclair - Cancer Council Victoria, Victoria, Australia

Craig Sinclair talks to ecancertv at the XV World Congress on Cancers of the Skin about the different ways in which skin cancer can be prevented and their cost-effectiveness.

The good thing that we’ve been able to experience, certainly in Australia, is over thirty years of investment in skin cancer prevention. As a result of that length of time of continuing to educate the Australian population about the importance of sun protection we’re starting to see some really good results now. We have a very solid decline in the number of people who are getting sunburnt, the preference for a tan has diminished significantly and, most importantly, we’re starting to see a really solid downturn in melanoma rates, particularly in young people. This is what you would expect because young people have had a lifetime exposure to the sun protection message. We’re not seeing a decline yet in the older adult population but that’s not surprising either, given the proportion of their life exposed to the sun protection message is considerably less. So the really good thing is that we’ve actually learned the recipe of what can motivate our behaviour, the behaviour of a large population, to drive them towards sun protective practices.

What do you think has helped get this message out?

The recipe is really a multi-component strategy; you need to have a strong media presence, you need to have investment in paid media, particularly television, even in this day and age, is an incredibly important way to reach out to the population at large. You also need, as part of the broad multi-component intervention, you need to be focussing on work to improve policies and practices in primary schools, early childhood centres, supporting sporting associations to introduce some protective practices, supporting local government to build shade structures over the pools and playgrounds. So you need a broad brush of effort. The important thing that we’ve learned, though, is that you need to be able to continue to have that level of intervention over a long period of time if you’re going to get the results that we’ve been able to see in Australia. Certainly the key point that I was making yesterday in relation to the United Kingdom is that when they have had an intervention you would be able to believe that there has been some improvements in both behaviour and attitudes but unfortunately we’re at a point now where there isn’t any investment by government for broad population education around sun protection, despite the cost to the public health system here in the UK of treating skin cancers, around €120 million.

So prevention is key?

Certainly in the Australian context the cost effectiveness is very strong. So what we’ve been able to learn through our economic analysis is that for every dollar a government invests they’ll get a $2.30 return on that investment over a twenty year period. Now this is a really strong return on investment as far as broad public health interventions go. Certainly, based on the rising costs of treating melanoma here in the United Kingdom, it may not be as strong as what we’ve been able to experience in Australia. But when you’ve got €120 million going out the door per annum, and I’m not quite sure what that converts into English pounds, but when you’ve got that level of investment going into treating melanoma and you have no investment going into help informing and educate the broad population around the importance of sun protection there’s only one way this can go and that is a rising burden to the health system, burden in terms of human costs of human lives and treatment and, of course, a burgeoning cost to the public health system.

Is government policy important, such as the UK’s?

It’s without doubt, and this is a key point I made yesterday, that when the data is so strong in terms of these rising costs, particularly in England because England has the fastest growing rate of melanoma incidence in the world. It hasn’t got the highest rate, Australia is clearly in a league of its own, but it is the fastest rising rate of melanoma is in England compared to any other country. So year on year you’ve got this compounding effect of the increased growth of melanoma which undoubtedly is going to continue to be a major and significant public health problem going forward.

Do you think we should ban sunbeds?

Absolutely and if you’d asked me three years ago whether that was in fact feasible, certainly in the Australian context I would have thought it’s not a chance. I’m really excited that now every jurisdiction bar one, Western Australia being the only exception, has made a commitment to completely eradicate commercial sunbeds from the whole environment. So the only sunbeds that will be existing from 1st January 2015, which is literally months away, sunbeds which have been purchased for home use or those that are being used for medical purposes. Now this is tremendously exciting to see governments within Australia commit to totally eradicating them; it’s very exciting. What I’m hoping is what we’ve learnt in public health, particularly in terms of Australia advancing the world in terms of plain packaging of cigarettes, an issue which I know the UK government is looking at very seriously at the moment, by us being a vanguard in this area that will enable others to follow. Certainly in relation to plain packaging of cigarettes we’re seeing that follow-on effect, both here in England and Ireland and New Zealand are all governments who are seriously looking at doing the same thing. I hope that with the complete decision by a government to eradicate sunbeds that we’ll have that similar flow-on effect in years to come.

Can you tell us a little about the SunSmart app?

The SunSmart app is a smartphone application which is designed to provide individuals with a clear indication of what the UV level is outside but also when it’s important to be sun protective. What happens with the SunSmart app is it provides an alert on the times of the day when the UV index is greater than three and it has been tremendously successful, we’ve had over 130,000 downloads just in relation to it. What’s unique, as a way of communication going forward in relation to skin cancer prevention, is the use of smartphone technology. It’s a very useful way to deliver timely and accurate information to consumers as opposed to looking at the nightly weather report and seeing what they need to dress for for the next day. Smartphone technology, if done well, can deliver very timely and very accurate advice that can hopefully inform behaviour.