UV radiation

Prevention Policy

This policy has been externally reviewed by Professor David Whiteman, Medical Epidemiologist, Acting Director, QIMR Berghofer and Professor Monika Janda, Behavioural Scientist, Centre for Health Services Research, University of Queensland. It has been approved by Cancer Council’s principal Public Health Committee in September 2020.

Contact: Amanda McAtamney

Key policy priorities

Investment in national mass media campaigns to increase public awareness about skin cancer risk, sun protection and associated behaviour change
Investment in population health research into sun protection behaviours to inform evidence-based policy and programs
Establish a roadmap towards optimising early detection of melanoma

Australia has the world’s highest skin cancer rates^[1], with 1,960 deaths in 2016 from melanoma and keratinocyte cancers (previously called non-melanoma skin cancer) combined^[2]. The estimated cost of treatment for keratinocyte cancers (KCs) in 2015 was $703 million^[3]. Yet a high proportion of skin cancers are preventable through appropriate sun protection from ultraviolet (UV) radiation^[4].

Skin cancer includes cutaneous melanoma, KCs (which comprises basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC)) and other rare subtypes. From as early as the 1950s and '60s, concern over high skin cancer rates led to a limited number of community education campaigns in Victoria and Queensland. These campaigns aimed to raise public awareness about skin cancer and to increase health professionals’ early detection of skin cancer.

Since the 1980s, more extensive public health programs aimed at preventing excessive exposure to UV radiation have been implemented across Australia by non-government cancer organisations and government health services. The ‘Slip! Slop! Slap!’ and SunSmart slogans, developed in 1980 and 1987, respectively, by Cancer Council Victoria, have been the themes of many campaigns and are well recognised by Australians in relation to sun protection.

Today the key sun protection messages have expanded to ensure a focus on individual and environmental strategies, including slip on sun-protective clothing, slop on sunscreen with a rating of SPF50 or 50+, slap on a hat, seek shade, and slide on sunglasses. The focus of these skin cancer prevention programs has been to reduce the risk of skin cancer by decreasing exposure to UV radiation while increasing early detection.

Despite the challenges of evaluating programs aimed at changing sun protection behaviour, evidence of the effectiveness and cost-efficiency of programs in Australia and overseas is accumulating. It is estimated that the maintenance of the SunSmart program at $0.24 per capita per annum will yield a $2.30 saving in return for every dollar spent on the program^[5].

Investment in skin cancer prevention over three decades has produced a body of evidence, collected largely by Cancer Councils, showing the effectiveness of such health promotion programs. Research shows that such programs have led to increased awareness of skin cancer prevention and improved sun protective behaviours. Skin cancer rates would be expected to decline as a result^{[6][7][8][9][10][11]}.

This chapter of Cancer Council Australia's National Cancer Prevention Policy documents the policy context and evidence-based policy priorities to prevent skin cancer.

References

Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Pineros M, et al.. Global Cancer Observatory: Cancer Today. [homepage on the internet] Lyon, France: International Agency for Research on Cancer; 2018 [cited 2020 Apr 24]. Available from: https://gco.iarc.fr/today.
Australian Institute of Health and Welfare. Cancer data in Australia. Canberra: AIHW; 2020 [cited 2020 Sep 10]. Report No.: Cat no. CAN 122. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/acim-books.
Fransen M, Karahalios A, Sharma N, English DR, Giles GG, Sinclair RD. Non-melanoma skin cancer in Australia. Med J Aust 2012 Nov 19;197(10):565-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23163687.
Olsen CM, Wilson LF, Green AC, Bain CJ, Fritschi L, Neale RE, et al. Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use. Aust N Z J Public Health 2015 Oct;39(5):471-6 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26437734.
Shih ST, Carter R, Sinclair C, Mihalopoulos C, Vos T. Economic evaluation of skin cancer prevention in Australia. Prev Med 2009 Nov;49(5):449-53 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19747936.
Dobbinson SJ, Wakefield MA, Jamsen KM, Herd NL, Spittal MJ, Lipscomb JE, et al. Weekend sun protection and sunburn in Australia trends (1987-2002) and association with SunSmart television advertising. Am J Prev Med 2008 Feb;34(2):94-101 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18201638.
Sinclair C, Foley P. Skin cancer prevention in Australia. Br J Dermatol 2009 Nov;161 Suppl 3:116-23 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19775367.
Slevin T, Clarkson J, English D. Skin Cancer Control Western Australia: Is it Working and What Have we Learned? Radiat Prot Dosimetry 2000;91(1-3): 303-6 Available from: http://rpd.oxfordjournals.org/content/91/1-3/303.abstract.
Staples MP, Elwood M, Burton RC, Williams JL, Marks R, Giles GG. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust 2006 Jan 2;184(1):6-10 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16398622.
Thursfield V, Giles G. Skin Cancer. Carlton: Cancer Epidemiology Centre, Cancer Council Victoria; 2007. Report No.: 44. Available from: http://www.cancervic.org.au/downloads/cec/CanStats/44-Skin-cancer.pdf.
Tabbakh T, Volkov A, Wakefield M, Dobbinson S. Implementation of the SunSmart program and population sun protection behaviour in Melbourne, Australia: Results from cross-sectional summer surveys from 1987 to 2017. PLoS Med 2019 Oct;16(10):e1002932 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31593565.