Impact

UV exposure is responsible for 4.3% of Australia’s cancer burden, primarily due to melanoma and keratinocyte cancers (KCs) ^[1]. It is estimated that incidence of melanoma accounted for 10% of all cancers diagnosed in 2016^[2]. Keratinocyte cancers (KCs) were estimated to be the most common form of cancer diagnosed in Australia in 2002 (most recent data available), with more KCs diagnosed each year than all cancers combined ^[3].

In 2016, skin cancer was the 19th most common cause of death in Australia^[4]. An Australian study estimated that 7,220 melanomas and almost all KCs occurring in Australia in 2010 could be attributed to UV radiation exposure^[5].

Melanoma

Incidence and mortality

Australia has one of the world’s highest incidence of melanoma ^[6]. In 2015, melanoma was the third most common cancer diagnosed in both Australian men (after prostate cancer and bowel cancer) and women (after breast cancer and bowel cancer) ^[7] In 2015, 13,694 people were diagnosed with melanoma (7,990 men and 5,704 women)^[7].

The survival rate of melanoma is among the highest of all cancers in Australia. In the period from 2011 to 2015, those diagnosed with melanoma had a 91% chance of surviving for at least five years. Five-year relative survival was higher for women compared with men (94% vs 89%) ^[7].

In 2016, there were 1,281 deaths from melanoma (863 men and 418 women) in Australia^[8].

Trends

The age-standardised incidence rate for melanoma increased by 93% between 1982 and 2015 from 27 cases per 100,000 persons to 52 cases per 100,000 persons; ^[7] however, some of this increase may be due to improved detection methods over this time period^[9].

Mortality from melanoma rose steadily from 1931 to 1985, with rates increasing annually by 6% in men and 3% in women^[10]. Between 1990 and 2016, mortality rates for men almost doubled, whereas for women it has remained relatively stable ^[7].

Among people under 40, melanoma incidence is declining^[2]. This is believed to be due to a change in sun protection behaviours as a result of public education programs ^[11][12].

Keratinocyte cancers

Incidence and mortality

Keratinocyte cancers (KCs) is the most common cancer in Australia, however data on incidence are not routinely collected^[13]. The most common types of KC are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The estimated age-standardised rate for BCC and SCC were 770 per 100,000 and 270 per 100,000 person-years respectively ^[14]. In 2016, there were 679 deaths from KC in Australia (AIHW 2019). In 2011-2015, individuals diagnosed with KC had a 71% relative chance of surviving at least 5 years ^[7].

While BCC and SCC cases are not routinely reported to cancer registries, it is estimated that almost 434,000 Australians were diagnosed with one or more KCs in 2008; 296,000 for BCC and 138,000 for SCC^[13]. KC is more commonly diagnosed in men than women; in 2008, 253,000 males compared with 180,000 females ^[13].

Trends

The total number of treatments for KCs increased by 86% between 1997 and 2010, from 412,493 to 767,347^[15].

The majority of KCs are treated by general practitioners. In 2014, 40,179 Medicare benefits claims were paid for 959,243 procedures for non-melanoma skin cancer ^[2].

Although KC incidence has been increasing, KC excision rates declined significantly among men and women younger than 45 years in the period from 2000-2011, suggesting incidence rates are decreasing in young Australians^[16].

Between 1968 and 2005 there was a slight overall decline in KC mortality rates, however from 1998 to 2015 the KC mortality rate was stable (ACIM 2017). An increase in KC deaths among men from the mid-1980s to the mid-1990s is thought to be related to HIV/AIDS^[10].

Economic impact

The cost burden of treatment for melanoma in Australia has increased from an estimated $30 million in 2001 to $272 million in 2017. ^[17] In 2015-16, pharmacotherapies cost the Australian government $92.3 million for an estimated 1,100 new annual cases of advanced melanoma.^[18] The mean cost of treatment per patient with melanoma was $10,716 and increased to an estimated mean cost of $14,606 three years post-diagnosis^[17].

Due to the high number of KCs treated each year, KCs are one of the most expensive cancers in Australia. In New South Wales alone, KC costs accounted for 68% ($365 million) of total lifetime economic costs in 2010, and 90% of total direct costs- $347 million ($2,336 per case). ^[19] During the same period, the total MBS benefit for KC treatments was $93.5 million.^[15]

More information

• Skin cancer incidence and mortality