SY1-2 Skin Cancer Prevention in Australia

Monika Janda1, Peter Soyer2

1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia 2University of Queensland, Brisbane, Australia

NHMRC CRE Funding: 1099021; NHMRC Fellowship: 1045247

MORE THAN

2000

DIE FROM SKIN

CANCER EACH

YEAR

AT LEAST 2 in 3 AUSTRALIANS WILL BE

DIAGNOSED WITH SKIN

CANCER BEFORE THE AGE OF

70

2

Melanoma in Australia Compared to World

Source: Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC

CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer, 2010. Available from: http://globocan.iarc.fr

0 5 10 15 20 25 30 35 40 45

South-Central Asia

Eastern Asia

Northern Africa

South-Eastern Asia

Caribbean

Western Africa

Central America

Western Asia

Eastern Africa

Middle Africa

South America

Central and Eastern…

Southern Europe

Southern Africa

Western Europe

Northern Europe

Northern America

Australia/New Zealand

World

Rate per 100,000

Wo

rld

Reg

ion

World Age-Standardised Incidence Rates of melanoma per 100,000 Population, World Regions 2008

Female

Male

MELANOMA

35 new cases

per 100,000

NON-MELANOMA SKIN CANCER

BCC: 884 new cases per 100,000

SCC: 387 new cases per 100,000

Age-Standardised Incidence Rates/Year

Still rising in older people, but!! - good news

Falling in young people (<40 years).

Melanoma Rates

Source: AIHW analysis of the Australian Cancer Database.

Whiteman et al,

Journal of

Investigative

Dermatology

doi:10.1016/j.jid.2016

.01.035

Source: Baade P, et al. (2015). Assessment of the effect of migration on melanoma incidence trends in Australia between 1982

and 2010 among people under 30. Acta Derm Venereol. 95: 118–120

a) Estimated “at risk” populations (0-29 years) b) Melanoma incidence trends according to estimates of migration (Australia, 0-29 years, invasive melanomas)

Comprehensive Skin Cancer Prevention Campaigns

Evolving over the years

Assessing Cost-Effectiveness in Prevention (ACE-Prevention) Report

Primary prevention programs

are cost-effective

Doran CM, et al. (2016) Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media

Campaigns Implemented in New South Wales, Australia. PLoS ONE 11(1): e0147665.

For each $1 invested

save $2.

Newer data even

estimated $3.85

SunSmart campaigns

prevented 120,000 DALYs

over a lifetime per

intervention

New challenges

1. Sustainability of primary prevention efforts

2. Trend to social media

3. Dealing with interruptions

4. Better communication and personalisation

New challenges

1. Sustainability of primary prevention efforts

Frequency of Sunburn in Queensland Adults

12% men and 8% women in Queensland sunburnt on

the previous weekend.

18-24 years 7x more likely and those 35-44 years 5x

more likely to report sunburn thank older people.

Sunburn remains a public health problem, especially in

young people.

Source: Green AC, et al. (2013). Frequency of sunburn in Queensland adults: still a burning issue. Med J Aust, 198(8):431-4.

QLD Health - Preventive health

survey results

Sunscreen

Regular sunscreen use prevents:

9.3% squamous cell carcinomas

prevented fraction 14% of melanoma.

Typical levels of sunscreen use reduce skin cancer

incidence by 10-15%.

Source: Olsen CM, et al. (2015). Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular

sunscreen use. Aust N Z J Public Health, 39(5):471-6

Masters Thesis Abbey Diaz

Diaz A, Neale R, Kimlin M, Jones L, Janda

M. The children and sunscreen study. Arch

Dermatol 2012; 148(5):606-12

8mm

Melanocyte

Proliferating Cells

UV Skin Study Conclusions

The density of epidermal melanocytes 14 days after exposure

to 2 MED SSUVR was two-fold higher than baseline

(unirradiated) skin.

• The change in epidermal melanocyte counts among people

carrying the red hair gene (MC1R) was significantly lower than those

with wild-type MC1R.

• Sunscreen applied to the skin before exposure to 2 MED SSUVR

completely blocked the UV-induced skin damage measured

New challenges

1. Sustainability of primary prevention efforts

2. Trend to social media

3. Dealing with interruptions

4. Better communication and personalisation

New challenges

2. Trend to social media

Youl P, Soyer HP, Baade P, Marshall

A, Finch L, Janda M. Can skin cancer

prevention and early detection be

improved via mobile phone text

messaging? A randomised, attention-

control trial. Prev Med, 2015;71:50-6

Text message interventions worldwide

Systematic review

8 studies fulfilled inclusion criteria (5 RCTS, 2 controlled

clinical trials, 1 cohort study).

5 used text messages, 2 mobile phone apps, 1 electronic

messages via email.

All studies resulted in at least one improved self-reported

behaviour.

Only one study used objective measure of electronically

monitored sunscreen.

Finch L, Janda M, Loescher LJ, Hacker E (2016) Can skin cancer prevention be improved through mobile

technology interventions? A systematic review. Preventive Medicine, 2016 Jun 29;90:121-132.

New challenges

2. Trend to social media

3. Dealing with interruptions

4. Better communication and personalisation

New challenges

3. Dealing with interruptions

Interrupters

Hill D, Boulter J. Sun protection behaviour – determinants and

trends. Cancer Forum 1996;20(3), 204-11.

Janda M, Youl P, Bolz K, Niland C,

Kimlin M. Knowledge about health

benefits of vitamin D in

Queensland Australia. Preventive

Medicine, 2010;50(4):215-6

Survey of Australian adults

People who worry about getting enough vitamin D

wear sunscreen less often (p=0.001);

wear shorts more often (p=0.04); and

tend to spend more time in the sun (p<0.001).

PhD thesis Ngadiman Djaja

Change in Sun Protection Due to Concern About Vitamin D Status

Source: Ngadiman N, et al. (2016). Self-reported changes in sun-protection behaviours at different latitudes in Australia. Photochemistry and

Photobiology, 92(3):495-502.

Temperature

Temperature

New challenges

4. Better communication and personalisation

Personalised Risk Information

Personalised Risk Information

Personalised Risk Information

Research needed

Do risk calculators – indicators –apps assist

people making optimal decisions?

Do they improve sun protection or screening

behaviours?

Evidence so far is largely negative

Need better data on how they may impact

behaviours

Schneider KI, Schmidtke J. Patient compliance based on genetic medicine: a literature

review. J Community Genet. 2014 Jan;5(1):31-48.

Key Elements to Successful Skin Cancer Prevention Programs

R/ship between social, political, and economic environment

Established, effective, and well-resourced organisation

Access to resources

Congruency of aims among partners

Strategic planning

Strong research and evaluation base

Awareness of system change

Strategies across the whole system

Tailoring media message to environment

Potential negative effect of strategies

Motivating ‘hard-to-reach’ groups

Source: Montague M, Borland R and Sinclair C. (2001). Slip! Slop! Slap! and SunSmart 1980 to 2000: Skin Cancer Control and 20 Years of Population

Based Campaigning. Health Education and Behaviour, 28(3): 1-18.

Skin cancer screening?

Melanoma Screening trial

Skin Awareness Study – men 50+

10 step guide ------------------ ------------------ ------------------ ------------------ ------------------

Intervention only

Intervention & control

Janda, Monika, Youl, Philippa, Neale, Rachel, Aitken, Joanne, Whiteman, David C., Gordon, Louisa, et al. (2014) Clinical

skin examination outcomes after a video-based behavioral intervention analysis from a randomized clinical trial. JAMA

Dermatology, 150(4), pp. 372-379.

Remote delivery of dermatology services

Teledermatology

Store and forward

Videoconferencing

See Peter Soyer’s

presentation on

Saturday

Sustainability of programs

Opportunities and challenges with new media

Stringent Evaluation

Many competing risks/health

Outlook