SY1-2 Skin Cancer Prevention in Australia · Sunscreen Regular sunscreen use prevents: 9.3%...
Transcript of SY1-2 Skin Cancer Prevention in Australia · Sunscreen Regular sunscreen use prevents: 9.3%...
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