Slip, Slop, Slap: We need fresh messages about skin cancer prevention

The Australian health system is now spending just over $200 million each year on the diagnosis and treatment of melanoma.

This is markedly higher than $30 million in 2001.

The reason for this massive growth in costs is three-fold: the increasing number of people with melanoma within our ageing population; health inflation; and the development of new and expensive immunotherapies to treat advanced-stage melanoma.

Melanoma and the cost of treatment in Australia

Melanoma is a serious disease and it kills more than 1800 Australians every year.

It is not a disease to be ignored and Australians want access to the best available treatment and care.

Thankfully, most patients with melanoma are diagnosed at an early stage. The cost of diagnosing and treating them averages just $1681 per patient.

However, we estimated the costs of treating advanced stage melanomas with Dabrafenib and Trametinib - two of the new targeted therapies available for government subsidy - to be $164,235 per patient, in the first year alone.

The overall costs for melanoma are just the tip of the iceberg, with hundreds of thousands of Australians being treated each year for other, less-serious skin cancers, known as keratinocyte skin cancers.

Due to their sheer volume, these other skin cancers are not recorded in our state cancer registries. However, we know collectively that keratinocyte skin cancers are the most expensive cancer to treat within the health system.

Savings through more accurate diagnosis

Melanomas and other skin cancers are sometimes difficult to diagnose.

Many pigmented lesions are removed because the doctor is uncertain of the diagnosis, or there is strong pressure from patients, driving up resource use and costs.

Although it is understandable that doctors and their patients err on the side of caution when it comes to treating or excising suspected melanomas, our recent study found it comes at a price.

We found that improving the diagnostic accuracy of skin lesions and avoiding unnecessary treatment could reduce health system costs in Australia by about $49 million a year.

Some people have a genetic tendency to develop melanoma but the dominant cause is exposure to UV radiation, which can be greatly minimised simply by being sun smart: wearing a hat, sunscreen and protective clothing. Virtually all keratinocyte skin cancers are preventable.

If skin cancers are largely preventable, why are our health system costs for treating them only sky-rocketing?

Governments are already paying for expensive cancer treatments, but how do we make it politically expedient to invest significant money into prevention campaigns that may not pay dividends for decades?

Prevention as cure

Skin cancer prevention is highly cost-effective and saves money by changing individual behaviour, community attitudes and cultural norms.

In Victoria alone, the SunSmart program is credited with preventing 43,000 skin cancers between 1988 and 2010.

Wearing sunscreen works and has been shown in a large Queensland trial to prevent melanomas and other skin cancers.

Although the current generation of 60-year-olds, who are now beginning to develop skin cancers, missed the Slip, Slop, Slap campaigns in their childhood, we are still waiting to see the benefits in later generations.

While the rates of melanoma have declined -0.7 per cent per year in Australia since 2005, absolute numbers will continue to increase due to population growth and the ballooning ageing demographic.

Even though primary prevention campaigns take time to change people's behaviour, ultimately they do bring significant benefits.

We've come a long way since the decades when Australia was the sunburnt country when a deep tan was de rigueur and we basked in the plentiful sunshine without a care for sun protection.

Considering where we started from, Australia has made major gains in public health with SunSafe accredited schools and childcare centres, workplace health and safety policies and a total ban on solariums.

Our sun protection practices are the envy of the world.

But the early campaigning in the 1980s with Slip, Slop, Slap, and numerous campaigns and updates since, have waned and people forget.

Keeping prevention at the forefront of government funding support is critical.

More than ever, we need to remind governments to invest in prevention first to avoid high-cost cancer treatments later.

Australia could also consider having a national skin cancer control and prevention strategy.

Melanoma immunotherapies are important medicines for those with advanced disease.

However, they don't work for everyone and medical research continues to learn why some people benefit and others do not.

If we continue to invest in expensive treatments and ignore investment in prevention, our health system will not be sustainable.

  • Associate Professor Louisa Gordon is a health economist with QIMR Berghofer Medical Research Institute

The story Slip, Slop, Slap: We need fresh messages about skin cancer prevention first appeared on The Sydney Morning Herald.

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