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Cancer success more than skin deep

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Advances in the detection and treatment of melanoma have meant those diagnosed with the potentially deadly disease have far greater chances of survival than for most other forms of cancer.

While Australia has an unwelcome record for having the second-highest rates of melanoma in the world, the Australian Institute of Health and Welfare (AIHW) has reported that those with melanoma have a five-year survival rate that is 90 per cent of their counterparts in the general population – well in excess of the 67 per cent five-year survival rate for all types of cancers combined.

In further good news, the Institute has found that although skin cancer is a major cause of illness, its prevalence among younger people is declining. After peaking at 13 cases per 100,000 in 2002, the incidence of melanoma in people aged 39 years or younger has since declined to 9.4 cases per 100,000.

The result has been seen by some as a sign that young people are heeding sun-safe messages, and has spurred calls from public health advocates for greater Government investment in campaigns encouraging people to protect their skin.

The Cancer Council Australia said this was much more cost-effective than the huge expense of treating skin cancer once it develops.

The AIHW said Medicare benefits worth almost $137 million were spent on skin cancer services in 2014, and the Cancer Council has estimated that treating the disease costs the country more than $1 billion a year.

Those costs appear likely to escalate.

While the incidence of melanoma in young people is declining, it is rising strongly in the broader population.  

Australia’s melanoma rate has doubled in the last 34 years from 27 to 49 cases per 100,000, according to the AIHW, and its incidence (35 new cases a year per 100,000) is now second only to New Zealand (36 per 100,000) in the world.

The Institute estimates that almost 13,300 people will be diagnosed with melanoma this year and 1770 will die, while further 560 will be killed by other forms of skin cancer, and almost 140,000 will be hospitalised.

Even though the prognosis for many is good, the distress for individuals and families, and the costs to the health system, are substantial.

The hospitalisation rate for patients with melanoma surged 63 per cent between 2002-03 and 2013-14, while the number of surgical procedures undertaken to treat melanoma jumped almost 54 per cent over the same period and the number of chemotherapy treatments more than doubled.

Though the hospitalisation rate for those diagnosed with other forms of skin cancer did not increase as sharply over this period (up 39 per cent between 2002-03 and 2013-14), surgical procedures increased 40 per cent and chemotherapy treatments were up 65 per cent.

In addition, effective but hugely expensive drugs are being used to treat melanoma. In the latest development, Melanoma Institute Australia is reporting promising results from the use of two immunotherapy medicines, Yervoy and Keytruda, in combination to treat advanced melanoma.  The two drugs, which can cost up to $120,000, are available at a reduced price through the Pharmaceutical Benefits Scheme, but have so far been denied full listing.

The AIHW findings have fuelled a backlash against celebrity chef Pete Evans, who last week described sunscreens as “poisonous chemicals” that gave people the illusion of protection from the sun’s harmful rays.

Cancer Council Chief Executive Professor Sanchia Aranda said skin cancer was the most preventable form of cancer, and the AIHW data underlined the need for campaigns to encourage people to take steps to protect themselves from sun damage.

“Given the rapid growth in skin cancer treatment costs, and mounting pressures on the health system as our population ages, there is an urgent need to get skin cancer prevention back on the federal agenda,” Professor Aranda said. “We need a mass media campaign, this summer and the next.”

Adrian Rollins 

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