Summer Down Under means long days and short nights, outdoor living and sun, sun, sun. Unfortunately, though, those sun-drenched days can put a rose-tinted filter over the ugly, blemished and scarring truth – New Zealand still has the highest rates of skin cancer in the world.
In 2012, skin cancer killed 486 New Zealanders. Excluding non-melanoma skin cancer, melanoma is the second most common cancer in New Zealand for men and women aged 25 to 64.
The humbling and horrifying truth is more than 90 per cent of all skin cancers are caused by exposure to ultraviolet radiation from the sun, something we can regulate and prevent.
“[We] have a huge problem as far as skin cancers and melanomas go,” says Associate Professor Stephen Shumack, a spokesman for the Australasian College of Dermatologists.
But Antipodeans are starting to get the message – new generations have grown up sun smart – and new treatments are providing hope to those who have been diagnosed, particularly those with advanced melanoma.
Shumack says New Zealand has much to be proud of when it comes to the fight against skin cancer. We lead the world in public education campaigns and in years to come we can expect to reap the benefits of such initiatives.
Most of us are familiar with the messages – the ones that told us to “slip, slop, slap and wrap” and then more aggressive sun smart campaigns.
The campaigns started in the late 1970s and early 1980s, meaning the generation under 40 have had a better shot at sun protection, and therefore avoiding skin cancer, than their parents. Shumack says it means that most children and young teenagers are now protected from the sun. Go to a beach in Europe, he says, and you will be able to spot the Antipodean families because they will, generally, be the ones covered up.
“It is working but older people didn’t reap the benefits of those campaigns when they were younger, so the rates of skin cancer over the age of 45 are still going up.” We are still ahead of our European and American counterparts, though, and our doctors are getting better at diagnosing skin cancers.
Skin cancer is categorised as melanoma or non-melanoma.
The three most common skin cancers are: melanoma, the most serious form of skin cancer, causing over two thirds of total skin cancer deaths; squamous cell carcinoma, which is easily treated if found early but can be fatal if left untreated; and basal cell carcinoma – the most common and least dangerous skin cancer.
Dermatologist Dr Amanda Oakley says we still need to drive home the prevention message. “We are still seeing an increasing burden of this cancer despite the message being out there for people to protect themselves.”
Chronic sun damage leading to skin cancer is still an increasing issue in industries where people work for long periods of time outside.
For those whom prevention is too late there is hope in the form of treatment advances. Shumack says “even in the past five years we have moved rapidly”, particularly when it comes to melanoma that has metastasised or spread to other parts of the body. “It used to be with advanced melanoma you had surgery and you couldn’t really do anything else. Now there are drugs available – and a number of them.”
The great new hope is in immunotherapy drugs such as Keytruda (the brand name for pembrolizumab). The drug has been called “revolutionary” but there is debate about whether such drugs should be publicly funded.
“Many of the treatments are very expensive so there is a debate about what is appropriate for the public purse fund,” Shumack says. “There is a difference between Australia and New Zealand in that regard.”
In 2015 the Australian Federal Government agreed to invest $57 million to list the breakthrough drug Keytruda on the Pharmaceutical Benefits Scheme, to improve the lives of more than 1000 patients. It meant the drug, which had cost patients $150,000 a year, now costs just $38.
Australian businessman and former Melbourne lord mayor Ron Walker, who accessed the drug from the US under a test scheme, told the ABC the treatment saved his life. “I was a walking person that was going to die and with this drug I came back to life again within a year, so it’s [had] an amazing effect on me and it’s having the same effect on others,” he says.
New Zealanders are not as lucky – melanoma experts have called on Pharmac, the government agency that decides which pharmaceuticals to publicly fund, to fast-track funding reviews for the latest treatments for advanced melanoma, saying Kiwis are missing out or having to foot massive bills.
Behind the debate over funding of pharmaceuticals, advanced research into skin cancer treatment, diagnosis and prevention continues. Researchers at King’s College London found having more than 11 moles on their right arm could mean a person has a higher risk of skin cancer. They believe it is the best indicator of how many moles a person has altogether and having more than 100 moles on the body is thought to be a “strong predictor” of a higher risk of melanoma.
People with more than seven on their right arm had nine times the risk of having more than 50 in total, while those with more than 11 were more likely to have more than 100 on their whole body. Dr Simone Ribero, the lead author, says the study would help GPs.
“The findings could have a significant impact for primary care, allowing GPs to more accurately estimate the total number of moles in a patient extremely quickly. This would mean that more patients at risk of melanoma can be identified.”
New research from the University of Sydney has found that a high dose of vitamin B derivative nicotinamide can prevent up to a quarter of non-melanoma skin cancers.
Nicotinamide is an active form of vitamin B3 that is commonly found in meat, fish, nuts and mushrooms, as well as some vegetables.
Shumack says such research means we have reason to be hopeful. He says, “I don’t know about a cure for melanoma over the next 10 years but certainly the outlook for patients with melanomas that have spread is going to be dramatically better than it has been.”
If people protect their skin and avoid sunburn throughout their lives, their risk of melanoma is reduced. It is important to be sun smart between September and April, especially between the hours of 10am and 4pm when UV radiation levels are high. In winter it is also important to be sun smart at high altitudes and around snow or water.
Steps to being SunSmart
Slip – into shade where possible.
Slip – on some sun- protective clothing.
Slop – on broad-spectrum sunscreen that has a sun protection factor (SPF) of at least 30. Apply 20 minutes before you go outside.
Slap – on a hat that protects your face, head, neck and ears.
Wrap – on some close- fitting sunglasses.
Most of us have spots on our skin. While this is normal, it’s important to get to know your skin so you can notice any changes. Finding skin cancer as early as possible is the key to successful treatment.
Speak to your health professional if you have a mole, freckle or spot that:
• Is new or changing
• Does not heal
• Looks different from others around it, has changed in size, thickness, shape, colour or has started to bleed.