A very sunburnt country: Skin cancer rising in Australia

Ciaran O’Mahony

Australia’s sunny weather may be the envy of the world, but it is proving to be both a blessing and a curse.

While we soak up more sun in a month than many countries do in a year, we also have one of the highest rates of skin cancer in the world.

New research has shown that this problem is increasing, with non-melanoma skin cancers rising at an estimated rate of 2-6% per year for the last 30 years.

The study, which was published in the Public Health Research & Practice journal last week, estimates that 69% of Australians will have at least one keratinocyte cancer (or non-melanoma) removed from their body in a lifetime.

This group comprises 73% of Australia’s male population and 65% of the female population.

Although numerous “sun smart” campaigns have been implemented over the last decade, many Australians who did not grow up with the familiar “Slip Slop Slap” messaging, are now at high risk.

Associate Professor Catherine Olsen and her colleagues highlighted that the greatest increase in skin cancer was amongst people aged 55 or older.

Photo: kali9 via Getty Images

Professor David Whiteman, a co-author of the study, explained to Guardian Australia that “as our population is living longer and more people move into those age groups that manifest in cancer, they’re now showing the effects of their sun exposure from years and decades before.”

The findings are based on the most recent population-based estimates of keratinocyte cancer incidence in Australia between 2001-2021. The researchers examined data trends over time and calculated the lifetime risk of developing these cancers whilst accounting for competing risks of death.

They also noted that their findings could be an underestimate, given that data on keratinocyte cancers is not recorded in state or territory registries (with the except of Tasmania).

While keratinocyte cancers are less deadly than melanoma, Professor Whiteman urges Australians not to be complacent.

Photo: Carol Yepes via Getty Images

“Keratinocyte cancers kill about 500 people a year, and if not treated they can borrow into nerves on the face and into the head and track back into the brain. People may need to have massive surgery and radiotherapy. So it is a dreadful disease.”

Royal Australian College of General Practitioners (RACGP) Specific Interests Dermatology Chair Dr Jeremy Hudson, told NewsGP that GPs across the country have a pivotal role to play as we manage this threat.

“GPs have an absolutely key role and continue to diagnose and manage the vast majority of skin cancers in Australia, particularly in rural, remote and low [socio-economic] areas,” he said.

“Generation X is coming of age,” Dr Hudson said. “We are planning to see a spike of skin cancers in 10 years’ time unless very robust education and preventive action is taken.”

As doctors across the country prepare for this spike, the Federal Government is set to implement Australia’s first national skin cancer campaign in over a decade.

In the meantime, Professor Whiteman says people of all ages should remain vigilant against the sun.

“The good news is that it’s never too late to use sun protection, and that even people in their 40s and beyond who start using sun protection every single day can reduce their risk of skin cancer and reduce the incidence of new skin cancers forming if they’ve already had it.”

Medical societies speak out against Queensland pharmacy pilot

Ciaran O’Mahony

Two medical societies have warned Queensland Health that its Urinary Tract Infection (UTI) Pharmacy Pilot will have serious health implications.

The pilot, which was recently extended until June 30 2022, allows pharmacists to prescribe antibiotics to women for UTIs, without any medical review or investigations.

The Urological Society of Australia and New Zealand (USANZ) and the Royal Australian College of GPs (RACGP) have cautioned that this approach poses numerous health risks, including delayed diagnosis of cancer.

President of USANZ, Associate Professor Prem Rashid, says UTIs are very common, but must be diagnosed through microbiological confirmation on urine testing.

“The importance of the mid-stream urine test in recurrent and chronic UTIs cannot be underestimated,” according to Rashid.

“This defines whether the patient has a bacterial UTI as opposed to other potential causes of similar symptoms and is also fundamental to ensure optimal and accurate treatment with the appropriate antibiotic,” he says.

USANZ President, Associate Professor Prem Rashid. Photo: Twitter.

Vice President of USANZ, Professor Helen O’Connell AO, shares Rashid’s concerns.

“Tracking of urinary white cells and epithelial cells is critical to assessment of patient progress and exclusion of a chronic state,” O’Connell says.

“It does not represent best practice for women to simply attend a pharmacist with symptoms which may or may not be due to bacteria and receive antibiotics which may not treat the bacteria present due to resistance,” she says.

UTI symptoms are similar to those experienced in a wide range of health issues, including bladder cancer.

It is therefore imperative that UTIs are correctly diagnosed to rule out other life-threatening conditions.

Photo: Science Photo Library via Getty Images.

“The symptoms of a UTI are common to a number of serious health issues, including bladder cancer, which is why a correct diagnosis of an UTI is necessary to rule out other potential health serious issues,” says Professor O’Connell.

“Blood in the urine and a burning feeling while passing urine are just two of the symptoms common to both bladder cancer and UTIs. More than 3000 people are diagnosed with bladder cancer each year, a significant number of these are women. This cancer is treatable if detected early but delayed diagnosis and treatment can compromise outcomes, and at worst may mean someone cannot be cured,” she says.

“Why should a common condition in women be redirected from medical care without long term proof of its safety?”

The RACGP says it welcomes an overhaul of the management of UTIs, but argues that the pilot is not supported by evidence and risks doing more harm than good.

RACGP President Dr Karen Price has “deep concerns about moves by the retail pharmacy sector to push through policy changes that put financial gains ahead of patient care and safety.”

“The trial in Queensland of pharmacists prescribing antibiotics for urinary tract infections is concerning,” says Price.

“One of the main problems here is that this trial is effectively an implementation trial. It’s not research on best practice and the results of the trial should be made publicly available.”

RACGP President Dr Karen Price. Photo: Twitter.

The pilot has been extended despite growing concerns around antimicrobial resistance resulting from the misuse or overuse of antibiotics.

While GPs have begun reducing unnecessary prescriptions of antibiotics, this Queensland Health initiative is seen as a threat to their efforts to tackle the problem.

Over 6,300 women have accessed this service to date.