The epidemiology of skin cancer in Queensland: the incidence

Validating the use of Medicare Australia billing data to examine trends in skin cancer

Background:  Epidemiological data surrounding non-melanomatous skin cancer (NMSC) is highly variable, in part due to the lack of government cancer registries. Several studies employ the use of Medical Australia (MA) rebate data in assessing such trends, the validity of which has not been studied in the past. Conversely, melanoma skin cancer is a notifiable disease, and thus, MA and cancer registry data is readily available. The aim of the current study is to assess the use of MA for epidemiological measures for skin cancers, by using melanoma as a disease sample.

Methods:  Following ethics approval, data from MA and Victorian Cancer Registry (VCR) from 2004-2008 were extracted. Incidence of MA and VCR unique melanoma cases were compared and stratified by age and local government area (LGA). Regression and a paired-samples t-test were performed.

Results: During the study period; 15,150 and 13,886 unique melanoma patients were identified through VCR and MA data sources respectively. An outlier in the >80­ year age group was noted between MA and VCR data. When stratified by age, significant correlation between MA and VCR was observed for all patients (gradient 0.91, R²= 0.936) and following exclusion of >80 patients (gradient 0.96, R²= 0.995). When stratified by LGA, a high degree of observation was observed for all patients (gradient 0.94, R²= 0.977) and following exclusion of >80 patients (gradient 0.996, R²= 0.975).

Conclusion: Despite the inclusion of outlier data groups, acceptable correlation between MA and VCR melanoma data was observed, suggesting that MA may be suitable for assessing epidemiological trends. Such principals may be used to validate the use of MA data for similar calculations assessing NMSC trends.

Incidence and prevalence of non-melanoma skin cancer in Australia: A systematic review

Non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is the most common cancer occurring in people with fair skin. Australia has been reported to have the highest incidence of NMSC in the world. Using a systematic search of the literature in EMBASE and Medline, we identified 21 studies that investigated the incidence or prevalence of NMSC in Australia. Studies published between 1948 and 2011 were identified and included in the analysis. There were six studies that were conducted on national level, two at state level and 13 at the regional level. Overall, the incidence of NMSC had steadily increased over calendar-years in Australia. The incidence of NMSC per 100,000 person-years was estimated to be 555 in 1985; 977 in 1990; 1109 in 1995; 1170 in 2002 and 2448 in 2011. The incidence was higher for men than women and higher for BCC than SCC. Incidence varied across the states of Australia, with the highest in Queensland. The prevalence of NMSC was estimated to be 2% in Australia in 2002. The incidence and prevalence of NMSC still need to be accurately established at both national and state levels to determine the costs and burden of the disease on the public health system in Australia.

Patterns of treated non-melanoma skin cancer in Queensland--the region with the highest incidence rates in the world

The incidence of non-melanoma skin cancer, comprising basal cell carcinoma and squamous cell carcinoma, was studied in Queensland during 1984. The world-standardised annual incidence rates (per 100,000 population) for the number of persons with non-melanoma skin cancer were estimated to be 1372 for men and 702 for women, the highest recorded incidence rates in the world. Rates in men were nearly double the rates in women and age-specific incidence rates increased curvilinearly with age. There were, on average, 1.4 skin cancers per person with non-melanoma skin cancer and the ratio of basal cell carcinomas to squamous cell carcinomas was approximately three to one. The age-standardised annual incidence rate (per 100,000 population) of basal cell carcinoma for residents of the Gold Coast was 1.83 times the Brisbane rate for men and 1.57 times that for women, indicating significant differences between the two regions. For squamous cell carcinoma the regional differences were not statistically significant. The average potential number of non-melanoma skin cancers (per person) treated during the lifetime of a cohort of 100,000 was estimated to be 0.014 for men and 0.009 for women by age 40. By age 65, these numbers increased to 0.22 for men and 0.11 for women. At age 90, these average numbers were 1.09 and 0.42, respectively. Although the incidence of non-melanoma skin cancer is much higher in the older age groups, it should be kept in mind that it also affects the younger population; 1028 Queenslanders under 40 required treatment for 2300 non-melanoma skin cancers in 1984. This study which provides baseline information about the occurrence of non-melanoma skin cancer in Queensland emphasises the importance of developing safe sun-exposure habits, detecting non-melanoma skin cancer early and protecting and restoring the atmosphere.

Skin cancers in Australia's Northern Territory 1981-85

SKIN CANCERS are commonly registered in the Northern Territory, where they largely affect the non-Aboriginal population. The trends in annual registration, the numbers and site distribution of Basal Cell carcinoma, Squamous Cell carcinoma and Malig nant Melanoma are described, together with the Age- Specific Incidence rates for these lesions. Some factors concerned with the low incidence of Malignant Mela noma are considered.

Squamous cell skin cancer in the north-west of England, 1967--69, and its relation to occupation

ABSTRACT During the three years 1967-69, 781 cases of squamous cell carcinoma of the skin were reported to the Manchester Regional Cancer Registry. The proportions of males to females were significantly different (p <0·001) among the skin cancer sites. The age-specific incidence rates were significantly different (p <0·001) between the sexes for the five-year age groups of 55 years and above. Full occupational histories were obtained on 598 (77%) patients; a further 148 (19%) patients gave one main occupation only, while the remaining 35 (4%) patients were untraced. The numbers of patients observed in broad occupational groups (occupational orders) were compared with the numbers expected using the 1931 and 1951 censuses. For all skin cancer sites combined the occupations of farming and textiles were found to have highly significant excesses of 150% and 135% respectively for males. The corresponding excesses for females were 30% for textile workers and varied from 1140% to 590% for farmers, but only for the farmers were the excesses highly significant. For males the occupation of metal worker also showed excesses of 38% and 23% which were of borderline significance. The association between occupation and individual skin cancer sites was then considered. For males there were excesses in the arm for the occupational orders of chemical workers, paper/printing workers and fishermen, and in the ears for builders, but these excesses were of borderline significance. There was a significant difference (p <0·05) in the proportion of male patients with atopic skin conditions in each cancer site. However, this was not found for the female patients. For both male and female patients no significant associations were found between the skin site and either eye colour, residence in the tropics or smoking habit.

Surgery and skin cancer

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The eqpidemilogy of skin cancer in Queensland: the influence of phenotype and environment

On the basis of data gathered from long term residents of 3 widely separated regions of Queensland a multivariate analysis has been made to determine the influence of a number of factors in the aetiology of skin cancer and solar keratosis. Factors considered were age, sex, susceptibility to sunburn, complexion, eye colour, ancestry, occupation, clothing habits and residential district. For both sexes, both diseases and all age groups the factor "susceptibility to sunburn" proved to be the most powerful single discriminant. On the whole it appeared that the genetically based factors as a group provided more information on susceptibility than the environmental factors. The relative importance of "occupation" remains in some doubt. In the tropical area away from the coast it appears to be of considerable importance. In coastal areas its influence appears to be blunted, presumably by factors such as sports and recreation habits.

GEOGRAPHIC ASPECTS OF MALIGNANT DISEASE

In view of recent publications describing a malignant lymphoma in African children, a review is presented of the geographical distribution of various cancers throughout the world. The epidemiological studies which have revealed these malignant tumours have provided valuable clues to the control of cancer and represent an effort to reduce and ultimately to eliminate certain forms of malignant disease. In Canada the distribution of cancer of the stomach has been observed to vary among provinces, being higher in Newfoundland than elsewhere. A study to determine the validity of this observation is currently being undertaken by the National Cancer Institute of Canada.