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Damning report: Leading skin cancer experts demand action

Two fifths of UK children sustain sunburn at school while government spends paltry 1 penny per person on public awareness

Posted: 16 June 2011

Nearly 40 per cent of school‐age children have arrived home with sunburn sustained at school, a new survey commissioned by clinical and charitable alliance Skin Cancer UK (SCUK) reveals.1 The survey of over 1000 people, in which over half were parents with children under 18, also showed that more than 40 per cent of parents believe teachers should be responsible for ensuring children are wearing sunscreen at school.1

The findings have been released in conjunction with today’s launch of a damning report from SCUK, commissioned by the All‐Party Parliamentary Group on Skin, which identifies an urgent need for a well‐funded, national awareness campaign, alongside a focus on sun education and protection in schools, to stem the growth of the fastest rising cancer in the UK.2

Richard Clifford, lead member of SCUK and Trustee of the Karen Clifford Skin Cancer Charity comments: “Children who are over‐exposed to the sun are storing up problems for the future. It is therefore imperative to encourage the use of sunscreens and sun protection to minimise their risk. Together with a shady area to play in and the wearing of hats, we would like to see provision made for teachers to take a role in the ‘common sense’ application and availability of sunscreens and protection.”

SCUK is calling on the Government to introduce a mandatory, enforceable, policy on sun safety based on national guidelines for UV exposure for schools.

CALL‐TO‐ACTION: BRITISH SCHOOLS MUST HAVE AN ENFORCEABLE POLICY ON SUN SAFETY

“The evidence shows that sunburn as a child, when the skin is most sensitive, doubles the risk of developing skin cancer later in life3 – it’s one of the most damaging things that can happen to skin ‐ so it’s worrying to learn that so many of our children are getting burned at school. While I don’t advocate avoiding the sun altogether, young children must be protected from the heat of the sun, particularly in the middle of the day during summer months,” commented Dr Andrew Wright, consultant dermatologist, St Luke’s Hospital, Bradford.

While the majority of skin cancers are treatable, the most deadly form (malignant melanoma) kills over 2,000 people in the UK each year, with all skin cancers killing a total of more than 2,500 people annually.2

CALL‐TO‐ACTION: SUN SAFETY MESSAGES SHOULD BE MANDATORY IN BRITISH SCHOOLS

Currently, the decision whether or not to deliver sun safety advice is largely left to the discretion of the individual teacher.

Over the last 30 years, the rate of malignant melanomas in Britain has risen faster than any of the top 10 cancers in males and females.4 More than 11,700 people in the UK are diagnosed with malignant melanoma each year.5 This figure will continue to grow as damage sustained in past years manifests as future melanomas.

Carol Goodman, Macmillan Cancer Information Nurse, said: “We welcome Skin Cancer UK’s recommendations in this report. They will play an important part in raising awareness and protecting future generations from the risk of skin cancer.

“It is alarming that the levels of skin cancer are dramatically rising in young people. These cancers could be prevented if they protected themselves from too much exposure to the sun. Educating young people with the facts on skin cancer will help them make informed choices about their sunbathing habits,” she said.

“It is critical that the Government listens to these recommendations and ensures stronger measures are put in place to protect this age group and future generations from skin cancer.”

SCUK believes that school classrooms throughout the length and breadth of the country must become the source of behavioural change.

CALL‐TO‐ACTION: EDUCATE ALL AREAS OF SOCIETY ON THE IMPORTANCE OF THE EARLY DETECTION OF SKIN CANCER

SCUK’s call‐to‐action to educate the public at large is supported by Department of Health figures, which estimate that more screening could uncover as many as 7,631 extra cases of melanoma ‐ the most deadly form of skin cancer ‐ in one year alone.6

SCUK believes that strategies to prevent sun damage to skin must be accompanied by strategies for the early detection of skin cancers, given that early detection is acknowledged as the key to successful treatment.7

Richard Clifford comments: “The fact that thousands of people in the UK may be unaware that they have a potentially serious cancer strengthens the argument for increased funding of public awareness to help people identify potential problems and to prevent future damage from the sun.

“There is no other common cancer so directly attributable to a single, avoidable cause. Each year skin cancer costs the UK in excess of £240 million and claims more than 2,521 lives, yet the British government spends less than 1p per person on awareness campaigns annually. This is obviously woefully insufficient to effect the necessary behaviour change.” 8, 1

Only half of respondents surveyed by SCUK were aware of any UK awareness campaigns relating to skin cancer or sun safety and only a quarter said that they had sought information on this subject.1

Richard continues: “In Australia, there is clear evidence of a decrease in the incidence of melanoma rate following their awareness campaigns.9 Obviously, there are differences in climate and culture between the two countries, yet we should learn from their success in demonstrating that education on prevention costs significantly less than treatment over the long‐term.”

Experts in Australia have demonstrated that, for every dollar spent on public awareness about the risk of damage from the sun, AUD$2.32 will be saved in eventual costs to the Australian healthcare system – representing a ‘blue chip investment in health’ for the Goverment.10, 11

Professor Barry Powell, burns, plastic and reconstructive surgeon at St George’s Healthcare Trust, London, commented: “As a plastic surgeon, I am aware of the increase in numbers of people with skin cancer and I also see delays between initial consultations and referrals. It is therefore critical to provide mandatory training and guidance for healthcare professionals, such as GPs, in the early
detection, recognition and referral of suspect lesions.

“For too long, the epidemic of skin cancer has been neglected in this country. The shame of it is that simple measures and education in this highly preventable cancer can contribute to a reduction in countless surgeries and even deaths. I applaud Skin Cancer UK for the recommendations in this report and urge the Government to take notice, and take action – it is long overdue,” he continues.

The report states that attempts to manage the rising costs of skin cancer set against the rising incidence of the disease must inevitably lead to the conclusion that successful education to bring about behaviour change will, in the long term, not only bring about huge savings for the NHS but also and, most importantly, save many lives.

Skin Cancer UK supports 15‐20 minutes of daily unprotected sun exposure – before 10.00am or after 3.00pm – as this is sufficient to generate the minimum required levels of vitamin D. WHO and sun experts in Australia also advise that unprotected exposure when the UV index* is lower than ‘3’ is considered safe.

The SCUK report: “Skin Cancer in the UK: The Facts”

The full SCUK report can be viewed online or downloaded as a PDF from: http://www.skcin.org/what-we-do/campaigning

Skin Cancer in the UK survey 2011: Other key findings

  • Respondents tan mainly because they think it makes them look healthy (77 per cent) and/or more attractive (48 per cent)
  • One‐third of respondents think pale skin is unattractive
  • Almost half (47 per cent) of respondents would be disappointed if they went on holiday abroad to a hotter climate but didn’t get a tan
  • When questioned about the proportion of holidays abroad they spend sunbathing, the great majority (90 per cent) said they spend at least some time sunbathing and almost half (49 per cent) spend between a ‘quarter’ to ‘most’ of their time sunbathing
  • Despite these sunbathing habits, well over half (59 per cent) of respondents think they have the type of skin that may be inclined to burn
  • Even though almost half of respondents (47 per cent) rate skin cancer as ‘extremely serious, even life threatening’ just under half (45 per cent) do not worry about getting skin cancer
  • The majority of respondents (79 per cent) admitted to have been sunburned at some point in their lifetime

The Skin Cancer UK Alliance
The report was produced by Skin Cancer UK, initiated and supported by the All‐Party Parliamentary Group on Skin, comprising the following organisations:
SKCIN (Karen Clifford Skin Cancer Charity)
Skin Care Campaign
British Dermatology Nursing Group ‐ skin cancer sub‐group
BASCSN (British Association of Skin Cancer Specialist Nurses)

Spokespeople

  • Richard Clifford, lead member of SCUK and Trustee of the Karen Clifford Skin Cancer Charity
  • Professor Barry Powell, burns, plastic and reconstructive surgeon, St George’s Healthcare Trust
  • Dr Andrew Wright, consultant dermatologist, St Luke’s Hospital, Bradford
  • Macmillan Cancer Support

References
1. Sun burn and sun safety, on‐line survey of 1020 members of t he general public. Eggington Research Associates, commissioned by Skin Cancer UK, May 2011
2. Cancer Research UK. Skin cancer statistics – Key facts http://info.cancerresearchuk.org/cancerstats/types/skin
3. Dennis LK, Vanbeek MJ, Beane Freeman LE, Smith BJ, Dawson DV, Coughlin JA. Sunburns and risk of cutaneous melanoma: does age matter?
A comprehensive meta‐analysis. Ann Epidemiol. 2008 Aug;18(8):614‐27.
4. Cancer Research UK, Skin cancer‐ UK incidence statistics http://info.cancerresearchuk.org/cancerstats/types/skin/incidence/
5. New registered cases of malignant melanoma in 2008. Office for National Statistics; Information Services Division (ISD) Scotland; Welsh Cancer Intelligence & Surveillance Unit and Northern Ireland Cancer Registry
6. The likely impact of earlier diagnosis of cancer on costs and benefits to the NHS. Summary of an Economic Modelling Project carried out by Frontier Economics on behalf of the Department of Health the National Awareness and Early Diagnosis Initiative (NAEDI) January 2011. Full document available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123576.pdf key facts on pages 21 & 63‐65
7. Mackie, R. M. (1995). Melanoma Prevention and Early Detection. Br Med Bull, 51(3), 570‐583.
8. Morris S. et al. ‘The cost of skin cancer in the UK.’ European Journal of Health Economics (2009), 10:267‐273
9. Evidence of decreased melanoma rate following awareness campaign, 1988 – 2004, Source: Cancer Council Victoria
10. Cancer Council Australia. http://www.cancer.org.au/policy/electionpriorities2010/skincancerawareness.htm (accessed March 2011)
11. Cancer Council Australia. http://www.cancer.org.au/policy/Publications/Skin_cancer_prevention_a_blue_chip_investment_in_health.htm
(accessed March 2011)

*The UV index is an international standard measurement of how strong the ultraviolet (UV) radiation from the sun is at a particular place on a particular day. It is a scale primarily used in daily forecasts aimed at the general public.

Disclaimer: Croda and St.Tropez have provided support and financial assistance. Bristol‐Myers Squibb has also provided communications guidance, editorial assistance and financial support for the launch of Skin Cancer UK.