Transcript Skin Cancer Prevention - Saskatchewan Cancer Agency

SKIN CANCER PREVENTION
May 2011
PART ONE
Background
Information
What is Skin Cancer?
 Cancer that forms in tissues of the skin
 Several types of skin cancer
 Most form in older people on parts of the body exposed
to the sun or in people who have weakened immune
systems
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Skin Cancer Statistics – Canada
 Most common form of cancer in Canada
 An estimated 79,600 Canadians will be diagnosed with
skin cancer in 2011
o 5,500 diagnosed with melanoma
o 74,100 diagnosed with non-melanoma skin cancer
 An estimated 1,220 deaths from skin cancer will occur
in 2011
o 950 from melanoma
o 270 from non-melanoma skin cancer
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Skin Cancer Statistics – Saskatchewan
 Of 8,930 new cancer cases in 2008
o 3,102 were skin cancer cases
 138 melanoma skin cancers
 2,964 non-melanoma skin cancers
 24 people died of melanoma in 2008
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What Causes Skin Cancer?
 Sun exposure is the main environmental cause of skin
cancer
o Ultraviolet radiation (UVR) is the solar wavelength involved
– UVA & UVB
o Most significant preventable risk factor for developing skin
cancer
 Artificial tanning equipment – tanning beds, sunlamps,
tanning lights – also emit ultraviolet radiation
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Types of Skin Cancer
 Non-melanoma
o Basal cell carcinoma (BCC)
o Squamous cell carcinoma (SCC)
 Melanoma
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Basal Cell Carcinoma (BCC)
 Most common form of skin cancer
 Occur on parts of the body excessively exposed to the
sun, especially the face, nose, ears, scalp, neck,
shoulders and back
 Seldom metastasizes (spreads) however causes
considerable damage to tissue
 Easily treated in the early stages however can be
aggressive requiring extensive treatment
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Squamous Cell Carcinoma (SCC)
 Second most common form of skin cancer
 Occurs most commonly in areas frequently exposed to
the sun such as, the rim of the ear, lower lip, face, bald
scalp, neck, hands, arms and legs
 If untreated can penetrate tissue causing damage and
metastasize (spread) to distant parts of the body
 With early detection almost always curable
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Melanoma
 Most dangerous form of skin cancer
 Can cause serious illness and death
 Majority of melanomas are brown or black however
some are skin-coloured, pink, red, purple, blue or
white
 If treated early it is nearly curable however if not it can
advance and spread
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ABCDEs of Melanoma
 A = Asymmetry
o The shape on one side is different than the other side
 B = Border
o The border or visible edge is irregular, ragged and imprecise
 C = Colour
o There is a colour variation with brown, black, red, grey or white within the
lesion
 D = Diameter
o Growth is typical of melanoma. It is usually more than 6 mm although it
can be less
 E = Evolution
o Look for change in colour, size, shape or symptom such as itching,
tenderness or bleeding
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5 Steps to Skin Cancer Self-Exam
1.
2.
3.
4.
5.
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Using a mirror in a well lit room, check the front of your body –
face, neck, shoulders, arms, chest, abdomen, thighs and lower
legs.
Turn sideways, raise your arms and look carefully at the right
and left sides of your body, including the underarm area.
With a hand-held mirror, check your upper back, neck and
scalp. Next examine your lower back, buttocks, backs of thighs
and calves.
Examine your forearms, palms, back of the hands, fingernails
and in between each finger.
Finally, check your feet – the tops, soles, toenails, toes and
spaces in between.
Sun Smart Saskatchewan
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Risk Factors for Skin Cancer
 Exposure to solar or artificial ultraviolet radiation
 Sunburns particularly during childhood and adolescence
 Fair or light skin pigmentation
 Lighter hair colour (blond or red)
 Lighter eye colour (blue, green, grey)
 Tendency to freckle, tan poorly and burn easily
 Family or past history of skin cancer
 Large number of moles or with one or more unusual moles
 Take medications that make one more sensitive to the sun
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Vitamin D
 Sun is a main source of Vitamin D
 Amount of sun needed to make Vitamin D changes from
person to person
o It depends on age, diet, skin colour, where you live, time of
day, and time of year
o A few minutes a day is usually all that is needed for most
people
 Prolonged sun exposure or a tan is not needed to get
enough Vitamin D
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PART TWO
Skin Cancer in
Saskatchewan & Canada
What is Incidence?
 Incidence is a measure of disease burden
 Reported either as
o # of new cases in a time period
o a rate for the time period
 Incidence rates are standardized in order to compare
groups from different backgrounds and age structures
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Provincial Skin Cancer Cases
 26,993 skin cancer cases were diagnosed from 1998
to 2007
o 19,361 cases of basal cell carcinoma
o 6,087 cases of squamous cell carcinoma
o 1,216 cases of melanoma
o 329 other skin cancer cases
 Represent the number of cases of skin cancer and not
the number of persons with skin cancer
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Basal Cell Carcinoma Cases in Saskatchewan
Basal Skin Cancer new cases in Saskatchewan
from 1998 to 2007
Number of cases
1400
1200
1000
800
Female
600
Male
400
200
0
Years
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Basal Cell Carcinoma Rates in Saskatchewan
Age Standardized Incidence Rates
Basal skin cancer in Saskatchewan from 1998 to 2007
250
200
150
Female
100
Male
50
0
Years
Standardized to 1991 Canadian Population (rate/100,000)
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GIS Maps
Age-Standardized Incidence
Rates (per 100,000) – Males
Basal Cell Carcinoma
1998 – 2007
Basal Cell Carcinoma in Males, 1998-1999
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Basal Cell Carcinoma in Males, 2000-2001
22
Basal Cell Carcinoma in Males, 2002-2003
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Basal Cell Carcinoma in Males, 2004-2005
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Basal Cell Carcinoma in Males, 2006-2007
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GIS Maps
Age-Standardized Incidence
Rates (per 100,000) – Females
Basal Cell Carcinoma
1998 – 2007
Basal Cell Carcinoma in Females, 1998-1999
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Basal Cell Carcinoma in Females, 2000-2001
28
Basal Cell Carcinoma in Females, 2002-2003
29
Basal Cell Carcinoma in Females, 2004-2005
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Basal Cell Carcinoma in Females, 2006-2007
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Squamous Cell Carcinoma Cases in Saskatchewan
Number of new cases
Squamous Skin Cancer new cases in Saskatchewan
from 1998 to 2007
500
400
300
Female
200
Male
100
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Years
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Squamous Cell Carcinoma Rates in Saskatchewan
Age Standardized Incidence
Rates
Squamous Skin Cancer in Saskatchewan
from 1998 to 2007
80
70
60
50
40
30
20
10
0
Female
Male
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Years
Standardized to 1991 Canadian Population (rate/100,000)
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GIS Maps
Age-Standardized Incidence
Rates (per 100,000) – Males
Squamous Cell Carcinoma
1998 – 2007
Squamous Cell Carcinoma in Males, 1998-1999
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Squamous Cell Carcinoma in Males, 2000-2001
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Squamous Cell Carcinoma in Males, 2002-2003
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Squamous Cell Carcinoma in Males, 2004-2005
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Squamous Cell Carcinoma in Males, 2006-2007
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GIS Maps
Age-Standardized Incidence
Rates (per 100,000) – Females
Squamous Cell Carcinoma
1998 – 2007
Squamous Cell Carcinoma in Females, 1998-1999
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Squamous Cell Carcinoma in Females, 2000-2001
42
Squamous Cell Carcinoma in Females, 2002-2003
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Squamous Cell Carcinoma in Females, 2004-2005
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Squamous Cell Carcinoma in Females, 2006-2007
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Melanoma Cases in Saskatchewan
Melanoma new cases from 1998 to 2007
90
Number of new cases
80
70
60
50
Female
40
Male
30
20
10
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Years
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Melanoma Rates in Saskatchewan
16
14
12
10
8
6
4
2
0
Female
Male
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
Age Standardized Incidence
Rates
Melanoma Skin Cancer from 1998 to 2007
Years
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Standardized to 1991 Canadian Population (rate/100,000)
May 2011
GIS Maps
Age-Standardized Incidence
Rates (per 100,000) – Males
Melanoma
1998 – 2007
Melanoma Skin Cancer in Males, 1998-1999
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Melanoma Skin Cancer in Males, 2000-2001
50
Melanoma Skin Cancer in Males, 2002-2003
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Melanoma Skin Cancer in Males, 2004-2005
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Melanoma Skin Cancer in Males, 2006-2007
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GIS Maps
Age-Standardized Incidence
Rates (per 100,000) – Females
Melanoma
1998 – 2007
Melanoma Skin Cancer in Females, 1998-1999
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Melanoma Skin Cancer in Females, 2000-2001
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Melanoma Skin Cancer in Females, 2002-2003
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Melanoma Skin Cancer in Females, 2004-2005
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Melanoma Skin Cancer in Females, 2006-2007
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Melanoma Skin Cancer
(Canada vs. Saskatchewan)
Melanoma skin cancer from 1998 to 2005
Age Standardized
Incidence Rate
12
10
8
Canada
6
SK
4
2
0
1998 1999 2000 2001 2002 2003 2004 2005
Years
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Standardized to 1991 Canadian Population (rate/100,000)
May 2011
Melanoma Skin Cancer
(Canada vs. Saskatchewan)
Age Standardized Incidence
Rates
Melanoma Skin Cancer (Males) from 1998 to 2005
16
14
12
10
8
6
4
2
0
Male-CA
Male-SK
1998 1999 2000 2001 2002 2003 2004 2005
Years
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Standardized to 1991 Canadian Population (rate/100,000)
May 2011
Melanoma Skin Cancer
(Canada vs. Saskatchewan)
Age Standardized Incidence
Rates
Melanoma Skin Cancer (Females) from 1998 to 2005
14
12
10
8
6
4
2
0
Female-CA
Female-SK
1998 1999 2000 2001 2002 2003 2004 2005
Years
Standardized to 1991 Canadian Population (rate/100,000)
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A Global Perspective
 The incidence of both non-melanoma and melanoma
skin cancers has been increasing over recent decades
 Between two to three million non-melanoma skin
cancers and 132,000 melanoma skin cancers occur
globally each year
 One in every three cancers diagnosed is a skin cancer
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Melanoma Incidence Rates in North America
Males
Females
(per 100,000)
(per 100,000)
2003
21.5
13.7
Canada
2003
12.8
10.0
Canada
2005
12.7
10.7
Country
Year
United
States
United States Incidence Rates standardized to 2000 US Standard Population
Canadian Incidence Rates standardized to 1991 Canadian Standard Population
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Global Melanoma Incidence Rates
Males
Females
(per 100,000)
(per 100,000)
2003
44.2
31.0
Finland
2003
9.2
7.8
Sweden
2003
13.1
12.9
Country
Year
Australia
Incidence Rates standardized to 2000 World Standard Population
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Survival Rates for Melanoma
 The five-year survival rate represents persons who are
living five years after diagnosis, whether disease-free, in
remission or under treatment
 American Cancer Society estimates:
o 5-year localized survival rate melanoma: 99%
o 5-year distant spread survival rate melanoma: 16%
o 5-year overall survival rate melanoma: 91%
 Estimated five-year relative survival rate in Canada is
90%
o 87% for men & 93% for women
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Summary
 Both sexes combined, the age-standardized incidence
rate of melanoma is lower in Saskatchewan than the
Canadian population over the time period of 1998 to
2005
 SK males: the trend has been lower than the Canadian male
population; however, rates are now increasing
 SK females: the trend has been higher than the Canadian female
population; however, rates are now decreasing
 Age-standardized incidence rates of melanoma and
non-melanoma (BCC, SCC) skin cancers are higher in
males than females
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PART THREE
Second National Sun Survey
(NSS2)
Second National Sun Survey
 National Skin Cancer Prevention Committee
 Conducted across Canada in 2006
 A sample of 7,121 adults aged 16+ years were interviewed
 Response rate was 63%
 1,008 participants from Manitoba and Saskatchewan
o n=504 in Saskatchewan
 Weighted estimates and age-standardization were used to
compare Saskatchewan with the Canadian population
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May 2011
Sun Exposure (Ultraviolet Radiation)
Canadians spending at least 2 hours in the sun
on a typical summer day, by region
60
52
50
42.5
34.8
Percent
40
30
27.6
Adults
Children
20
10
0
CAN
SK
Region
Adult estimates age-standardized to 2001 Canadian Population
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Prevention – Sun Safety
 Sun protection behaviours are important from late
spring to early fall between 11 a.m. – 4 p.m., April
through September or whenever the UV Index is 3 or
higher
o Cover up, wear a hat, sunglasses and sunscreen
 Caution is also recommended near reflective surfaces
such as water, snow, sand, concrete and ice
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May 2011
Seek Suntans
Canadian Adults seeking a tan during the past year,
by region
30
Percent
25
23.9
21.7
Tan from the sun
20
15
10.9
9.0
10
Tanning equipment
use
5
0
CAN
Age-standardized to 2001 CAP
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Sun Smart Saskatchewan
SK
Region
May 2011
Use of Artificial Tanning Equipment
Canadian adults use of artificial tanning
equipment in the past 12 months, by region
40
34.8
35
Percent
30
24.7
25
20
15
10
5
0
Canada
Saskatchewan
Region
Age-standardized to 2001 Canadian Population
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May 2011
Prevention – Knowledge
 Exposure to ultraviolet radiation (UVR), whether from
the sun or from tanning devices, increases your risk of
melanoma and other skin cancers
 The risk of melanoma is increased by 75% when the
use of tanning devices starts before age 35
 Avoid tanning beds, especially youth under the age of
18
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May 2011
Sun Protection Behaviors
Canadians practising sun protection behaviors, by
region
100
Percent
80
83.2
80.0
69.0
62.1
60
Adults
40
Children
20
0
CAN
SK
Region
Sun protection behaviors: Always/often seeking shade and avoiding the sun OR wearing protective clothing and a hat
OR spending fewer than 30 minutes in the sun OR wearing sunscreen SPF15+ on face and body
Adult estimates age-standardized to 2001 Canadian Population
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Prevention – Sun Protection
 Seek shade or create your own (e.g., umbrellas, trees,
canopies, awnings, gazebos, portable tents)
 Wear a wide-brimmed hat to shade your face, ears, and
neck
 Wear protective clothing; dark, loose, and closely woven
fabrics to cover your arms and legs
 Wear sunglasses to protect your eyes from sun damage.
Choose ones with UVA and UVB protection
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May 2011
Prevention – Sunscreen
 Wear a broad spectrum (UVA & UVB) sunscreen
 Wear a sunscreen with a sun protection factor (SPF) of
at least 15 or higher (SPF 30 or higher for outdoor
workers and people spending the day outside)
o Products carrying the Canadian Dermatology Association’s (CDA) logo
have been specially tested to ensure safety and effectiveness
 Sunscreens should be used in combination with other
methods of sun protection such as hats, clothing and
shade
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Prevention – Sunscreen
 Apply generous amounts of sunscreen 15 to 30
minutes before going outdoors whenever the UV Index
is 3 or higher and when you are planning to be outside
for 30 minutes or more
 Reapply every few hours and even more frequently
when physically active (swimming, sweating)
 Apply sunscreen on cloudy days and during the winter
months if you are involved in outdoor activities
 Apply a broad spectrum lip balm (SPF 30 or higher)
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May 2011
Sunburns
Canadians who got at least one sunburn during the
summer, by region
21.8
25
Percent
20
18.5
19.5
16.2
15
Adults
10
Children
5
0
CAN
SK
Region
Adult estimates age-standardized to 2001 Canadian Population
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Sun Smart Saskatchewan
May 2011
Prevention – Knowledge
 Both a sunburn or a tan are unhealthy; both are signs
of skin damage
 A sunburn as a child increases the risk of developing
skin cancer as an adult
 Learn about the UV Index – the higher the number the
stronger the sun’s rays
 Protect yourself outdoors when the UV Index is 3 or
higher – cover up, wear a hat, sunglasses and
sunscreen
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Sun Smart Saskatchewan
May 2011
Outdoor Workers
Percent
Canadians aged 16+ years who worked outdoors
during the summer, by region
40
35
30
25
20
15
10
5
0
34.3
22.5
Canada
Saskatchewan
Region
Age-standardized to 2001 Canadian Population
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Sun Smart Saskatchewan
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Outdoor Workers
Percent
Outdoor workers, by age and region
45
40
35
30
25
20
15
10
5
0
38.1
33.5
32.4
40.0
22.0
24.2
24.5
CAN
SK
9.1
16-24
25-44
45-64
65+
Age groups
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Sun Smart Saskatchewan
May 2011
Outdoor Workers – Sun Protection Behaviours
Sun protection behaviours in outdoor workers
aged 16+ years, by region
45
41.3
40
35
31.2
Percent
30
25
22.7
20
Covering**
15
10.6
Sunscreen*
10
5
0
CAN
**covering their head &body
SK
*use sunscreen on their face and the rest of body
Age-standardized to 2001 Canadian Population
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May 2011
Outdoor Workers – Sunburns
Canadians aged 16+ years who worked outdoors and
got at least one sunburn during the summer, by region
30
Percent
25
25.9
22.3
20
15
10
5
0
Canada
Saskatchewan
Region
Age-standardized to 2001 Canadian Population
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Sun Smart Saskatchewan
May 2011
National Sun Survey – Key Findings
 Saskatchewan residents are likely to spend more time
in the sun and practice fewer sun protection behaviours
in comparison to Canadians
 Saskatchewan residents are more likely to seek a tan,
keep a tan, experience sunburns, and to use artificial
tanning equipment in comparison to Canadians
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Sun Smart Saskatchewan
May 2011
National Sun Survey – Key Findings
 Saskatchewan residents are less likely than Canadians
to check the UV Index
 Saskatchewan residents are more likely to take extra
efforts to protect themselves when the UV Index is high
or very high
 Saskatchewan children (age one to twelve years) spend
less time in the sun, practice fewer sun protection
behaviours and have more sunburns in comparison to
Canadian children
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Sun Smart Saskatchewan
May 2011
National Sun Survey – Key Findings
 Saskatchewan has more outdoor workers in all age
groups in comparison to all Canadian outdoor workers
 Saskatchewan outdoor workers are more likely to cover
their head and wear protective clothing but less likely to
wear sunglasses and to use sunscreen on their face
than other Canadian outdoor workers
 Saskatchewan outdoor workers are more likely to have
a sunburn in comparison to other Canadian outdoor
workers
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May 2011
Sun Smart Saskatchewan
 Established in June 2009
 Vision – aware and engaged communities throughout
Saskatchewan actively preventing skin cancer
 Create awareness of the risk for skin cancer from
ultraviolet radiation exposure
 Encourage other organizations, groups and individuals
to increase skin cancer prevention efforts
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May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
1.
Improve knowledge, attitudes and behaviours of
Canadians concerning skin cancer and solar/non
solar ultraviolet radiation protection
 Review and revise messages about health risks from
UVR, tailored to population subgroups
 Include messages about Vitamin D to aid the public in
making healthy decisions about sun safety
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Sun Smart Saskatchewan
May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
1.
Improve knowledge, attitudes and behaviours of
Canadians concerning skin cancer and solar/non
solar ultraviolet radiation protection … continued
 Educate those who work outdoors about the risks of
high levels of sun exposure
 Promote “Sun Awareness Week” within particular
settings such as, day care centres, schools,
workplaces, and recreation centres
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Sun Smart Saskatchewan
May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
2.
Achieve healthy settings, organizations, products,
policies and practices that promote sun protection
 Enhance organizational and school policy for sun
protection in schools (grades K to 12)
 Encourage workplaces to offer benefits to outdoor
workers practicing sun safety
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Sun Smart Saskatchewan
May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
2.
Achieve healthy settings, organizations, products,
policies and practices that promote sun protection …
continued
 Develop shade policies that can be adapted for use by
municipal governments, schools, etc., that plan for
shade when new facilities for outdoor recreation are
being designed or remodeled
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May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
3.
Strengthen the community’s capacity for effective
action on skin cancer prevention
 Educate travel agents and companies promoting
holidays to sunny places about the harms of excessive
sun exposure and assist them in promoting sun safety
to their clients
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Sun Smart Saskatchewan
May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
3.
Strengthen the community’s capacity for effective
action on skin cancer prevention … continued
 Work with the cosmetics industry to promote sunscreen
in their products, encourage customers to purchase
these products, and encourage safe alternatives to
tanning
 Educate provincial and municipal tourism departments
about the need for sun safe behaviours
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Sun Smart Saskatchewan
May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
4.
Strengthen informed decision making in the design,
implementation and evaluation of skin cancer
prevention strategies
 Identify ways to denormalize tanning and the tanned
look
 Require appropriate evidence to support incorporation
of Vitamin D information into sun safety messages
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Sun Smart Saskatchewan
May 2011
National Strategic Directions for
Primary Prevention of Skin Cancer
4.
Strengthen informed decision making in the design,
implementation and evaluation of skin cancer
prevention strategies … continued
 Evaluate the significance of the regional differences in
UV Index knowledge, attitudes and behaviours, and
take action to address these differences
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Questions
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May 2011
For More Information Contact…
Sun Smart Saskatchewan via:
Saskatchewan Cancer Agency
Prevention Department
Population Health Division
400 – 2631 28th Avenue
Regina, SK S4S 6X3
P: 306-359-5877
www.saskcancer.ca
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May 2011