Australia's Experience with UV protection, Skin Cancer and Sun Protective Clothing

Australia has the highest incidence of skin cancer of any country in the world. Two out of three Australians will be treated for some form of skin cancer during their lifetime and melanoma is more commonly diagnosed than lung cancer. Factors contributing to Australia's skin cancer rates include the generally light skinned population, the active outdoor lifestyle, the country's relatively clear skies and depleted ozone layer, and the country's location close to the equator.

Data from the Australian Institute of Health and Welfare/Australasian Association of Cancer Registries shows the incidence of melanoma in Australia had been on the rise since the 1930s. In 1997 the raw incidence was 50.5 per 100,000 in men and 39.9 per 100,000 in women. Queensland, the state with the highest incidence of melanoma in Australia, had rates almost 30% higher. Raw melanoma mortality rates for Australia in 1997 were 6.3 per 100,000 for men and 3.5 per 100,000 for women.

Slip! Slop! Slap! and SunSmart

Starting in the early 1980s, in response to the rapidly rising toll of skin cancer, state anti-cancer societies ran public education programs to encourage Australians to reduce their exposure to the sun. The Slip! Slop! Slap! program encouraged fair-skinned Australians to protect themselves by slipping on a shirt, slopping on sunscreen, and slapping on a hat. Over time, this program evolved into the comprehensive SunSmart campaign involving public education, training for various professionals, the provision of resources to organizations and communities, and formal program evaluation activities.

The Development of Sun Protective Clothing

In the early 1990s, Australian scientists started to publish studies of the UV protective properties of different clothing fabrics--inspired, in part, by the poor protective level provided by the ubiquitous white t-shirt. Textile scientists developed a range of specially woven fabrics as well as UV absorbing chemicals to enhance the UV protection provided by various fabrics. The Australian Radiation Laboratory (ARL), part of the Australian Department of Health, began to test fabrics and issue hang tags to garment manufacturers. These hang tags specified an Ultraviolet Protection Factor (UPF) for the garment--similar to the Sun Protection Factor (SPF) rating for sunscreens. The garments were marketed by pharmacies and state anti-cancer societies. Sun protective clothing gained rapid acceptance because it was much easier to use than sunscreen and it's effectiveness was certified by a Federal government agency.

Sun Protective Clothing Today

Today, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA--the successor to ARL) issues almost 4 million UPF hang tags with individual serial numbers each year. The Australian market for sun protective clothing has become much larger than the market for sunscreen. Besides state anti-cancer organizations and pharmacies, many department stores, children's stores, and sports stores in Australia stock UPF rated clothing and accessories. Much of this sun protective apparel is targeted towards children, such as the garments we feature in our children's swimwear/playwear section.

SunSmart Program Effectiveness

Survey research from the Anti-Cancer Council of Victoria shows that the proportion of people who like to get a suntan has decreased markedly over the past decade, from 61 percent in 1988 to 35 percent in 1998. The findings also show a consistent increase over the last 13 years in the proportion of people who report seeking shade in the middle of the day, using a hat, covering up with clothing, and applying sunscreen. There has been a 50 percent reduction in people getting sunburnt in the decade from 1988 to 1998.

Trends in Skin Cancer Incidence and Mortality Rates

The incidence of melanoma fell from the mid 1980s to the mid 1990s in Australians under 60 years of age, however it continued to increase in older Australians. Similarly, the incidence of basal cell carcinoma and squamous cell cancinoma declined in people below 50 from the mid 1980s to the mid 1990s but continued to increase in older people, particularly men.

In terms of mortality, after more than 60 years of steadily increasing mortality from melanoma, the trend finally changed. Specifically, the mortality rate slowed in men and declined in women from the mid 1980s to the mid 1990s--the first time a fall in melanoma mortality had ever been reported for any population of European origin.

Summary

Overall, skin cancer rates have declined among young people and melanoma mortality has stabilized. This would suggest younger Australians are now better at protecting themselves than in the past, while older people are now detecting and seeking treatment for melanomas earlier than in the past.