Skin cancer in Australia

The solarium industry is regulated on a state by state basis. The first states to regulate solarium use (2008) were Victoria, South Australia and Western Australia following the death of skin cancer victim Clare Oliver.[7][8][9][10] The 2008 regulations required solaria to obtain a license, display health warnings. In Victoria, those under 16 and people with fair skin were banned from solaria and 16-17 year olds were required to have parental consent whereas in South Australia and Western Australia, under 18s were banned.[7]

In February 2009, the Victorian Government introduced license changes, including banning under 18s, consistent with the revised Australian standard, released in January 2009. Victorian solarium legalisation was revised in late 2010, strengthening controls around citing evidence of age documents for under 18s.[11][12][13][14]

The Australian standard requires that operators must:[12]

• ban people under 18s;
• sight evidence-of-age documents for those who may be under 18;
• ban people with very fair skin (skin type I);
• provide mandatory health warnings;
• provide a consent form outlining the risks of solarium use for customers to read and sign;
• complete a skin assessment of each client;
• ensure all staff have completed training in carrying out skin assessments and determining exposure times;
• ensure clients wear protective eyewear.

New South Wales, Queensland, ACT and Tasmania introduced legislation applying these standards in 2009 and 2010.[15][16][17][18] In 2011, the New South Wales government called for public submissions in relation to a proposal to extend the age ban to those under 30. In February 2012 the New South Wales Government announced its intention to ban tanning beds, starting in 2014.[19] In October 2013, the Victorian parliament passed an official ban on solaria to take effect by 2015.[20] As of 2018, there was illegal solarium use in Australia, often advertised on Gumtree.[21]

Melanoma, basal cell carcinomas and squamous cell carcinomas are predominantly caused by exposure to ultra violet radiation (UVR), and both UVA and UVB radiation has internationally been categorised as carcinogenic.[6] Artificial UVR primarily used in tanning salons and sunbeds, has generated concern among health officials and it was observed to considerably heighten the risk of developing cutaneous malignant melanoma.[6] A study in 2010 found strong evidence supporting association between indoor tanning salon use and increased risk of developing melanoma.[2] The study demonstrated strong correlations between increased risk of melanomas and carcinogenic ultraviolet radiation related outcomes.[2] These increased risks were specifically associated with younger participants,[2] with tanning and solarium use relatively popular among teens and young adults. An increase of 59% in risk of developing melanoma was associated with people who used sun beds before they were 35.[22]

Australia has recorded increased mortality rates of melanoma from the 1950s, continuing to rise until the late 1980s and beginning to steady from 1990 onwards.[4] Australia has some of the world's highest melanoma-related fatalities—double the mortality rates of south and central Europe.[4] The introduction of preventive campaigns correlate with the transition to decreases in melanoma mortality. Sun protection, other forms of primary protection, early detection and increased public awareness have had the greatest impact.[4]

Australia spends more than $2 billion annually treating cancer,[35] with skin cancer the most costly. From 2005-15 over $300 million was spent annually on diagnosis, treatment and pathology-related costs of skin cancer. With $512.3 million spent in 2010 on melanoma carcinomas,[22] costs continued to rise. The number of life-years lost and loss of productivity both have a bearing on the financial cost of the disease. The direct and indirect expenses of skin cancer in the Australian state of New South Wales (NSW) have been investigated.[36] Direct costs included those resources related to skin cancer management, and indirect costs were concerned with premature mortality and morbidity.[36] Review of 150 000 skin cancer patients in NSW (2010) revealed a total lifetime cost estimation of AU$536 million, with 72% of this cost related to direct costs, and the remaining 28% to indirect costs; the direct costs were higher in females and indirect costs higher in males.[36] Prevention initiatives make up an important part of financial expenditure for skin cancer funding and investments. Prevention programs are a productive tool, as they beneficially influence attitudes and behaviours towards skin cancer, but also deliver positive financial returns.[3] A 2009 study analysed the economic impact of prevention programs such as SunSmart. SunSmart demonstrated positive health impacts, was cost effective. The Victoria-based program returned $3.60 for every $1 invested. It concluded that SunSmart prevented 103,000 skin cancers and more than 1,000 related fatalities from 1988-2003. The study found strong evidence that continued investment and support for SunSmart was economically sound and presented beneficial outcomes for Australia.[37]