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In their paper on non-melanoma skin cancer (NMSC) Brougham et al raise a number of important issues.1 Their paper is very timely, given recent upwardly revised estimates of the scale and substantial cost burden on the health system of treatment,2 for a problem that is, largely, considered potentially preventable through control of excessive exposure to UV radiation.3In addition to treatment issues, Brougham et al. identify the need for ‘community-wide preventive measures.' One of the challenges with these is to ensure that resources are allocated to implementing interventions for which there is evidence of effectiveness.With respect to interventions implemented to reduce harmful UVR exposure, a systematic review found ‘sufficient evidence' for the effectiveness of only two classes of interventions: education and policy approaches in (a) primary schools and (b) recreational and tourism settings.4 It is, therefore, fortunate that a national SunSmart Schools Accreditation Programme has been implemented by the Cancer Society in New Zealand,5 and it is important that the SSAP continues to receive adequate resourcing.Greater attention to recreational and tourism settings is warranted. However, the review found insufficient evidence to determine the effectiveness of interventions in other settings, including workplaces, or interventions focused on healthcare settings and providers, parents or caregivers of children, media campaigns alone or community-wide multi-component interventions.Since that review was undertaken, substantial numbers of additional interventions have been implemented and plans to up-date the review are under way. An up-dated review would provide an important guide for decisions made in New Zealand. In the meantime, planning for interventions in New Zealand should take into account not only existing evidence for effectiveness, but identified international research needs, which include better design, measurement and description of interventions and studies among multi-ethnic populations.Although it is currently not possible to quantify their NMSC burden, one population group which clearly deserves greater attention is those who work outdoors, potentially 14% of the workforce.6 There is evidence that outdoor workers in NZ can be exposed to high levels of real-time UVR at work,6 that better workplace sun protective behaviours are found where there is perceived workplace support,7,8 and perceived prioritisation of sun protection at work.8Another area for increased attention should be sun-bed regulation, given the increased skin cancer risks associated with their use,9 their wide distribution in NZ10 and a recent Australian report of their sometimes very high emissions (up to a UVI of 48, or about four times higher than the midday summer sun in NZ).11 Taken together, these factors provide strengthened support for arguments about the need for better controls on this potential hazard in New Zealand, which would bring us more into line with existing regulations in Australian states.So, in addition to the immediate need for adequate treatment services and surveillance there is also a need to plan for long term reduction in the scale of the skin cancer burden through targeted, carefully evaluated, often settings-based interventions while maintaining the overarching context of population health-promotion messages about the need for sensible UVR protection. This should not only help to reduce the substantial NMSC burden, but also the around 300 deaths from melanoma in NZ every year - given that excessive UVR exposure is also currently the only potentially readily modifiable risk factor for melanoma. Anthony I Reeder Director Cancer Society of New Zealand Social & Behavioural Research Unit Department of Preventive & Social Medicine Dunedin School of Medicine University of Otago, Dunedin

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Brougham NDL, Dennett E, Tan ST. Non-melanoma skin cancers in New Zealanda neglected problem. N Z Med J 2010;123:59-65. http://www.nzmj.com/journal/123-1325/4421/content.pdfO'Dea D. The Costs of Skin Cancer to New Zealand. Wellington: Wellington School of Medicine, University of Otago; 2009.Armstrong B. How sun exposure causes skin cancer: an epidemiological perspective, in Prevention of Skin Cancer. Hill D, Elwood JM, English DR, Eds. Dordrecht: Kluwer Academic Publishers; 2004.Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med 2004;27(5):422-66.Reeder AI, Jopson JA, Gray A. Baseline survey of sun protection policies and practices in primary school settings in New Zealand. Health Educ Res 2009; 24(5): 778-787.Hammond VA, Reeder AI, Gray A. Patterns of real-time occupational ultraviolet radiation exposure among a sample of outdoor workers in New Zealand. Public Health 2009; 123(2):182-187.Hammond VA, Reeder AI, Gray A, Bell ML. Are workers or their workplaces the key to occupational sun protection? Health Promotion J Aust 2008; 19(2):97-101.McCool JP, Reeder AI, Robinson EM, et al. Outdoor workers perceptions of the risks of excess sun-exposure. J Occup Health 2009;51(5):404-411.International Agency for Research on Cancer Working Group on ultraviolet light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Cancer 2006;120(5):1116-1122.Jopson JA Reeder AI. An audit of Yellow Pages telephone directory listings of indoor tanning facilities in New Zealand, 1992-2006. Aust NZ J Public Health 2008;32(4):372-376.Gies P, Javorniczky J, Henderson S et al. UVR Emissions from Solaria in Australia and Implications for the Regulation Process.Photochem Photobiol 2011;87(1):184-190.

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In their paper on non-melanoma skin cancer (NMSC) Brougham et al raise a number of important issues.1 Their paper is very timely, given recent upwardly revised estimates of the scale and substantial cost burden on the health system of treatment,2 for a problem that is, largely, considered potentially preventable through control of excessive exposure to UV radiation.3In addition to treatment issues, Brougham et al. identify the need for ‘community-wide preventive measures.' One of the challenges with these is to ensure that resources are allocated to implementing interventions for which there is evidence of effectiveness.With respect to interventions implemented to reduce harmful UVR exposure, a systematic review found ‘sufficient evidence' for the effectiveness of only two classes of interventions: education and policy approaches in (a) primary schools and (b) recreational and tourism settings.4 It is, therefore, fortunate that a national SunSmart Schools Accreditation Programme has been implemented by the Cancer Society in New Zealand,5 and it is important that the SSAP continues to receive adequate resourcing.Greater attention to recreational and tourism settings is warranted. However, the review found insufficient evidence to determine the effectiveness of interventions in other settings, including workplaces, or interventions focused on healthcare settings and providers, parents or caregivers of children, media campaigns alone or community-wide multi-component interventions.Since that review was undertaken, substantial numbers of additional interventions have been implemented and plans to up-date the review are under way. An up-dated review would provide an important guide for decisions made in New Zealand. In the meantime, planning for interventions in New Zealand should take into account not only existing evidence for effectiveness, but identified international research needs, which include better design, measurement and description of interventions and studies among multi-ethnic populations.Although it is currently not possible to quantify their NMSC burden, one population group which clearly deserves greater attention is those who work outdoors, potentially 14% of the workforce.6 There is evidence that outdoor workers in NZ can be exposed to high levels of real-time UVR at work,6 that better workplace sun protective behaviours are found where there is perceived workplace support,7,8 and perceived prioritisation of sun protection at work.8Another area for increased attention should be sun-bed regulation, given the increased skin cancer risks associated with their use,9 their wide distribution in NZ10 and a recent Australian report of their sometimes very high emissions (up to a UVI of 48, or about four times higher than the midday summer sun in NZ).11 Taken together, these factors provide strengthened support for arguments about the need for better controls on this potential hazard in New Zealand, which would bring us more into line with existing regulations in Australian states.So, in addition to the immediate need for adequate treatment services and surveillance there is also a need to plan for long term reduction in the scale of the skin cancer burden through targeted, carefully evaluated, often settings-based interventions while maintaining the overarching context of population health-promotion messages about the need for sensible UVR protection. This should not only help to reduce the substantial NMSC burden, but also the around 300 deaths from melanoma in NZ every year - given that excessive UVR exposure is also currently the only potentially readily modifiable risk factor for melanoma. Anthony I Reeder Director Cancer Society of New Zealand Social & Behavioural Research Unit Department of Preventive & Social Medicine Dunedin School of Medicine University of Otago, Dunedin

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Brougham NDL, Dennett E, Tan ST. Non-melanoma skin cancers in New Zealanda neglected problem. N Z Med J 2010;123:59-65. http://www.nzmj.com/journal/123-1325/4421/content.pdfO'Dea D. The Costs of Skin Cancer to New Zealand. Wellington: Wellington School of Medicine, University of Otago; 2009.Armstrong B. How sun exposure causes skin cancer: an epidemiological perspective, in Prevention of Skin Cancer. Hill D, Elwood JM, English DR, Eds. Dordrecht: Kluwer Academic Publishers; 2004.Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med 2004;27(5):422-66.Reeder AI, Jopson JA, Gray A. Baseline survey of sun protection policies and practices in primary school settings in New Zealand. Health Educ Res 2009; 24(5): 778-787.Hammond VA, Reeder AI, Gray A. Patterns of real-time occupational ultraviolet radiation exposure among a sample of outdoor workers in New Zealand. Public Health 2009; 123(2):182-187.Hammond VA, Reeder AI, Gray A, Bell ML. Are workers or their workplaces the key to occupational sun protection? Health Promotion J Aust 2008; 19(2):97-101.McCool JP, Reeder AI, Robinson EM, et al. Outdoor workers perceptions of the risks of excess sun-exposure. J Occup Health 2009;51(5):404-411.International Agency for Research on Cancer Working Group on ultraviolet light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Cancer 2006;120(5):1116-1122.Jopson JA Reeder AI. An audit of Yellow Pages telephone directory listings of indoor tanning facilities in New Zealand, 1992-2006. Aust NZ J Public Health 2008;32(4):372-376.Gies P, Javorniczky J, Henderson S et al. UVR Emissions from Solaria in Australia and Implications for the Regulation Process.Photochem Photobiol 2011;87(1):184-190.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

In their paper on non-melanoma skin cancer (NMSC) Brougham et al raise a number of important issues.1 Their paper is very timely, given recent upwardly revised estimates of the scale and substantial cost burden on the health system of treatment,2 for a problem that is, largely, considered potentially preventable through control of excessive exposure to UV radiation.3In addition to treatment issues, Brougham et al. identify the need for ‘community-wide preventive measures.' One of the challenges with these is to ensure that resources are allocated to implementing interventions for which there is evidence of effectiveness.With respect to interventions implemented to reduce harmful UVR exposure, a systematic review found ‘sufficient evidence' for the effectiveness of only two classes of interventions: education and policy approaches in (a) primary schools and (b) recreational and tourism settings.4 It is, therefore, fortunate that a national SunSmart Schools Accreditation Programme has been implemented by the Cancer Society in New Zealand,5 and it is important that the SSAP continues to receive adequate resourcing.Greater attention to recreational and tourism settings is warranted. However, the review found insufficient evidence to determine the effectiveness of interventions in other settings, including workplaces, or interventions focused on healthcare settings and providers, parents or caregivers of children, media campaigns alone or community-wide multi-component interventions.Since that review was undertaken, substantial numbers of additional interventions have been implemented and plans to up-date the review are under way. An up-dated review would provide an important guide for decisions made in New Zealand. In the meantime, planning for interventions in New Zealand should take into account not only existing evidence for effectiveness, but identified international research needs, which include better design, measurement and description of interventions and studies among multi-ethnic populations.Although it is currently not possible to quantify their NMSC burden, one population group which clearly deserves greater attention is those who work outdoors, potentially 14% of the workforce.6 There is evidence that outdoor workers in NZ can be exposed to high levels of real-time UVR at work,6 that better workplace sun protective behaviours are found where there is perceived workplace support,7,8 and perceived prioritisation of sun protection at work.8Another area for increased attention should be sun-bed regulation, given the increased skin cancer risks associated with their use,9 their wide distribution in NZ10 and a recent Australian report of their sometimes very high emissions (up to a UVI of 48, or about four times higher than the midday summer sun in NZ).11 Taken together, these factors provide strengthened support for arguments about the need for better controls on this potential hazard in New Zealand, which would bring us more into line with existing regulations in Australian states.So, in addition to the immediate need for adequate treatment services and surveillance there is also a need to plan for long term reduction in the scale of the skin cancer burden through targeted, carefully evaluated, often settings-based interventions while maintaining the overarching context of population health-promotion messages about the need for sensible UVR protection. This should not only help to reduce the substantial NMSC burden, but also the around 300 deaths from melanoma in NZ every year - given that excessive UVR exposure is also currently the only potentially readily modifiable risk factor for melanoma. Anthony I Reeder Director Cancer Society of New Zealand Social & Behavioural Research Unit Department of Preventive & Social Medicine Dunedin School of Medicine University of Otago, Dunedin

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Brougham NDL, Dennett E, Tan ST. Non-melanoma skin cancers in New Zealanda neglected problem. N Z Med J 2010;123:59-65. http://www.nzmj.com/journal/123-1325/4421/content.pdfO'Dea D. The Costs of Skin Cancer to New Zealand. Wellington: Wellington School of Medicine, University of Otago; 2009.Armstrong B. How sun exposure causes skin cancer: an epidemiological perspective, in Prevention of Skin Cancer. Hill D, Elwood JM, English DR, Eds. Dordrecht: Kluwer Academic Publishers; 2004.Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review. Am J Prev Med 2004;27(5):422-66.Reeder AI, Jopson JA, Gray A. Baseline survey of sun protection policies and practices in primary school settings in New Zealand. Health Educ Res 2009; 24(5): 778-787.Hammond VA, Reeder AI, Gray A. Patterns of real-time occupational ultraviolet radiation exposure among a sample of outdoor workers in New Zealand. Public Health 2009; 123(2):182-187.Hammond VA, Reeder AI, Gray A, Bell ML. Are workers or their workplaces the key to occupational sun protection? Health Promotion J Aust 2008; 19(2):97-101.McCool JP, Reeder AI, Robinson EM, et al. Outdoor workers perceptions of the risks of excess sun-exposure. J Occup Health 2009;51(5):404-411.International Agency for Research on Cancer Working Group on ultraviolet light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Cancer 2006;120(5):1116-1122.Jopson JA Reeder AI. An audit of Yellow Pages telephone directory listings of indoor tanning facilities in New Zealand, 1992-2006. Aust NZ J Public Health 2008;32(4):372-376.Gies P, Javorniczky J, Henderson S et al. UVR Emissions from Solaria in Australia and Implications for the Regulation Process.Photochem Photobiol 2011;87(1):184-190.

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