Points de Vue: Professor Olver, please could you provide our readers with your perspective on the current scope of the activities of Cancer Council Australia and give them a little background on its origins and vision?
Prof. Ian Olver: Cancer Council Australia is the national body in a federated structure of state and territory Cancer Councils. We are funded by our member organisations to undertake national activity, such as advocacy for cancer policy to the Federal Government and national media. We help drive national prevention campaigns and activities, and working with our national committees, we produce the National Cancer Prevention Policy, which isupdated by our committees according to the latest evidence available. We also produce clinical practice guidelines on a custom designed wiki to allow continual updating and wide dissemination. Our Supportive Care Committee co-ordinates patient information and we communicate to the public through social media and interactive sites such as iheard.com, which allows people to ask questions about cancer claims that they have seen on the web. We promote cancer prevention lifestyle messages such as tobacco control, diet and exercise and sun protection, as well as early detection by encouraging participation in national cancer screening programs. On the fundraising side, Cancer Council Australia is responsible for national corporate partnerships and national promotion of major fundraising events such as Daffodil Day, Pink Ribbon and Australia’s Biggest Morning Tea. Cancer Council Australia’s vision is to minimise the threat of cancer to Australians, through prevention, best treatment and optimal support for patients with cancer and their families.
Overwhelmingly Australians have been made aware of the risk of skin cancer via the “Slip Slop Slap” campaigns of the Council. How important is this awareness of the dangers of UV exposure both locally and internationally? What is the impact of this on public health?
Children can be very sensitive to sun damage.
Protection against excessive UV exposure is a modifiable risk factor for skin cancer. In Australia skin cancers are a great economic burden.There are over 1 million GP consultations each year for non-melanoma skin cancer. Over 430,000 non-melanoma skin cancers are diagnosed each year and around 12,000 melanomas. We have over 2,000 deaths form skin cancer each year. The “Slip Slop Slap” campaigns have raised awareness of the importance of covering up the skin, as well as using sunscreen on exposed areas to reduce skin damage, and subsequent skin cancers, when the UV level is three or above. We know from measures like our National Sun Survey, younger Australians are starting to get the message. For example, in our 2004 survey, 60 per cent of adolescents said they would like to get a suntan, which had fallen to 45 per cent by 2011.
What have been the most significant developments in the scientific or clinical research in relation to UV exposure and cancer since you started with Cancer Council?
From the public health perspective the introduction of the UV index and its reporting in the press gives people an accurate picture of what times during the day in their geographic location the UV index will be 3 and above, which signals the need for sun protection. With regard to skin cancers, the most lethal, melanoma, has been curable if caught early and surgically removed, but fatal after it spreads. For the first time we have seen new targeted therapies developed that increase the survival time of widespread disease, because they target altered genes that are responsible for the growth of the cancer or target proteins that are preventing the body’s immune system from attacking the cancer. These drugs alone and in combination offer promise of vastly improved outcomes with less side effects than previous therapies.
In recent years Cancer Council has added “Seek and Slide” as required actions against UV exposure. What were the drivers behind this change, in particular with relation to ocular health?
Cancer Council added “Seek and Slide” to “Slip Slop Slap” to reinforce the message that seeking shade when the sun is most intense also helps to reduce the risk of skin damage. Sliding on sunglasses recognised the damage that UV exposure can do to the eyes, ranging from cataracts to retinal cancers and cancers on the skin surrounding the eyes. We have encouraged both children and adults to get used to protecting their eyes along with protecting the rest of the skin.
Sunglasses have had mandated standards and classification for UV protection for some time, but now Cancer Council is embarking on the endorsement of the “clear” prescription spectacle coating Crizal ® UV. What role do you believe this will play in the further prevention of ocular and peri-ocular cancers?
Many who wear prescription spectacles have had difficulty adequately protecting their eyes. Devices such as clip on sun lenses are often bulky and address the UV that comes through the lens, but not that which comes in from the sides and reflects of the back surface of the lens into the eye. The Crizal ® UV prescription lenses reduce both the UV coming to the eye through the lens and that being reflected onto the eye from the back of the lens, which will increase the protection of the eyes and skin around them. Reducing the UV exposure translates into reduced risk of skin cancer and eye cancer.
What other initiatives do you believe are required to improve the level of public safety and awareness to help reduce avoidable cancers, particularly in relation to the eyes?
There are target groups such as outdoor workers who are constantly exposed to UV as part of their regular job. They should be aware of the risks of sun damage to their skin and eyes and provided with protection or even have working hours changed to avoid the times of day when the UV index is high. Protection should include adequate eye protection.
Children are often thought of but also often overlooked when it comes to protecting their eyes. With their clear ocular media allowing greater UV transmission, what level of protection do they actually require?
Children can be very sensitive to sun damage. Avoiding sun exposure when the UV level is three or above is a good strategy for young infants. As a part of encouraging sun protection behaviour, children should wear hats, suitable clothing and have their eyes protected. Behaviours commenced in primary school are important. In addition schools should provide adequate shade cloth protected areas to allow shelter when the UV level is 3 or above.
In your opinion, what is the key role that ophthalmic clinicians (ophthalmologists, optometrists and optical dispensers) should be playing in prevention and protection against cancer?
The key role of ophthalmic clinicians in cancer prevention is in examining the eyes to ensure that they monitor pigmented lesions on the retina and detect early cancers in the skin around the eyes. Early detection of both is important to their outcomes. In terms of prevention, they should counsel patients to protect the eyes as well as wearing hats, appropriate clothing and using sunscreen when the UV exposure warrants it (a UV index of 3 or above).
Reducing the UV exposure translates intoreduced risk of skin cancer and eye cancer.
Where to next? What are the key areas in the next decade for this important health issue?
Increasing public awareness of the need for sun protection, including the eyes, remains the major challenge to reduce the incidence of skin cancer. The UV coating of prescription lenses and the wearing of sunglasses each has a place in modifying this risk. The advances in personalised medicine with more targeted therapies for melanoma will result in increasing survival rates for those with widespread disease.
Interviewed by Tim Thurn.