1. May 2011 SKIN CANCER PREVENTION

2. Background Information PART ONE

3. 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 Sun Smart Saskatchewan 3 May 2011

4. 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 Sun Smart Saskatchewan 4 May 2011

5. 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 Sun Smart Saskatchewan 5 May 2011

6. 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 Sun Smart Saskatchewan 6 May 2011

7. Types of Skin Cancer Non-melanoma o Basal cell carcinoma (BCC) o Squamous cell carcinoma (SCC) Melanoma Sun Smart Saskatchewan 7 May 2011

8. 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 8 Sun Smart Saskatchewan May 2011

9. 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 9 Sun Smart Saskatchewan May 2011

10. 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 Sun Smart Saskatchewan 10 May 2011

11. 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 Sun Smart Saskatchewan 11 May 2011

12. 5 Steps to Skin Cancer Self-Exam 1. Using a mirror in a well lit room, check the front of your body – face, neck, shoulders, arms, chest, abdomen, thighs and lower legs. 2. Turn sideways, raise your arms and look carefully at the right and left sides of your body, including the underarm area. 3. With a hand-held mirror, check your upper back, neck and scalp. Next examine your lower back, buttocks, backs of thighs and calves. 4. Examine your forearms, palms, back of the hands, fingernails and in between each finger. 5. Finally, check your feet – the tops, soles, toenails, toes and spaces in between. Sun Smart Saskatchewan 12 May 2011

13. 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 Sun Smart Saskatchewan 13 May 2011

14. 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 Sun Smart Saskatchewan 14 May 2011

15. Skin Cancer in Saskatchewan & Canada PART TWO

16. 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 Sun Smart Saskatchewan 16 May 2011

17. 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 Sun Smart Saskatchewan 17 May 2011

18. 18 Basal Cell Carcinoma Cases in Saskatchewan May 2011 Sun Smart Saskatchewan

19. 19 Standardized to 1991 Canadian Population (rate/100,000) Basal Cell Carcinoma Rates in Saskatchewan May 2011 Sun Smart Saskatchewan

20. Age-Standardized Incidence Rates (per 100,000) – Males Basal Cell Carcinoma 1998 – 2007 GIS Maps

21. Basal Cell Carcinoma in Males, 1998-1999 21

22. Basal Cell Carcinoma in Males, 2000-2001 22

23. Basal Cell Carcinoma in Males, 2002-2003 23

24. Basal Cell Carcinoma in Males, 2004-2005 24

25. Basal Cell Carcinoma in Males, 2006-2007 25

26. Age-Standardized Incidence Rates (per 100,000) – Females Basal Cell Carcinoma 1998 – 2007 GIS Maps

27. Basal Cell Carcinoma in Females, 1998-1999 27

28. Basal Cell Carcinoma in Females, 2000-2001 28

29. Basal Cell Carcinoma in Females, 2002-2003 29

30. Basal Cell Carcinoma in Females, 2004-2005 30

31. Basal Cell Carcinoma in Females, 2006-2007 31

32. Sun Smart Saskatchewan 32 Squamous Cell Carcinoma Cases in Saskatchewan May 2011

33. 33 Standardized to 1991 Canadian Population (rate/100,000) Squamous Cell Carcinoma Rates in Saskatchewan May 2011 Sun Smart Saskatchewan

34. Age-Standardized Incidence Rates (per 100,000) – Males Squamous Cell Carcinoma 1998 – 2007 GIS Maps

35. Squamous Cell Carcinoma in Males, 1998-1999 35

36. Squamous Cell Carcinoma in Males, 2000-2001 36

37. Squamous Cell Carcinoma in Males, 2002-2003 37

38. Squamous Cell Carcinoma in Males, 2004-2005 38

39. Squamous Cell Carcinoma in Males, 2006-2007 39

40. Age-Standardized Incidence Rates (per 100,000) – Females Squamous Cell Carcinoma 1998 – 2007 GIS Maps

41. Squamous Cell Carcinoma in Females, 1998-1999 41

42. Squamous Cell Carcinoma in Females, 2000-2001 42

43. Squamous Cell Carcinoma in Females, 2002-2003 43

44. Squamous Cell Carcinoma in Females, 2004-2005 44

45. Squamous Cell Carcinoma in Females, 2006-2007 45

46. Melanoma Cases in Saskatchewan 46 Sun Smart Saskatchewan May 2011

47. Melanoma Rates in Saskatchewan 47 Standardized to 1991 Canadian Population (rate/100,000) May 2011 Sun Smart Saskatchewan

48. Age-Standardized Incidence Rates (per 100,000) – Males Melanoma 1998 – 2007 GIS Maps

49. Melanoma Skin Cancer in Males, 1998-1999 49

50. Melanoma Skin Cancer in Males, 2000-2001 50

51. Melanoma Skin Cancer in Males, 2002-2003 51

52. Melanoma Skin Cancer in Males, 2004-2005 52

53. Melanoma Skin Cancer in Males, 2006-2007 53

54. Age-Standardized Incidence Rates (per 100,000) – Females Melanoma 1998 – 2007 GIS Maps

55. Melanoma Skin Cancer in Females, 1998-1999 55

56. Melanoma Skin Cancer in Females, 2000-2001 56

57. Melanoma Skin Cancer in Females, 2002-2003 57

58. Melanoma Skin Cancer in Females, 2004-2005 58

59. Melanoma Skin Cancer in Females, 2006-2007 59

60. Melanoma Skin Cancer (Canada vs. Saskatchewan) 60 Standardized to 1991 Canadian Population (rate/100,000) May 2011 Sun Smart Saskatchewan

61. Melanoma Skin Cancer (Canada vs. Saskatchewan) 61 Standardized to 1991 Canadian Population (rate/100,000) May 2011 Sun Smart Saskatchewan

62. Melanoma Skin Cancer (Canada vs. Saskatchewan) 62 Standardized to 1991 Canadian Population (rate/100,000) May 2011 Sun Smart Saskatchewan

63. 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 Sun Smart Saskatchewan 63 May 2011

64. Melanoma Incidence Rates in North America 64 CountryYear Males (per 100,000) Females (per 100,000) United States 200321.513.7 Canada 200312.810.0 Canada 200512.710.7 United States Incidence Rates standardized to 2000 US Standard Population Canadian Incidence Rates standardized to 1991 Canadian Standard Population May 2011 Sun Smart Saskatchewan

65. Global Melanoma Incidence Rates 65 CountryYear Males (per 100,000) Females (per 100,000) Australia 200344.231.0 Finland 20039.27.8 Sweden 200313.112.9 Incidence Rates standardized to 2000 World Standard Population May 2011 Sun Smart Saskatchewan

66. 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 Sun Smart Saskatchewan 66 May 2011

67. 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 Sun Smart Saskatchewan 67 May 2011

68. Second National Sun Survey (NSS2) PART THREE

69. 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 Sun Smart Saskatchewan 69 May 2011

70. Sun Exposure (Ultraviolet Radiation) 70 Adult estimates age-standardized to 2001 Canadian Population May 2011 Sun Smart Saskatchewan

71. 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 Sun Smart Saskatchewan 71 May 2011

72. 72 Seek Suntans May 2011 Sun Smart Saskatchewan

73. 73 Age-standardized to 2001 Canadian Population Canadian adults use of artificial tanning equipment in the past 12 months, by region Use of Artificial Tanning Equipment May 2011 Sun Smart Saskatchewan

74. 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 Sun Smart Saskatchewan 74 May 2011

75. Sun Protection Behaviors 75 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 May 2011 Sun Smart Saskatchewan

76. 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 Sun Smart Saskatchewan 76 May 2011

77. 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 Sun Smart Saskatchewan 77 May 2011

78. 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) Sun Smart Saskatchewan 78 May 2011

79. Sunburns 79 Adult estimates age-standardized to 2001 Canadian Population May 2011 Sun Smart Saskatchewan

80. 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 Sun Smart Saskatchewan 80 May 2011

81. 81 Age-standardized to 2001 Canadian Population Canadians aged 16+ years who worked outdoors during the summer, by region Outdoor Workers May 2011 Sun Smart Saskatchewan

82. Outdoor Workers 82 Outdoor workers, by age and region May 2011 Sun Smart Saskatchewan

83. Outdoor Workers – Sun Protection Behaviours 83 Age-standardized to 2001 Canadian Population Sun protection behaviours in outdoor workers aged 16+ years, by region May 2011 Sun Smart Saskatchewan

84. Outdoor Workers – Sunburns 84 Age-standardized to 2001 Canadian Population Canadians aged 16+ years who worked outdoors and got at least one sunburn during the summer, by region May 2011 Sun Smart Saskatchewan

85. 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 Sun Smart Saskatchewan 85 May 2011

86. 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 Sun Smart Saskatchewan 86 May 2011

87. 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 Sun Smart Saskatchewan 87 May 2011

88. 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 Sun Smart Saskatchewan 88 May 2011

89. 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 Sun Smart Saskatchewan 89 May 2011

90. 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 Sun Smart Saskatchewan 90 May 2011

91. 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 Sun Smart Saskatchewan 91 May 2011

92. 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 Sun Smart Saskatchewan 92 May 2011

93. 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 Sun Smart Saskatchewan 93 May 2011

94. 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 Sun Smart Saskatchewan 94 May 2011

95. 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 Sun Smart Saskatchewan 95 May 2011

96. 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 Sun Smart Saskatchewan 96 May 2011

97. Questions Sun Smart Saskatchewan 97 May 2011

98. For More Information Contact… Saskatchewan Cancer Agency Prevention Department Population Health Division 400 – 2631 28 th Avenue Regina, SK S4S 6X3 P: 306-359-5877 www.saskcancer.ca Sun Smart Saskatchewan 98 Sun Smart Saskatchewan via: May 2011