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House of Assembly - Fifty-Second Parliament, First Session (52-1)
2011-03-24 Daily Xml
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MELANOMA

The Hon. R.B. SUCH (Fisher) (12:23): I move:

That this house acknowledges the seriousness of melanoma as a health issue and commends the Australian Melanoma Research Foundation for its work to tackle this disease.

There are a lot of cancers that afflict the community; melanoma is but one. The most devastating cancer in Australia is prostate cancer, followed in numbers by breast cancer. We also have that very insidious cancer, ovarian cancer, and there are others, of course. I am not trying to suggest that melanoma is more important or significant than the other cancers, but simply bring to the attention of the house and the wider community what is a very serious issue that does not get the recognition it should in our community.

Melanoma is a skin cancer that arises in the pigment cells of the skin. It is the most dangerous form of the three common skin cancer types that humans develop. Australia has the highest rate of melanoma in the world and it has been dubbed 'the Australian cancer' for that reason. It is closely related to sun exposure, ultraviolet light, outdoor activity in the middle of the day, and particularly with episodes of sunburn. One in two Australians get a skin cancer of some type, and one in 20 will develop a melanoma.

Just on that point, in respect of what has happened to many of us, when we were children we have probably got sunburnt. We have now learned, I think, as a community and as parents, not to expose children to excessive sunlight, although we do now have a bit of a paradox that people have been covering up their children so effectively that some children are facing a deficiency in vitamin D, which you get through sunlight.

In terms of occupations affected by skin cancers, this is where I want to see organisations like the South Australian Farmers Federation, the AWU and other unions that cover outdoor workers really focusing on this issue too, because it afflicts their members in a very severe way. In fact, sadly, I know of people in their 40s who have been outdoor workers with councils, and farmers, who have developed a melanoma.

It can affect people of various ages, although it is the cancer most likely to affect young adults from 15 to 39 years of age. Just to show you—and this is, I guess, an unusual case—a woman in her 20s who I know of recently died from having a melanoma on the sole of her foot. You can get them internally. One of the insidious things about them is that you might have a little indication on the surface of your skin but, like trees and their roots, the melanoma may well penetrate further into the body.

Melanoma is the fourth most common cancer occurring in Australian men and women. A new melanoma is diagnosed every hour in Australia, on average, and one Australian dies from melanoma every six hours, on average. If diagnosed early enough and removed with surgery, melanoma is an almost completely curable disease. If it spreads, it becomes more difficult to treat effectively, and when it spreads to internal organs, the cure rate is very low because our current treatments are often poorly effective.

Survival from advanced melanoma is about 1 per cent overall at two years after diagnosis regardless of any form of treatment. I will talk about the Australian Melanoma Research Foundation in a moment—and I indicate that I am a member of it; they are all unpaid on it—but one of the drivers behind founding that organisation, Jon Flaherty, will not mind me mentioning that he is one of the 1 per cent who has survived advanced melanoma. That is a very low statistic—1 per cent survival, where the melanoma has spread.

Despite melanoma being so common in our country and such a significant problem for Australians, the amount of funding for research into improving the treatments for melanoma is, surprisingly, extremely poor. A brief calculation shows that less than 1 per cent of the National Health and Medical Research Council grant allocations are spent directly on melanoma research. This is despite about $400 million being spent annually on skin cancer treatment and care, with a significant part of this amount being spent on melanoma. The cost saving for the Australian public and governments, apart from the human aspect, will be substantial if prevention strategies, early treatment and effective therapies are implemented.

I will just indicate briefly the charter of the Australian Melanoma Research Foundation. The foundation was formed to spearhead research efforts into melanoma and to improve the amount of funding for this research as rapidly as possible, given the significance of this problem for the Australian community.

The foundation was formed out of this necessity and by a group of concerned citizens and businesspeople who have been increasingly alarmed at the lack of research and financial support towards rapidly improving progress in this area. Some of the research findings have been unable to be progressed sufficiently through conventional avenues and means, so the foundation aims to support such efforts as effectively as it can. As I indicated, I am on that board, but it is an unpaid position.

I will give you a brief overview of the people who are involved: Jonathon Flaherty is the ex-managing director of Clements; Jeff Carr is a lawyer at Strachan Carr; Elizabeth McGrice was advertising manager of the Sunday Mail and The Advertiser for many, many years but has recently resigned; Kevin McGuinness is the chair of the Adelaide Zoo and the chief financial officer of Exact Mining Services; and Associate Professor Brendon Coventry is the research director and, in my view, an outstanding medical specialist who is committed to patient welfare in a way that I find very impressive.

Dr Coventry is a surgical oncologist, a general cancer surgeon, and a PhD immunologist with many years' experience in cancer research, vaccine therapies and the role of the immune system in cancer control. His work as a clinical oncologist has emphasised that, while melanoma can often be dealt with successfully using surgery, when it spreads the available treatments are a long way from successful. His commitment, and that of the rest of us, is to try to get in early and reduce the number of people who end up having melanoma.

In his work as an associate professor at University of Adelaide, Dr Coventry has been involved in some interesting research, and one area relates to the development of more effective treatments for melanoma. In particular, he says that evidence is emerging worldwide that patients undergoing chemotherapy might realistically be treated just as effectively with less toxic doses and without producing the pain and suffering from the side effects we currently see in people undergoing higher dose chemotherapy.

That leads to something I have found particularly interesting. Dr Coventry is working with John Hopkins University in the US, as well as locally, and they are seeking to work more harmoniously with the body's immune system. Rather than using blanket chemotherapy, they are targeting what they call 'a window of opportunity', that is, targeting with the chemotherapy when the body itself is not trying to fight back with the immune system. What often happens with the blanket treatment of chemotherapy is that you are actually fighting the body, which in turn is trying to fight the cancer itself. So, that is a very interesting development. Part of that program is also trying to develop more effective melanoma vaccines and reduce the cost of treatments.

One area of research that has recently come to our attention in terms of funding is an awareness that curry powder has long been suspected as an anti-cancer agent, although if you ingest it, it does not have a great impact on the cancer. Through local research, we are looking to see whether direct application of curry powders can tackle cancer cells. We know that generally they do not hurt normal cells but are very effective in targeting cancer cells. The foundation is committed to trying to reduce the incidence of melanoma. I do not have time to go into all aspects of it, but I ask members to support an awareness program.

Dr McFETRIDGE (Morphett) (12:33): I rise to support this motion. As the member for Fisher has said, the incidence of melanoma is far too high in Australia and around the world. According to my information, 160,000 new cases of melanoma are diagnosed worldwide each year and, as the member for Fisher has said, melanoma is the cause of many deaths and, unfortunately, many of those deaths are avoidable. The early detection of melanoma is so important, and the ability to treat it is equally as important because there will be melanomas which, for some reason or another, are not diagnosed or detected.

A number of years ago in my vet practice I was called to do some work on a dairy. The farmer's teenage daughter was helping me. She had on a sleeveless shirt and I noticed there was a little mark, a little melanoma, on her forearm, and I said to her, 'You need to get that checked out. It doesn't look quite right.' In veterinary practice we see lots of melanomas, particularly in light-skinned dogs, and you get pretty good at picking those that are a bit off, so I told young Samantha to get off to the doctor. When her mother saw me two weeks later, she came up to me and gave me a big hug and a kiss and said 'Duncan, you've saved my daughter's life.' It was an extremely malignant melanoma and it was good that Sam went to the doctor and got it excised completely, and she has had no problems since.

I encourage everybody—none of us is too old or too young to protect ourselves in the first place—to have the melanomas checked when you have your health check-ups. Make sure you go to the doctor and have a check-up because there is nothing more important than your health. You cannot look after your family if you do not have your health, and you cannot do what you want to do for the community as a member of parliament if you do not have your health. Unfortunately, melanoma is one of those cancers that we are seeing far more frequently.

The use of sun beds (tanning beds) is a real issue for me as the shadow minister for health. We are seeing a lot of cancers being initiated and stimulated by the use of tanning beds. Of course, like many people of my age, I have to be very careful about watching the little moles and dark areas on my skin because I had many misspent hours on the beach as a youth, surfing and having a great time—and getting sunburnt, unfortunately. We thought in those days that the oils and such things would protect our skin, but it was far more dangerous than we recognised. We are starting to recognise it now.

There are huge issues around this. It is a very expensive issue. There is some fantastic research that is being done. I understand that some of the monoclonal antibody research that is being done to develop individual specific anti-cancer vaccines is progressing rapidly, and I hope one day that we do get a cure for cancer and particularly melanoma. It is a cancer—like colon cancer, in many ways—that needs early detection. I encourage both the blokes and ladies to do your faecal occult blood tests and have colonoscopies as you get older, because it is treatable, preventable and curable in the early stages.

Melanoma is really nasty. It can start from just a tiny nodule. In some cases you have what is known as amelanotic melanomas. So, if you have a little lesion that you are not sure about, go and get it checked, because it could be a melanoma but not a dark one. It is so important. Do not just take it for granted, because you are a long time dead. There are no pockets in shrouds, as a lady said to me, and it might cost you a bit to go to the doctor in some cases, but go and get it checked out. Do not spend any time worrying about what should have been and could have been. Prevention is the way to go.

I support the motion that the member for Fisher has brought. Melanoma is one of the many cancers we are still battling. I hope that the research foundations such as the Australian Melanoma Research Foundation are able to get sufficient funding and support to do the great work they undertake, and I hope they are able to develop a treatment. It may be one of the monoclonal vaccines or some other treatment—some chemotherapy of some sort—that will solve this problem for those unfortunate people who do get melanomas. It is a very important issue and I commend the motion to the house.

Mr SIBBONS (Mitchell) (12:38): I also rise to support the motion. Many in the house will know that melanoma research and support is very important to me. My daughter was born with a very rare congenital condition—congenital melanocytic naevus. Her body is covered with large to small moles that are very susceptible to melanoma.

Melanoma is the most serious form of skin cancer. It can be fast-growing, has a tendency to spread to other parts of the body and, importantly, is more common in Australia than any country in the world. Melanoma is the fifth most common cancer among people in South Australia. In South Australia melanoma comprises 7 per cent of all new cancer cases, equating to 617 people being diagnosed in 2007. Melanoma accounted for 2.6 per cent of all cancer-related deaths in 2007. The mortality rate among men is considerably higher than the rate among women. The incidence of this form of cancer is also much higher in younger people (those aged between 15 and 44), being the second most common cancer and accounting for approximately 15 per cent of all cancers in this age group. Of all skin cancers, melanoma accounts for the largest percentage of deaths, despite contributing to only a small percentage of the overall incidence of total skin cancers diagnosed.

Melanoma is one of the cancers that is potentially curable. The risk factors for melanoma include excessive exposure to sunlight (including artificial sunlight in solariums), having a fair complexion, having multiple moles and atypical moles and having a personal or family history of melanoma. Most significantly, though, over 90 per cent of skin cancers such as melanoma are considered preventable through reducing exposure to harmful UV rays.

The Cancer Council advises that reducing the level of skin cancer in the population is best achieved by the following:

increasing sun protection within the population, especially higher-risk populations such as those who work outside;

banning solariums or at least advising people about their dangers. Solariums can emit much higher concentrations of UV radiation than the summer midday sun.

South Australia and Victoria are the first states in Australia to regulate solarium operators through the Radiation Protection and Control (Cosmetic Tanning Units) Regulations 2008. These regulations cover:

minimum age of 18 for solariums or sun-bed use;

health warnings that solariums can cause skin cancer also must be displayed;

people with fair skin cannot use solariums:

solarium operators must have training, including in skin-type assessment;

clients must be supervised by a trained operator;

informed consent sought from all clients; and

restrictions on frequency and duration of tanning sessions.

There are a number of actions to reduce risk of melanoma that can be taken. These include continuing to promote the SunSmart message, including the 'Slip, Slop, Slap, Seek and Slide (on glasses)' program. The daily UV reading also helps remind people of the importance of this issue.

Many of our schools also have sun-smart policies, such as shade areas, mandatory hats, minimising events outside in the middle of the day, sunscreen availability and protective uniforms. This also applies to sporting events. One of the most simple forms of prevention is to regularly self-examine our skin and then act early on any unusual findings or concerns (such as changes in colour, size and borders) by seeking advice from a general practitioner.

We are very fortunate in South Australia to have an active program of cancer prevention and early detection strategies of relevance to controlling melanoma. I would particularly like to recognise the long-term commitment of the Cancer Council to the SunSmart program and the changes implemented in a number of schools, workplaces and our communities.

I also note that, in the newly-released South Australian Cancer Plan 2011-15, melanoma is clearly identified as a cancer of significant concern, and that the importance of minimising risk is well promoted. I am also aware that the Cancer Clinical Network has melanoma as one of its priority areas for action in 2011, and that the development of a melanoma pathway—an evidence-based care guide to treating melanoma—is the next tumour stream pathway to be developed. While prevention, detection and treatment are essential aspects of cancer care, research is essential in the effort to control cancer. The Australian Melanoma Research Foundation funds research that will provide direct benefits to people with melanoma and their families.

On a national level, the Australian Melanoma Research Foundation is providing funding for research into the causes, preventions and cure for melanoma and skin cancers. The Australian Melanoma Research Foundation is committed to spending at least 75 per cent of donations towards research, with the current focus of the foundation to develop simple, low-cost treatments focused around vaccines and the immune system.

It is a not-for-profit charity organisation established by a group of volunteers. The Australian Melanoma Research Foundation research programs are funded through the support and donations of the public. The state government, in partnership with the Cancer Council, is supporting the South Australian Cancer Research Collaborative, which will benefit from $20 million over the next five years to focus on research across all cancers.

The South Australian Cancer Research Collaborative will be a very important part of the new $200 million South Australian Health and Medical Research Institute, currently under construction next to the site of the new Royal Adelaide Hospital. In conclusion, I would like to commend the work around melanoma within the state of South Australia, which shares the common goal of improvement of patient care and outcomes.

Mrs GERAGHTY (Torrens) (12:47): I will be very brief. Just to reinforce the comments that have been made, people who do believe that they may have a melanoma or something that looks a little bit suspect on their skin should immediately seek medical attention. I say that from my husband's situation, where he had a melanoma on his back—he had several on his body over the years and had them removed—that grew, and then disappeared, and came back again. He underwent quite severe surgery to remove the melanoma. Over the years he had constant chest x-rays and a whole series of tests to ensure that the melanoma had not spread.

The most serious problem with melanoma is that they metastasise in other organs in the body, particularly the lungs and the brain. He continued to have testing of his lungs to ensure that it had not gone into his lungs. Unfortunately, in his case, I do not believe that they undertook proper testing to ensure that it had not gone into his brain, which it had. Of course, by the time we found it, it was far too late to do anything.

So, I would suggest to people that, when you are looking at family, as we do now constantly—our children and grandchildren—if we see a little bubble that looks even mildly suspicious that you get it checked, and if you have any concerns do take a second opinion about it. Once they have metastasised too far in the body sometimes there is nothing you can do. If you take that one little step, get it checked, you can save a life. So, I do endorse the sentiments of the members who have spoken and commend the member for Fisher in bringing it to the house.

The DEPUTY SPEAKER: Thank you very much, member for Torrens. I would advise all members that, while I understand that sometimes they have to take calls, spending a significant amount of time on a telephone chatting is probably deeply inappropriate. Member for Fisher.

The Hon. R.B. SUCH (Fisher) (12:49): I thank members who have contributed. We are talking about human beings here, and I am very much committed—as I am sure other members are—to try to ensure that people in our community do not suffer unnecessarily from whatever illness or disease.

I will just make some quick points. The minister and the shadow minister indicated that it was hard to find the Australian Melanoma Research Foundation on the web. I am not a technical person, but I have discovered that if you want to be high up on the notice list on the web, as it were, you have to pay extra money, and a research group like the Australian Melanoma Research Foundation does not have the money to do that. So, I apologise if members have had trouble finding it on the web. It is there, but it is just that we cannot afford to put it up to the top.

The advice is very sensible: get a skin check—and I appreciate the sadness in the member for Torrens' situation—and make sure you get one done by a properly qualified professional. Like the member for Morphett, I saw what looked like a mole on my niece's (who is about 25) leg and said, 'You better get that checked out.' Her doctor said to her recently, 'You better give your uncle a big thank you because that's got to come out; that's heading towards cancer.'

One of the issues that the foundation has looked at and is particularly concerned about is that we do not know what is in a lot of the sunscreens that are sold. We do not know what effect they have on the body. It is not just the nano-type particles but, as Professor Coventry points out, 'What goes on your skin goes into your body,' and people need to be aware of that. The foundation is trying to develop a totally natural skin protection cream, unlike some of those on the market now, which are questionable in terms of their long-term impact.

When people are driving they often get the sun on their hands and arms. The Cancer Council, to its credit, sells protective gloves and arm shields—cloth that you can wear to minimise that risk. People who travel frequently by air are at risk because of the UV, pilots in particular. Someone who travels a lot more than I do said that these new screening devices at airports have increased the risk of radiation for people, so you get a double dose: you get it when you go through the check-screen at the airport and you also get it when you are sitting on the aircraft. So, people need to be aware of that.

Just finally, people who have a Celtic background are highly susceptible to skin cancer, and they should be very well aware of the high risk of melanoma. I commend the motion to the house and thank members for their support.

Motion carried.

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