15 October 2021
Article from October 2021 edition of INPractice
World-first targeted pop-up screening program aims to empower nurses as ‘melanographers’.
The sunburnt country isn’t always the lucky country. Skin cancer is known as Australia’s national cancer, with Aussies having the highest incidences of skin cancer per capita in the world.
The staggering statistic is 2 out of every 3 Australians will be diagnosed with some form of skin cancer by the age of 70.
Skin cancer kills one of us every five hours, and more of our young people than any other cancer.
And despite prevention campaigns and improved treatments, the statistics are not slowing down. Currently, skin cancer costs the Australian health system over $400 million a year, more than any other cancer.
“It’s Australia’s, by numbers, it’s our most prolific cancer,’’ says Professor Marion Eckert, Director of the Rosemary Bryant AO Research Centre.
“There are multiple reasons. Predominantly our lifestyle, most of our population live on the coast, and then we have obviously the agricultural rural areas which also have high incidences of skin cancer (due to amount of time spent working outdoors).
“There is a scale around skin types and susceptibility. They do say red hair, freckles, fair skin, have higher prevalence of skin cancers. But no matter your skin type, UV radiation from the sun and other sources can cause dangerous, lasting damage to your skin.
“It’s lifestyle but it also comes down to historically how we’ve gone about being aware of the harmful risks of UV radiation on our skin.
“So we’re really trying to encourage people to do the right thing to protect their skin, but that preventative health messaging is not getting through to everybody and often with skin cancers the challenge is behavioural in terms of exposure.
“Usually that relates to what you did in your youth in regards to degree of exposure. Two in three people will have some form of skin cancer by the time they are 70, usually that’s as a result of their exposure from the age of 0 to 25.’’
Now Professor Eckert and her team of distinguished medical and clinical researchers are embarking on Project Check Mate, to research a revolutionary world-first targeted pop-up skin cancer screening program, one that aims to train and empower nurses as ‘melanographers’ - to lead the fight against skin cancer through pop-up clinics, particularly in vulnerable regional areas.
The Rosemary Bryant AO Research Centre is the product of a partnership between the University of South Australia and the ANMF (SA Branch) and its adjunct service, the Rosemary Bryant Foundation, which is helping to fund the research. The Centre was established and funded by the ANMF (SA Branch) to strengthen and empower the role of nursing and midwifery through the development of a research-driven, evidence-based platform of health care.
The Centre, based at UniSA, and the Foundation, based at the ANMF (SA Branch), are named after Rosemary Bryant AO, Australia’s first Commonwealth Chief Nurse and Midwifery Officer, Emerita Director of Nursing at the RAH and honorary Iife member of the ANMF (SA Branch).
Over 95 per cent of skin cancers can be successfully treated – if detected early. But there has never been a coordinated national focus on skin cancer screening due to the perceived high costs involved.
However, with the AI (artificial intelligence) technology now available in skin cancer detection use, the aim is to train some 3,000 primary care nurses across Australia in dermoscopy, a procedure performed with a handheld instrument called a dermatoscope, one which allows for the visualisation of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the upper dermis. These structures are usually not visible to the naked eye.
The project’s industry partner DermEngine, considered the world’s most intelligent dermatology platform, is pioneering world-class AI, designed to improve the accuracy and effectiveness of skin cancer screening. The project administrator is Skin Check Champions, a non-profit, health promotion charity.
“We’re pretty excited because we have a limited supply of dermatologists in the country and trained nurses can undertake the dermatological scanning across primary health care sites and at events to reach more people,’’ Professor Eckert says.
“We have a significant health workforce in nursing and we know that nurses traverse across all areas of health, particularly in private health care, so we see them as a bit of a natural fit to addressing some of these key challenges, particularly in regional and
rural and remote areas of Australia.
“It really is nurses taking on the lead role around screening people who come in and using technology to be able to screen and check - with the results reviewed formally by a dermatologist.
“Dermatologists aren’t necessarily going to see everybody face to face, so it is definitely a nurse-led initiative.’’
Professor Eckert says the plan would be to involve the Australian Nursing and Midwifery Education Centre, a service of the ANMF (SA Branch), in training nurses in dermoscopy.
“There are dermoscopy training sites across Australia but we would see this potentially as a unique training opportunity to run and coordinate a dermoscopy training program,’’ she says.
“In particular nurses working in rural and remote areas could then complete the program so they would be skilled in dermoscopy, to be able to do this and work with other clinicians who are skilled in this area, to build up their skills and then to be able to run those (pop-up) skin clinics.
“For rural and remote people distance is definitely a disadvantage in terms of health care and access so this is really taking that health care initiative to people and there’s often a culture too, around going to the doctor when you feel fine and healthy, ‘why would you need to go to a GP or why do I need to do this?’.
“That’s one of the challenges, going and seeking medical or health input when you do feel fine. Farmers living in rural remote areas, we know that in particular the Riverina areas, there are higher incidences around lip cancers. People do feel OK and may not seek treatment when they do have changes to their skin.
“So one of the unique opportunities of this model and approach as well is that it’s going to target some of those events where people gather, it’s really trying to take on a bit of an opportunistic type screening.
“For example it’s going to be able to mobilise and go to places like your Outback races, derbies, festivals, where people do congregate. “We’ve seen good examples with that, say car racing and events when you’ve got health promotion settings there, people do pick up the call just to pop in, so it does create another opportunity for people to be able to do that whereas they may not have had that opportunity before.’’
Professor Eckert says the South Australian project could be a world-leader.
“Yes, absolutely. This is where it gets really exciting in terms of this model. If it’s potentially scalable and replicable you could traverse to other areas as well.’’
The aim now is to conduct between 10,000 and 15,000 skin cancer checks over the next three years and compile the evidence from those screenings to be tabled in Parliament as part of a National Skin Cancer snapshot. The hope then is to secure ongoing government funding for this national issue.
It’s believed the project could save the health system up to $80 million a year in late-stage cancer treatment and associated costs.
“On an even brighter note, it could save hundreds, maybe thousands of lives a year,’’ Professor Eckert notes.
Click here to read the October 2021 edition of INPractice