Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) notes that:

(a) skin cancer, particularly melanoma, is and remains a greatly concerning health problem in Australia;

(b) Australians require more equitable access to skin cancer checks with the need for greater access through general practitioner (GP) clinics and dermatologists;

(c) early diagnosis is the key to good outcomes;

(d) not-for-profit groups, such as the Australian Skin Cancer Foundation and the Cancer Council, are the key to better awareness of skin cancer and the importance of early diagnosis; and

(e) diagnosis is being inhibited by the costs involved in GP and dermatologist skin cancer checks; and

(2) calls for the consideration of a separate bulk-billed GP and specialist item number for skin cancer checks.

Skin cancer is a huge health problem in Australia and in other countries. Unfortunately, Australia leads the world in melanoma diagnoses per capita. There are also a very large number of people diagnosed with other forms of skin cancer, such as squamous cell carcinoma and basal cell carcinoma—many more than in other countries. In the average year we have about 13,000 diagnoses of melanoma in Australia, and over 950,000 non-melanoma skin cancer diagnoses. That's a huge number, and a huge burden on the health system.

The causes of skin cancer can be complex, but the two main factors are: No. 1, exposure to ultraviolet light, which we get in Australia because of our climate, and the other is genetics. People with pale skin and blond or red hair are at much higher risk of skin cancer than people with olive or dark skin. Australia, because of its history of colonisation by the Europeans, has the genetics that increase the risk of skin cancer, and also very high ultraviolet light exposure.

Melanoma is the most serious form of skin cancer; it can spread very quickly, and its growth can be very rapid. Early diagnosis of melanoma and other forms of skin cancer is very important for a cure. We know with melanomas that if they have, at diagnosis, less than one millimetre thickness, then there's a well over 90 per cent chance of survival for 10 years. However, once the lesion is more than four millimetres in thickness, there's only a 50 per cent or less chance of survival for 10 years. So the important thing to know is that early diagnosis is very important, as is prevention.

Things have changed in Australia: in my childhood there was a very limited understanding of the causes of skin cancer. We were all exposed to ultraviolet light unwittingly and without the use of sun protection or proper clothing, and for prolonged periods of time. Those in many occupations, such as people who work on the land and people who work outdoors, have a much higher incidence of skin cancer, unfortunately. And whilst melanoma is the most serious form, other forms of skin cancer can be quite disfiguring. Basal cell carcinoma can invade local structures, particularly around the head, neck and face, and can cause quite disfiguring scars when removed. Very rarely it can metastasise—that's quite rare with basal cell carcinomas. Squamous cell carcinomas, however, can cause multiple lesions and can metastasise. Whilst it doesn't grow as quickly as melanoma, it can be a serious and life-threatening illness.

Diagnosis can be quick, but we have to give people access to treatment. Very briefly: before I came to the chamber this afternoon I rang around several of my local clinics. To see a dermatologist in Campbelltown there's no bulk-billing and the average dermatologist charges almost $300—$290, to be exact—with a rebate from Medicare of $78. So there's an out-of-pocket cost of well over $200. That's very expensive for people at this time of cost-of-living stressors. GP skin cancer clinics charge less, at $220 and with a rebate from Medicare of about $60, but the wait time is almost six months. So it's very hard for people to access skin checks. I think it's very important that we consider a special bulk-billed item number for GP and dermatologist skin checks so that people can access timely, early assessment, because that is the key to diagnosis and that is the key, particularly with melanoma, to long-term survival.

We need to get people aware of the importance of things like melanoma. I've seen melanoma in retinas, in ears, on feet and in nail beds. It can occur in places that are hard to see, so it is very important that people are aware of the importance of a full skin check.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

Is the motion seconded?

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

I'd be very happy to second the motion. I'd like to thank the member for Macarthur for bringing this to the House. It's a subject very close to my heart. As someone who represents a western New South Wales electorate with great exposure to the sun, I'm well aware of the complications. As a matter of fact, I could be exhibit A. Tomorrow, I won't be here; I'll be in Tamworth having a melanoma and two basal cell carcinomas removed from my face. That's a low-grade melanoma so it should be fine. I've grown those in the last 12 months after I had the last melanoma. The doctor told me that once you've had a melanoma you're 20 times more likely to get another one.

There have been great advances made. With immunotherapy, particularly for the stage 4s and once it's metastasised, they've had great results—however, not with everyone. I understand about 65 per cent of people will respond very positively to immunotherapy. As a matter of fact, I have a cousin who had a melanoma in his bowel, and he's had great results through immunotherapy. Why in his bowel? Some would say that's where he thinks the sun shines from, but that's another matter!

As the previous speaker said, they can come under the arches of your feet, under your fingernails and all sorts of places. Indeed, the one I'm having removed tomorrow has been under a hat. As a younger person, all through summer, I would work out in the paddocks with a pair of shorts, a hat and a pair of boots. That was what everyone did in those days. Indeed, I was 50 when I made my first speech in this place, and up until then all my work had been outside under the sun.

So I think we need to do more. I do have some concerns from during the pandemic. A lot of the services to the bush are delivered by FIFO—fly-in fly-out—specialists. Thankfully, we have ones that will come out from the city and run a clinic in Dubbo and places like that. But, with the closures and the clamping down of travel during the pandemic, I am concerned that we are going to see possibly some undiagnosed skin cancer issues, because people haven't been having those regular check-ups. I can see some people in the chamber here who have issues connected to drug companies, and there have been some great advances in treatments in that space.

Following on from the member for Macarthur's opening statement, I think we do need to be more aware. I wholeheartedly agree with getting a Medicare item number for this. My procedure tomorrow will cost $1,600 out of pocket to get done. For some people that would be a big imposition on their budget. I would certainly think it would be a tragedy if people chose not to get these things dealt with because they were concerned about the financial implications.

I was a member of the Apex Club of Warialda for 20 years before I came here. The Apex Club of Moree started a campaign about melanoma and skin cancer. That was back in the early eighties. They'd lost a member of their club at a young age through melanoma. So we started putting skin protective creams at local swimming pools and awareness campaigns in local media, because there really was no understanding of the connection between exposure to the sun and the ongoing effects later in life. If you look at my grandkids now, they wear rashies, hats and SP50 before they even go outside, so the message has got through. Hopefully, we might be the last generation that rides this wave of high incidences of melanoma, BCCs and, as the member for Macarthur said, squamous cells, which can be quite dangerous. So slip, slop, slap, but get an annual check-up at least, because it could save your life.

Tracey Roberts (Pearce, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the motion from my parliamentary colleague the member for Macarthur on skin cancer, and on the Albanese Labor government's significant funding of programs and campaigns to ensure that skin cancer is appropriately managed.

Skin cancer and cancer in general are diseases that unfortunately impact on too many families and individuals. Melanoma was estimated to be the second-most commonly diagnosed cancer in males in 2021, behind prostate cancer, and it was the third-most common in females, behind breast cancer and colorectal cancers. Last year, in 2022, more than 17,500 people were expected to have been diagnosed with melanoma. As a survivor of cancer and patron of Relay for Life West Coast, I know all too well the devastation and fear that the diagnosis sparks in individuals, family and friends. It is a frightening moment in time—a moment in which, if we could, we would immediately turn back the clock. For some people who are diagnosed with skin cancer, the spot may not be detected for some time, especially if it's located somewhere on the body that's concealed—whether that be the scalp or the bottom of the foot. A friend of mine had a skin cancer that appeared on the bottom of her foot—as you'd understand, that isn't a spot that we would check regularly, if at all. The spot is understood to have developed while she was sunbathing facedown and feet up, something that we now know to avoid by being sun safe. Unfortunately, there was not really an awareness of that then.

Early diagnosis is absolutely crucial. Early detection and treating of cancers like skin cancer can have a better outcome and a high success rate. But if detection is not early then there are significant problems. Fortunately, Australia's survival rate following a skin cancer or melanoma diagnosis is one of the highest in the world. The current five-year survival rate for melanoma is 93 per cent, and for non-melanoma skin cancer is nearly 70 per cent.

The Albanese Labor government is absolutely committed to improving outcomes for people affected by this disease. We're working alongside experts in the field. A two-year national cancer prevention campaign was announced by health minister, Mark Butler, in 2022. This, appropriately, took place during the Cancer Council's National Skin Cancer Action Week in November. Ten million dollars was invested in the campaign, which is being delivered in partnership with the Cancer Council Australia. This builds on a $10 million skin cancer campaign that the department delivered in partnership with the Cancer Council Australia in the summer of 2021-2022.

Increased awareness is vital to early detection, and this campaign seeks to raise awareness of how to prevent skin cancer. While all Australians will be targeted in the 2022- 2023 campaign, there will be a focus on men aged between 40 and 59 because, typically, they practise less sun-safe behaviours. Data from the Cancer Council's National Sun Protection Survey shows that between 2003 and 2004, and 2016 and 2017, some protection behaviours have improved, but it noted that there are still significant gains to be made, especially for adolescents when compared with adults. This is important, given that all Australian capital cities except for Hobart and Melbourne have at least one month a year when the average UV rating is extreme, which is a health risk.

Beyond that significant $10 million awareness campaign investment, the Albanese Labor government has also delivered on a budget commitment of $14.8 million in funding over four years to the Melanoma Institute Australia. This important funding is to extend the delivery of the institute's melanoma nurse program across the country from where it currently operates in Perth, Sydney, Wagga Wagga and Hobart. The national melanoma nurses program will support 35 melanoma nurses by 2025-26. The work of a melanoma nurse is incredibly valuable. They help patients find their way through the health system and make informed decisions about their cancer treatment and management. The Albanese Labor government is ensuring that skin cancer and melanoma awareness and treatment are being appropriately funded.

Michael McCormack (Riverina, National Party, Shadow Minister for International Development and the Pacific) Share this | Link to this | Hansard source

I certainly agree with this motion on skin cancer. I acknowledge the comments made by previous speakers, and I wish the member for Parkes all the very best. Let's hope, in the words of a Robbie Williams song, that he comes back a 'better man'. Let's hope that the biopsy is negative. We need the member for Parkes. We need his common sense in this place.

It's common sense to stay out of the sun as much as you can. It's common sense to put sunscreen on, to wear a hat and to do all of those things. But, as the member for Parkes and the member for Macarthur have already stated, back in the day, the harmful effects of the sun weren't all that well known. I was fortunate that I had a mother—my late mother, Eileen—who always made sure that I had a hat on when I went outside and, certainly, when I was playing cricket, not that I used to bat that long! But that was more of an issue of my ability, rather than, perhaps, the fact that I needed to wear a hat.

Wagga Wagga is a very sporting community. I well recall somebody who was a good cricketer, Peter St Claire. He and his wife, Annette, had a beautiful daughter Amie, and she is no longer with us. One day after her 23rd birthday, she lost her battle with melanoma. She had discovered a lump in her groin when she was only 20 years old, and she was very prompt in seeking medical advice. She did all the right things: she had an ultrasound and a biopsy. But she was diagnosed with melanoma, and there was no primary skin lesion ever found—ever.

Her parents will be here this Wednesday, to attend the launch of the Parliamentary Friends of Melanoma and Skin Cancer Awareness. I commend the member for Blaxland and the member for Gippsland for co-chairing that important group. I hope as many members as possible can join that particular group and turn up to the launch function. I know the member for Blaxland, the Minister for Education. He's a good man, a very good man. I think all members of parliament would agree that he is a very valuable member of this parliament and his contribution is mighty. In September 2019, he had a scare with melanoma, and I'm not talking out of turn; I'm not talking out of school. He did. He made it well known that he had a situation with his leg, which required an operation that was quite severe, and he said himself that it made him reflect on life and on how lucky he was, because it, too, proved benign. But it could have been the other way.

I note the comments made by previous speakers about the incidence of melanoma in men. Men aren't always as quick or as willing to seek medical treatment as, perhaps, women are, and that is a fault of ours. It's always: 'She'll be right, mate'. But it's not right. When it comes to these sorts of things, get checked out. Take the opportunity this week, as parliamentarians—others, too, should take the opportunity—to be checked out. I concur with the comments of the member for Parkes about the cost. I concur with the comments of the member for Macarthur about making it a Medicare provider number. That would be an important initiative, and I will do anything I can to support him in that.

In relation to Amie St Clair, her parents now have a wonderful trust to raise money and awareness for skin safety. Just this weekend, in fact, they had a Colour Run, raising very valuable awareness and, moreover, funds for that, at Apex Park. Whilst a lot of fun was had and a lot of people attended—and a lot of people got smothered with paint—it is a great education program that they provide, and, certainly, the legacy of Amie St Claire lives on. Whilst she is no longer with us—and more is the pity—indeed her legacy lives on through her parents and through the advocacy of all her friends and family, who support the cause, who support the trust, who continue to advocate. If is saves just one life, if it makes one person go and have a check, go to the medical appointment, then the whole cause will be worthwhile. So, I commend the motion. I thank both the member for Blaxland and the member for Gippsland for having the foresight to have that 'friends of' group. And I wish the member for Parkes, my great friend and colleague, all the very best for tomorrow in Tamworth.

Tony Zappia (Makin, Australian Labor Party) Share this | Link to this | Hansard source

Firstly, I commend the member for Macarthur for bringing this matter of skin cancer before the house for debate. As someone with lifelong medical experience, I believe that this House should take note of his comments in respect to this matter and his general wisdom when it comes to medical procedures more broadly.

Every illness or disease is extremely debilitating and disruptive, and I'm sure the member for Parkes, who talked about his own situation, would attest to that. It's emotionally and financially draining. For people who suffer from a serious illness, I suspect that very little else matters to them until the illness is under control. Their focus would be solely on that, so that they can get back to normal life. The reality is that so many illnesses are indeed preventable, including melanoma and other skin cancers. We've seen over the years that we can get good results with campaigns, such as with smoking, bowel cancer, asbestos awareness and even the 'slip-slop-slap' campaign, which I have no doubt has made a difference and saved lives.

Melanoma is a serious cancer and, again, I think we could do a lot more. It costs lives, and apart from the fact that it costs some $400 million each year, the reality is, as the member for Pearce quite rightly pointed out, that each year some 17,500 people are diagnosed with the illness. Of those, 1,225 or thereabouts will not get past the first five years. If you put that into a more understandable series of statistics, every day around 48 people are diagnosed with melanoma and, of those, somewhere between three and four will not survive it. When you look at it like that, you realise that this is a medical issue that affects a lot of lives. Just as importantly, it's a medical issue that I believe we as a society can do more about. Again, the member for Pearce has quite rightly pointed to the $14.8 million over four years to the melanoma Institute of Australia that was announced by this government and that would deliver some 35 nurses across the country, and also the $10 million of funding over two years for skin cancer awareness campaigns. That builds on a previous $10 million. Again, I welcome those commitments and I commend the minister for them, and I believe that they will make a huge difference.

But I want to go to the substance of this motion, and I will just read three parts of it, because I think they go to the heart of what we're debating here today. The member for Macarthur moves that 'Australians require more equitable access to skin cancer checks with the need for greater access through general practitioner clinics and dermatologists'. That's (1)(b). Then (1)(e) goes on to say 'diagnosis is being inhibited by the costs involved in GP and dermatologist skin cancer checks', and part (2) of the motion 'calls for the consideration of a separate bulk-billed GP and specialist item number for skin cancer checks'. Those three points of the motion I think go to the heart of what we're debating, because they highlight the fact that we need more skin checks and that that's the way to prevent more people not only from getting melanoma but from perhaps dying from it.

Secondly: the cost, and the member for Macarthur, again, referred to the cost when he quoted the statistics from his own research only today. I know from speaking to people literally every day that medical costs do stop people from going to see doctors to have regular check-ups that they should be having, not just for this illness but for many others, which could save their lives. But they won't do it because they simply cannot afford it in many cases, and other priorities take over.

We have to try to overcome that. Therefore, the member for Macarthur provides a suggestion that we consider a separate bulk-billed GP and specialist item No. 4 for skin cancer checks. My view is that, if we can do that, the cost that we bear upfront will be more than offset by the savings further down the track. Regrettably, and I have made this point in respect to a number of other health matters, governments—of all persuasions—always look at the upfront cost without factoring in the economic savings right along the line and at the end. It's time that we started to do that, because, if we did, my view is that the process and procedure that the member for Macarthur is suggesting is actually affordable and fundable. It's fundable by looking at those savings, and I commend this motion to the House.

James Stevens (Sturt, Liberal Party) Share this | Link to this | Hansard source

Like all other speakers, I rise to speak in favour of the motion and start by commending the member for Macarthur for bringing it before us, and I also thank the other speakers who have all shared very important contributions, which have often involved personal stories. One of the great things we can do in this chamber is share experiences and perhaps come to understand just how far-reaching some of the issues and challenges that we face are in our community.

I particularly commend the member for Macarthur—being from the government—for moving a motion that is indeed asking for a significant reform of the government that he is a part of. I don't make that as a political point at all. I think that is to be commended, and it reminds us that we humble legislators can indeed make sensible suggestions to the members of the executive, and I hope that this debate is an opportunity to pursue, with some unanimity, reform in this area. So thank you very much.

I also think it's worth, on the positive side, noting how far we have come in awareness around the risk of skin cancer and the sorts of behavioural changes that need to be made. There are some horror stories I've heard from my parents about their childhoods. Far from being sun smart, there were practices in the fifties and sixties that were almost asking for trouble. I think my father's sister used to apply oil on her body and lie in the sun with mirrors pointed at her and a transistor radio on. I know that was because of ignorance and not deciding that a short-term tan was worth the potential risk of death later in life.

I grew up in the eighties at the beginning of the slip, slop, slap campaigns, and I think there are a few other words that the younger ones are aware of now—I think there's a wrap and a something else—that has led to a much transformed awareness of the risk of skin cancer, and that's a great thing. As the member for Parkes pointed out through his own vocation, we live in this country where there is a very significant risks for so many people in the way they live their lives and earn their livelihoods, particularly in this multicultural society. We're very proud of the multicultural society we are in, but I've got Western European heritage, and we're not that good at standing up to the harsh Australian sun. The fact that that awareness is there now and everyone knows what the risks are is really important.

The point I want to dwell on was already made by the member for Riverina, and I make that point as part of my age cohort. I'm still just in my 30s. As an almost 40-year-old man, one of the biggest problems we've got is the 'she'll be right, mate' attitude that the average Aussie bloke like me tends to have when it comes to our own health—across all topics, not just skin. It's probably most concerning around mental health, and it's been great to see the de-stigmatisation of having conversations about those sorts of things in recent years. A very dear friend of mine was diagnosed at a ridiculously young age—in his 20s—with bowel cancer. Regrettably, he didn't take his early symptoms seriously enough. He went on a holiday and decided he would see his doctor about it a few months later when he got back and, regrettably, it was all too late for him. Within 10 years he had died of the cancer that had started as bowel cancer and spread to other parts of his body.

We've got to do all we can, particularly with cohorts like the one I am in, to remind people how seriously to take our health and—to the member for Makin's point—how much of a difference it can make to embrace early intervention and understand that, apart from the important health outcome, whatever the cost might be to government it's actually not the cost that it looks like on paper. The cost of treatment if diagnosis hasn't happened early enough is always going to be much higher than the cost of doing that.

I really welcome the opportunity to contribute to this and make the point that all of us—and it's really a great example, and the Member for Macarthur has brought something into the space—have been able to share personal stories and talk about how we can do better as leaders in our community. That awareness is one thing I would like to take the opportunity to do more of as an elected representative, and this motion has provided that opportunity, so I thank you very much. I commend the motion.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

I thank all members for their contributions in this debate. They were very thoughtful. The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order the day for the next sitting.