Deaths due to squamous cell carcinoma in Australia: is there a case for a public health intervention?

The death certificates of all people who died from cancer in Victoria for the years 1988-1990 were examined looking for deaths due primarily to squamous cell carcinoma (SCC) of the skin. The findings were compared with the Australian Bureau of Statistics (ABS) published data on the number of deaths due to non melanoma skin cancer (NMSC) for the same period. One hundred and fifteen deaths due to SCC were identified. The mean age of death for the 74 males (64%) was 74.2 (s.d. 11.7) years and the 41 females (36%) was 81.3 (s.d. 10.3) years. Seventy (80%) of the 91 people where satisfactory information was able to be extracted had one or more major illnesses which were likely to have contributed substantially to the death. Only 3.5% of the total tumours were on the trunk in the covered areas, the remainder were on exposed areas of the body easily seen during a consultation. Seventeen cases of AIDS (Kaposi's Sarcoma) were incorrectly classified by the ABS as primary NMSC deaths. Seventeen other misclassifications included seven deaths from melanoma, eight deaths from cancers which were not skin tumours and two non-cancer deaths. Thirty-one deaths due to SCC were identified from death certificates and careful medical follow up which were not recorded in ABS data. The results suggest that there is likely to be little, if any, reduction in the number of deaths due to SCC as a result of an early detection programme directed at those people currently developing lethal tumours. A professional education programme directed at doctors who are seeing these elderly people with tumours on easily examined sites is more likely to be fruitful. The results also suggest the need for further education about the correct filling out of death certificates by medical practitioners and the careful supervision of those who extract data from these records at the ABS.