Skin cancer rates set to double by 2040

Growing on up a small mixed farm near Cahir, Co Tipperary, Kay Curtin spent her childhood like many others – outside. It was the kind of outdoorsy, rural upbringing shared by most people of her generation in Ireland – helping on the farm, bringing in hay, picking spuds and thinning the carrots and turnips out in the fields.

“I grew up in that kind of context in the 1970s and ’80s when we spent all our time outdoors. Whenever there was a sunny day, we were out, even when it wasn’t sunny, we were out. That was just the way everybody lived those times.”

The other shared experience at that time was the lack of awareness about skin protection. Kay vividly remembers getting burnt as a child each summer and dipping a towel in the river to cool down.

“It wasn’t even on anybody’s radar. I can remember my dad used to wear a straw hat and he farmed in his good shirt with a high collar. That was the only kind of sun protection, if you want to call it that, that I would have seen.”

It was only in 2004, years after leaving the family farm, that Kay started to reflect on those unprotected days outside. She was living in London and married with two daughters (aged five and seven) and an eight-month-old son when she was diagnosed with melanoma skin cancer.

Skin cancer is the most common cancer that presents in Ireland, with 11,500 people diagnosed every year. It is also on the rise, and the National Cancer Registry of Ireland (NCRI) expects the number of people diagnosed with skin cancer in Ireland to double by 2040.

An ageing population and cheaper air travel are two of the reasons for this increase, explains Deirdre Murray, director at NCRI. “People are much more likely to go to France, Spain and Portugal, and our skin is not designed for that. The Irish are not designed for Mediterranean sun, no matter what we would like [to think].”

Deirdre says that childhood sunburn, like Kay experienced, is particularly risky. “A number of bad burns can increase your risk of developing skin cancer,” says Deirdre.

Melanoma is a cancer that affects the younger age cohort and Kay was only 33 when she received her diagnosis. It was sheer luck that she did.

“I had gone to a follow-on appointment for my son and I just happened to mention to the doctor that I had a mole in the centre of my back and that it was itchy. He had a look at it and he gave me a referral letter to go to a local pigmented lesion clinic.” Pigmented lesions are brown and black in colour.

Red flags

When Kay was seen by the doctor at the lesion clinic, she describes, “little red flags going off in my head because they were asking me if anybody in my family had skin cancer or had I used sunbeds. Unfortunately, I had before I got married. It was kind of the trend in the 1990s and there wasn’t the same awareness.”

The doctor removed the mole on Kay’s back but it was only a few weeks later when she returned to get her stitches removed that she was told that it was a melanoma.

“It’s just very surreal when somebody says that to you. It is like people describe it, all of the air being sucked out of your body and time standing still. You are hearing these words, but nothing’s going in.”

Kay was diagnosed with stage two melanoma and needed further surgery. She was also sent to an oncologist and offered the opportunity to go on a clinical trial, something she admits she “didn’t enter into lightly”.

“They had explained to me that my risk of recurrence was 35% over the next five years. At that time, there was no other treatment. A prognosis of advanced melanoma felt really like a death sentence then.”

In 2006, Kay and her family decided to come home to Tipperary. Her files were transferred to Cork University Hospital (CUH) and she flew back over to London for injections once a month as part of the treatment [until the clinical trial was withdrawn]. She had regular appointments at CUH, including mole mapping [a clinical procedure to monitor moles which can help to detect skin cancer early].

Five years on from her diagnosis, Kay was discharged, although she admits: “I was still always on high alert, because I knew enough then to know that melanoma is very sneaky.”

There was a risk that the melanoma could come back, and in 2015, it did.

A recurrence

Kay started feeling unwell, ending up with a chest infection and her weight dropped to about eight stone.

“I went to my GP and she said it might be gallstones. Melanoma wasn’t mentioned.”

Having been admitted to Mercy University Hospital in Cork, Kay spent the night on a trolley in A&E and she was sent for a CT scan the following morning. “Alarm bells started going off, and I felt I knew myself that this isn’t good.”

Kay was told that the cancer had come back, this time spreading to her organs. “It was a stage-four prognosis, and it was in both my lungs. I had extensive tumours in my liver and I had it in both my hips as well.”

She knew her chances were slim, but she was determined not to give up. “I couldn’t afford to go to pieces. I still had young children and when I was discharged, I remember we got a takeaway that night and I explained to the kids. I knew that this is the kind of news in a rural community that was going to spread like wildfire and I had to tell them straight away. Then we just got on with it really.”

There had been more scientific research since Kay’s first diagnosis in 2004 and being able to access those new medications was key. One of the drugs Kay needed was not approved in Ireland at the time, but fortunately the pharmaceutical company, Novartis, gave her the drug on compassionate grounds. “I would’ve died without it,” says Kay.

“Slowly my scans started improving and the tumours started just disappearing. About one year and a half in, I probably had my first full scan where there was no sign of anything.”

That’s the way it has been since. Kay feels incredibly lucky but says: “I’m never not going to be a melanoma patient now. I will never be discharged.

“I have blood tests every month. I take a targeted therapy drug every day, and I will keep taking that drug every day for the rest of my life. I have echocardiograms every three months and I still have my scans and all the scanxiety [the anxiety cancer patients experience with scans] that causes.

“My veins are shot to bits from having the blood tests and the scans. The last 20 years have been taken over by melanoma. It’s not as simple as cut it out and carry on – this can dominate your life forever.”

Although skin cancer is the fastest-growing cancer in Ireland, it has a very good survival rate. However, this very much depends on it being detected early.

Deirdre says that unfortunately we are not seeing enough improvement in sun-safe behaviour in Ireland. A 2024 study, led by Professor Michelle Murphy at University College Cork, found that nearly half of people (48.9%) regularly sunbathed when the sun was out and 41.5% had used tanning beds at least once.

“Sunbeds should be avoided completely,” cautions Deirdre. “There’s no justification for them. The Public Health (Sunbeds) Act 2014 banned sunbeds for anyone under 18 years old, but workarounds happen,” she goes on. “People can hire them into their houses, for example.”

Deirdre points to Australia as a country that has successfully brought down their rates of skin cancer. “They had to work on that because a lot of people with the Celtic skin were out there for many centuries and now there’s over 100,000 Irish-born people living in Australia.”

Since 1981, Australia have pushed their Slip! Slop! Slap! campaign comprising five Ss: slip on a shirt, slop on sunscreen, slap on a hat, which has been credited with helping to reduce melanoma rates in Australians under 40. “They did other things,” says Deirdre, “including banning commercial sunbeds. It’s all made a difference.”