CANCER PREVENTION INSTITUTE OF CANADA

Last updated: 15-Jan-2007

High Risk Groups

Outdoor Workers

All outdoor workers exposed to the sun are at increased risk of ultraviolet (UV) exposure. Farmers, police, athletes and construction workers are only a few of the workers who may experience up to 10% more UV than indoor workers.[1] Mountain guides have been shown to be exposed to 23 times the recommended limits for UV radiation[2] and professional cyclists have been shown to exceed the international exposure standards by more than 30 times.[3] This increased exposure has been shown to damage eyes[4] as well as amplify the risk for cancer.[5] One study estimated that 44% of outdoor workers are at increased risk for skin cancer, with the estimated lifetime skin cancer risk of this group being up to 20 times higher than other workers.[6] An Australian study found that outdoor workers with sensitive skin experienced more skin cancers and lesions, and developed them earlier, than indoor workers.[7] These studies are consistent with general reviews comparing skin cancer incidence rates by occupation.[8],[9] The results show that specific sun-safety interventions targeting outdoor workers are necessary as a part of an overall strategy of occupational carcinogen control (see the next section of this report).

There are a number of measures that can be put in place to control UV exposure in the outdoor workplace, including engineering controls, such as providing shade covers for workers, and administrative controls, such as rescheduling outdoor work programs or moving jobs to shady areas. Rotating staff between indoor and outdoor tasks would lessen each employee’s total UV exposure. Other measures include the provision of personal protective equipment and training for all workers exposed to high levels of UV radiation.[10] Personal precautions include wearing approved sunglasses and protective clothing, using sunscreen on exposed skin, and regular skin cancer screenings.[11] The majority of intervention programs encourage these individual measures through education. One effectiveness evaluation showed that in outdoor workers who were screened for skin cancer, told about the level of sun damage on their skin, and educated about sun protection, sun protection behaviour increased by 16%.[12]

As a related issue, it is notable that workers exposed to non-solar UV, from sources such as welding torches and fluorescent lights, can also be at an increased risk for cancer.[13],[14] Engineering and administrative controls, as well and personal protective equipment can minimize health risk to such exposed workers.[15]

Skin Cancer Patients

Skin cancer patients are at increased risk of developing further skin cancer as a result of solar UV because of their existing genetic or behavioural susceptibility.[16],[17] Previous or current skin cancer patients present an opportunity to deliver intervention programs to what amounts to a presumably motivated “captive audience.”

Although some skin cancer patients have been shown to use sunscreens more regularly, without education many of the sun exposure habits of these patients show no statistically significant difference from the rest of the population.[18],[19] When education is provided to previous skin cancer patients, results can be positive. In one study, 1042 people received repetitive and interactive oral and written education about sun protection after having non-melanoma skin cancer surgically removed. At one-year follow-up, 62% continued to use sunscreens and 56% changed their outdoor activity habits.[20]

[2] Moehrle M, Dennenmoser B, Garbe C. Continuous long-term monitoring of UV radiation in professional mountain guides reveals extremely high exposure International Journal of Cancer 2003; 103(6): 775-8.

[3] Moehrle M, Heinrich L, Schmid A et al. Extreme UV exposure of professional cyclists Dermatology 2000; 201(1): 44-5.

[4] Sun Safety Guidelines for Outdoor Workers. Leeds, Grenville and Lanark District Health Unit, 2003. Available at www.healthunit.org/sunsafety/outsidework.htm (accessed November 2004).

[5] Scarlett WL. Ultraviolet radiation: sun exposure, tanning beds, and vitamin D levels. what you need to know and how to decrease the risk of skin cancer Journal of the American Osteopathic Association 2003; 103(8): 371-5.

[6] Azizi E, Modan M, Fushs Z et al. Skin cancer risk of Israeli workers exposed to sunlight Harefuah 1990; 118(9): 508-11.

[7] Woolley T, Buettner PG, Lowe J. Sun-related behaviours of outdoor working men with a history of non-melanoma skin cancer Journal of Occupational & Environmental Medicine 2002; 44(9): 847-54.

[8] Beral V, Robinson N. The relationship of malignant melanoma, basal and squamous skin cancers to indoor and outdoor work British Journal of Cancer 1981; 446: 886-91.

[9] Marks R, Jolley D, Dorevitch AP et al. The incidence of non-melanoucytic skin cancers in Australian population: results of a five-year prospective study Medical Journal of Australia 1989; 150: 475-8.

[10] Ultraviolet radiation as a hazard in the workplace World Health Organization, 2003.

[11] Skin cancer and sunlight Canada’s National Occupational Health & Safety Resource, 1999. Available at www.ccohs.ca/oshanswers/diseases/skin_cancer.html (accessed November 2004).

[12] Girgis A, Sanson-Fisher RW, Watson A. A workplace intervention for increasing outdoor workers’ use of solar protection American Journal of Public Health 1994; 84(1): 77-81.

[13] Currie CL, Monk BE. Welding and non-melanoma skin cancer Clinical Dermatology 2000; 25: 28-9.

[14] Guenel P, Laforest L, Cyr D et al. Occupation risk factors, ultraviolet radiation, and ocular melanoma: a case-control study in France Cancer Cause & Control 2001; 12(5): 451-9.

[15] Ultraviolet radiation as a hazard in the workplace World Health Organization, 2003.

[16] The Genetics of Skin Cancer Stanford Cancer Centre, 2004. Available at http://cancer.stanford hospital.com/healthInfo/geneticsAndCancer/types/skin/index.html (accessed November 2004).

[17] Melia J, Pendry L, Eiser JR et al. Evaluation of primary prevention initiatives for skin cancer: a review from a U.K. perspective British Journal of Dermatology 2000; 143: 701-8.

[18] Harth Y, Ulman Y, Peled I et al. Sun protection and sunscreen use after surgical treatment of basal cell carcinoma Photodermatology, Photoimmunology & Photomedicine 1995; 11(4): 140-2.

[19] Scarlett WL. Ultraviolet radiation: sun exposure, tanning beds, and vitamin D levels. what you need to know and how to decrease the risk of skin cancer Journal of the American Osteopathic Association 2003; 103(8): 371-5.

[20] Robinson JK. Behaviour modification obtained by sun protection education coupled with removal of a skin cancer Archives of Dermatology 1990; 126(4): 477-81.