Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers

Tizek, L.; Schielein, M. C.; Berger, Ursula; Ege, M.J.; Schneider, S. und Zink, A. (4. Mai 2020): Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers. In: Journal of the European Academy of Dermatology and Venereology, Bd. 34, Nr. 11: S. 2526-2533

Abstract

Background: Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees.

Objectives: We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk.

Methods: In July 2018, a cross‐sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC.

Results: A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected.

Conclusion: Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.

• Dokumententyp: Zeitschriftenartikel
• Publikationsform: Publisher's Version
• Fakultät: Medizin > Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch

Literaturliste

Nehal KS, Bichakjian CK. Update on keratinocyte carcinomas. N Engl J Med 2018; 379: 363– 374.

Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population, 2012. JAMA Dermatol 2015; 151: 1081– 1086.

Apalla Z, Lallas A, Sotiriou E et al. Epidemiological trends in skin cancer. Dermatol Pract Concept 2017; 7: 1– 6.

Zink A. Trends in the treatment and prevention of keratinocyte carcinoma (non‐melanoma skin cancer). Curr Opin Pharmacol 2019; 46: 19– 23.

Lomas A, Leonardi‐Bee J, Bath‐Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol 2012; 166: 1069– 1080.

Rudolph C, Schnoor M, Eisemann N, Katalinic A. Incidence trends of nonmelanoma skin cancer in Germany from 1998 to 2010. J Dtsch Dermatol Ges 2015; 13: 788– 797.

Xiang F, Lucas R, Hales S, Neale R. Incidence of nonmelanoma skin cancer in relation to ambient UV radiation in white populations, 1978–2012: empirical relationships. JAMA Dermatol 2014; 150: 1063– 1071.

Lee JH, Kim YH, Han KD et al. Incidence of actinic keratosis and risk of skin cancer in subjects with actinic keratosis: a population‐based cohort study. Acta Derm Venereol 2018; 98: 382– 383.

Schaefer I, Augustin M, Spehr C et al. Prevalence and risk factors of actinic keratoses in Germany–analysis of multisource data. J Eur Acad Dermatol Venereol 2014; 28: 309– 313.

Zink A, Tizek L, Schielein MC et al. Different outdoor professions have different risks – a cross‐sectional study comparing non‐melanoma skin cancer risk among farmers, gardeners and mountain guides. J Eur Acad Dermatol Venereol 2018; 32: 1695– 1701.

Tizek L, Schielein MC, Seifert F et al. Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest. J Eur Acad Dermatol Venereol 2019; 33: 1421– 1428.

John SM, Trakatelli M, Gehring R et al. Consensus report: Recognizing non‐melanoma skin cancer, including actinic keratosis, as an occupational disease – a call to action. J Eur Acad Dermatol Venereol 2016; 30(Suppl 3): 38– 45.

Schmitt J, Seidler A, Diepgen TL, Bauer A. Occupational ultraviolet light exposure increases the risk for the development of cutaneous squamous cell carcinoma: a systematic review and meta‐analysis. Br J Dermatol 2011; 164: 291– 307.

Diepgen TL. New developments in occupational dermatology. J Dtsch Dermatol Ges 2016; 14: 875– 889.

Modenese A, Korpinen L, Gobba F. Solar radiation exposure and outdoor work: an underestimated occupational risk. Int J Environ Res Public Health 2018; 15: 2063.

Smit‐Kroner C, Brumby S. Farmers sun exposure, skin protection and public health campaigns: an Australian perspective. Prev Med Rep 2015; 2: 602– 607.

Woods CE, O’Shea E, Barrett F et al. Occupational exposure: rural Australian farmers’ sun‐protective behaviours. J Public Health (Berl.) 2019; 24: 652.

Ziehfreund S, Schuster B, Zink A. Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019. J Eur Acad Dermatol Venereol 2019; 33: 1477– 1495.

Gordon LG, Scuffham PA, van der Pols JC et al. Regular sunscreen use is a cost‐effective approach to skin cancer prevention in subtropical settings. J Invest Dermatol 2009; 129: 2766– 2771.

Køster B, Søndergaard J, Nielsen JB et al. Knowledge deficit, attitude and behavior scales association to objective measures of sun exposure and sunburn in a Danish population based sample. PLoS ONE 2017; 12: e0178190.

Grandahl K, Ibler KS, Laier GH, Mortensen OS. Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers. Environ Health Prev Med 2018; 23: 47.

Zink A, Wurstbauer D, Rotter M et al. Do outdoor workers know their risk of NMSC? Perceptions, beliefs and preventive behaviour among farmers, roofers and gardeners. J Eur Acad Dermatol Venereol 2017; 31: 1649– 1654.

Zink A, Schielein MC, Wildner M, Rehfuess EA. 'Try to make good hay in the shade – it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer. Br J Dermatol 2019; 180: 1412– 1419.

Ziehfreund S, Schuster B, Biedermann T, Zink A. Understanding roofers' sun protection behaviour: a qualitative study. J Eur Acad Dermatol Venereol 2019; 33: e193– e195.

Ou‐Yang H, Jiang LI, Meyer K et al. Sun protection by beach umbrella vs sunscreen with a high sun protection factor: a randomized clinical trial. JAMA Dermatol 2017; 153: 304– 308.

Religi A, Backes C, Moccozet L et al. Body anatomical UV protection predicted by shade structures: a modeling study. Photochem Photobiol 2018; 94: 1289– 1296.

Schneider S, Diehl K, Schilling L et al. Occupational UV exposure and sun‐protective behaviour in German outdoor workers: results of a nationwide study. J Occup Environ Med 2018; 60: 961– 967.

Grandahl K, Eriksen P, Ibler KS et al. Measurements of solar ultraviolet radiation exposure at work and at leisure in Danish workers. Photochem Photobiol 2018; 94: 807– 814.

Görig T, Diehl K, Greinert R et al. Prevalence of sun‐protective behaviour and intentional sun tanning in German adolescents and adults: results of a nationwide telephone survey. J Eur Acad Dermatol Venereol 2017; 32: 225– 235.

Schilling L, Schneider S, Görig T et al. "Lost in the sun"‐The key role of perceived workplace support for sun‐protective behavior in outdoor workers. Am J Ind Med 2018; 61: 929– 938.

Glanz K, Buller DB, Saraiya M. Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations. Environ Health 2007; 6: 22.

Grandahl K, Olsen J, Friis KBE et al. Photoaging and actinic keratosis in Danish outdoor and indoor workers. Photodermatol Photoimmunol Photomed 2019; 35: 201– 207.

Venna SS, Lee D, Stadecker MJ, Rogers GS. Clinical recognition of actinic keratoses in a high‐risk population: how good are we? Arch Dermatol 2005; 141: 507– 509.