Settings: Workplace

From Skin Cancer Statistics and Issues
Skin Cancer Stats & Issues > Settings: Workplace

Outdoor workers

It is estimated that around 200 melanomas and 34,000 non-melanoma skin cancers per year are caused by occupational exposures in Australia.[1] Recent meta-analyses have found that risk of SCC among outdoor workers is nearly double that of indoor workers,[2] while risk of BCC is increased by almost 1.5 times.[3] A recent study assessed the contribution of occupational UV radiation exposure to Swiss outdoor workers’ SCC lifetime risk at age 60 for various simulated annual anatomical UV doses and occupational scenarios. The upper estimates of SCC risk following 25 years of outdoor work were twofold in the majority of scenarios, notably both year-round and seasonal workers with high or moderate exposure had an elevated risk, as compared with indoor workers.[4]

Australians are estimated to receive an annual UV exposure of 20,000-50,000 J/m2 (excluding exposure during vacation), with outdoor workers estimated to receive approximately 10% of the available ambient UV radiation and, therefore, three times the dose experienced by indoor workers.[5] It is possible outdoor workers are receiving as much as nine times the UV exposure experienced by indoor workers.

The Australian Work Exposures Study reported that 22% of Australian workers are exposed to solar UV radiation at work. The results also showed that although sun protection was used by 95% of Australians outdoors workers exposed to solar radiation, only 8.7% of workers were classified as fully protected (used hat, sunscreen, clothing and shade for more than half the outdoor working time), while 94.9% used at least one form of sun protection, with protective clothing (80.4%) and hats (72.2%) most common. Outdoor workers exposed to solar UV radiation were more likely to be males and those residing in lower socioeconomic and regional areas. The occupations with the highest percentage of outdoor workers were farming, painting and plumbing.[6]

The 2008 National Hazard Exposure Worker Surveillance examined the provision of sun protection to employees and found that hats, sunscreen and protective clothing were the most frequently provided control measures. Sunscreen was provided to 65% of exposed workers, hats to 63%, and protective clothing to 59%. Only one in five workers (21%) who worked in direct sunlight undertook their work outside of peak UV hours to reduce sun exposure. Close to a fifth of workers (17%) who worked in direct sunlight reported that they or their employer did nothing to prevent health problems caused by exposure to direct sunlight or sunburn.[7]

Safe Work Australia recommends that outdoor workers who spend extended periods of time outdoors, work in alpine regions and/or work near highly reflective surfaces, use sun protection even when the UV Index is below three. Sun protection (hats, sunscreen and shade) is recommended for outdoors workers, as is minimising sun exposure time through rotations.[8] A study of sun protection in Queensland men who had been treated for keratinocytic skin cancer found that men whose workplace had a mandatory sun protection policy were more likely to protect themselves from the sun.[9] Large studies with extended follow-up times have demonstrated that educational and multi-component interventions are effective in increasing sun protection.[10]

The most common cause of compensated cancer claims between 2000 to 2009 was sun exposure (51%), followed by asbestos (27%).[11] A total of 1,970 workers compensation claims for sun related injury/disease have been made in Australia between 2000 and 2012, at a total cost of $63 million in compensation payments.[12]

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Indoor workers

Overseas research suggests that the incidence of cutaneous malignant melanoma may be similar or higher among indoor workers than in outdoor workers’.[13] Melanoma may be associated with a pattern of intense, intermittent UV radiation exposure,[14],[15] and this may explain why indoor workers are at similar risk of melanoma compared to outdoor workers despite lower UV exposure overall. Research of this kind is lacking in Australia,[16][17] considering our environment of high UV levels.

At the same time, indoor workers may be at increased risk of vitamin D deficiency.The Australian Bureau of Statistics Australian Health Survey in 2011-12 showed that those employed in occupations that were mostly based inside, such as sales workers (28%) and professionals (26%), were more likely to have a vitamin D deficiency than those working in jobs based mostly outdoors, such as machinery operators and drivers (18%).[18] However, these vocational differences were much less pronounced during the summer months. These occupational findings align with two studies conducted in Queensland showing that, even in a subtropical climate, vitamin D insufficiency was prevalent among indoor workers (30%[19] - 14% and 51% in summer and winter time, respectively[20])

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References

  1. Fritschi L, Driscoll T. Cancer due to occupation in Australia. Aust N Z J Public Health 2006 Jun;30(3):213-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16800196.
  2. 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 Feb;164(2):291-307 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21054335.
  3. Bauer A, Diepgen TL, Schmitt J. Is occupational solar ultraviolet irradiation a relevant risk factor for basal cell carcinoma? A systematic review and meta-analysis of the epidemiological literature. Br J Dermatol 2011 Sep;165(3):612-25 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21605109.
  4. Milon A, Bulliard JL, Vuilleumier L, Danuser B, Vernez D. Estimating the contribution of occupational solar ultraviolet exposure to skin cancer. Br J Dermatol 2014 Jan;170(1):157-64 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23980934.
  5. Godar DE. UV doses worldwide. Photochem Photobiol 2005 Jul;81(4):736-49 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15819599.
  6. Carey RN, Glass DC, Peters S, Reid A, Benke G, Driscoll TR, et al. Occupational exposure to solar radiation in Australia: who is exposed and what protection do they use? Aust N Z J Public Health 2014 Feb;38(1):54-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24494947.
  7. Australian Safety and Compensation Council. National hazard exposure worker surveillance (NHEWS) survey: 2008 results. Canberra, Australia; 2008 Available from: http://www.safeworkaustralia.gov.au/sites/swa/research/hazard-surveillance/pages/hazard-surveillance.
  8. Safe Work Australia. Guide on Exposure to Solar Ultraviolet Radiation (UVR). Canberra Australia; 2013.
  9. Woolley T, Buettner PG, Lowe J. Predictors of sun protection in northern Australian men with a history of nonmelanoma skin cancer. Prev Med 2004 Aug;39(2):300-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15226038.
  10. Horsham C, Auster J, Sendall MC, Stoneham M, Youl P, Crane P, et al. Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review. BMC Res Notes 2014 Jan 7;7:10 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24397996.
  11. National Data Team, Safe Work Australia. Workplace compensation data. Canberra, Australia; 2011. p. 4.
  12. Safe Work Australia. Workplace compensation data. Canberra, Australia: National Data Team, Safe Work Australia; 2014.
  13. Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer 2005 Jan;41(1):28-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15617989.
  14. Armstrong BK, Kricker A. The epidemiology of UV induced skin cancer. J Photochem Photobiol B 2001 Oct;63(1-3):8-18 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11684447.
  15. Elwood JM, Jopson J. Melanoma and sun exposure: an overview of published studies. Int J Cancer 1997 Oct 9;73(2):198-203 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9335442.
  16. Holman CD, Armstrong BK, Heenan PJ. Relationship of cutaneous malignant melanoma to individual sunlight-exposure habits. J Natl Cancer Inst 1986 Mar;76(3):403-14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3456458.
  17. Green A, Siskind V, Bain C, Alexander J. Sunburn and malignant melanoma. Br J Cancer 1985 Mar;51(3):393-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3970815.
  18. Australian Bureau of Statistics. 4364.0.55.006 - Australian Health Survey: Biomedical Results for Nutrients, Vitamin D 2011-12. Canberra, Australia: Australian Bureau of Statistics; 2014 Available from: http://www.abs.gov.au/ausstats/abs@.nsf/latestProducts/4364.0.55.006Media%20Release22011-12.
  19. Jayaratne N, Russell A, van der Pols JC. Sun protection and vitamin D status in an Australian subtropical community. Prev Med 2012 Aug;55(2):146-50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22634425.
  20. Vu LH, Whiteman DC, van der Pols JC, Kimlin MG, Neale RE. Serum vitamin D levels in office workers in a subtropical climate. Photochem Photobiol 2011 May;87(3):714-20 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21255019.

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