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People Who Work in the Sun Less Likely to Get Skin Exams

Posted: May 13, 2008

While occupational risks are inherent in many jobs, workers who make a living toiling in the sun face an increased threat of skin cancer from repeated overexposure to the sun's harmful ultraviolet (UV) rays. Now, new research finds that workers who need skin exams the most by nature of their occupation--such as construction, forestry, fishing and farming workers--are the least likely to get them.

In the study published online in the Journal of the American Academy of Dermatology entitled "Reported skin cancer screening of U.S. adult workers," dermatologist Robert S. Kirsner, MD, PhD, FAAD, professor and vice chairman of the departments of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Miami, and his colleagues used the National Health Interview Survey (NHIS) data from 2000 and 2005 to estimate the percentage of U.S. workers who had ever had a thorough skin examination in their lifetime or during an appointment with a primary health care provider in the past 12 months.

"Previous studies have shown that total-body screening examinations are not frequently performed during routine health examinations by primary care physicians, even among potentially high-risk populations," said Dr. Kirsner. "As dermatologists, we know that the early detection of skin cancer by routine skin examinations is crucial in successfully treating this potentially life-threatening condition--particularly for workers routinely exposed to harmful ultraviolet light. This study shows that workers who need careful monitoring for skin cancer due to the nature of their jobs are less likely to receive skin exams than workers in low-risk occupations."

Conducted by the National Center for Health Statistics (NCHS), the NHIS is an annual, cross-sectional in-person household survey of U.S. workers. In 2000 and 2005, the Cancer Control Module was included as part of the NHIS and included questions on skin examinations that were administered to 19,702 and 18,422 employed participants, respectively. Questions included "Have you ever had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?" and "When did you have your most recent skin exam?"

Dr. Kirsner explained that data of all participants who reported a full-body skin examination were grouped into two categories: those who received a skin exam in the last 12 months and ever in their lifetime. Workers also were asked about their sun-protection behavior, if they reported going out in the sun for an hour or more, and, from their responses, were classified as "sun exposed" for the purposes of the study.

In addition, detailed employment information was coded by occupation and industry for all participants aged 18 years or older employed during the time of the survey. Occupations were grouped into four standard occupational categories: white-collar workers; service workers; farming, fishing, and forestry workers; and blue-collar workers. Workers were then subsequently grouped into eight industrial sector classifications: agriculture, forestry and fishing; mining; construction; manufacturing; wholesale and retail trade; transportation, warehousing and utilities; services; and health care and social assistance.

"When we examined the data for the 38,124 total worker participants interviewed from the 2000 and 2005 Cancer Control Supplements, we found that the prevalence of both lifetime and 12-month skin examinations was low," said Dr. Kirsner. "Only 15% of all U.S. workers reported ever receiving a skin examination during their lifetime, and only 8% of those who also had seen a health care provider in the past year reported that they had received a skin exam during that time."

In addition, the data clearly showed that the rate of reporting skin cancer screening was lowest for high-risk occupations most likely to experience increased sun exposure. Specifically, in the 2000 and 2005 Cancer Control Modules, the prevalence of 12-month skin examinations among those who had seen a physician in the past year was lowest among farm workers (5.8% and 1.6%, respectively) and blue-collar workers (3.9% and 4.9%, respectively.)

"When we analyzed the data by industry sectors, we concluded that agriculture, forestry, fishing and construction workers reported the lowest rate of skin exams in 2000," said Dr. Kirsner. "Although the number of agriculture, forestry and fishing workers reporting a skin exam increased from 2000 to 2005--from 4.2% to 13.6%--the prevalence of skin exams among construction workers stayed essentially the same, from 5.2% to 5.6%."

Dr. Kirsner added that occupational groups at increased risk for exposure to UV light on the job were less likely to have ever received a skin examination in their lifetime than the average U.S. worker (15%). This included farm operators and managers (10%), farm workers and other agricultural workers (7%), forestry and fishing occupations (3%), construction and mining trades (8%), and construction laborers (8%).

"Socioeconomic factors also were significant predictors of having a skin exam in the past year," said Dr. Kirsner. "Specifically, younger black or Hispanic women with no health insurance, who were service, farm or blue-collar workers, and who did not use sun protection were the least likely to report ever having been screened for skin cancer. All patients, especially those that have occupations where they are exposed to UV light, should request that their physician provide skin exams during their routine exams."

"In addition, developing and implementing local community health fairs that include screening programs targeting high-risk workers who are reporting low skin examination rates could help reverse this alarming trend," commented Dr. Kirsner. "One way to receive a free screening is through the Academy's National Melanoma/Skin Cancer Screening Program, where dermatologists volunteer to provide free skin cancer screenings in their communities. The public can visit www.aad.org to find a free skin cancer screening in their area."

For more information about skin cancer, please visit the SkinCancerNet section on www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.