Bringing Light into Darkness-Comparison of Different Personal Dosimeters for Assessment of Solar Ultraviolet Exposure

Risk assessment of occupational skin cancer among outdoor workers in southern Spain: local pilot study

OBJECTIVE

Overexposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. Outdoor workers, exposed to the sun for many hours throughout their working lives, are at special risk. The aim of this study is to determine occupational photoexposure and photoprotection among outdoor workers employed by a municipality in southern Spain.

METHODS

Cross-sectional descriptive study focusing on outdoor workers employed by the municipality of Fuengirola (in areas such as construction, gardening, urban cleaning and beach maintenance). The participants were monitored by personal dosimetry, participated in a dermatological check-up and answered a validated questionnaire (CHACES) on their habits, attitudes and knowledge related to sun exposure.

RESULTS

The median effective erythema dose of exposure to solar UV radiation during the working day (n=20) was 379.4 J/m², equivalent to 3.8 standard erythema doses, almost 3 times higher than the recommended limits for an 8-hour workday. Skin examination (n=128) revealed the presence of actinic lentigines (79.7%), actinic keratoses (8.6%) and skin cancer (3.9%). The CHACES questionnaire (n=128) revealed a sunburn rate of 50.0%. Photoprotection practices were markedly deficient: only 16.7% of the survey respondents sought protection in the shade, 20.3% avoided exposure during the peak exposure hours and 33.1% applied sunscreen.

CONCLUSIONS

This is the first study to evaluate UV radiation exposure, occupational sun protection practices, sunburn and actinic injuries of different outdoor workers in one of the sunniest regions of Spain and underlines the need for effective interventions to protect outdoor workers' health.

Workplace exposure to UV radiation and strategies to minimize cancer risk

BACKGROUND

Workplace exposure to solar ultraviolet (UV) causes malignant melanoma and non-melanoma skin cancer. The evidence for beneficial effects of solar UV exposure in reducing the risks for other cancers is increasing. The intensity of UV radiation at the Earth's surface is dependent on latitude, but even in northern European countries exposure can be high enough for outdoor work to cause skin cancer.

GROWING POINTS

Awareness of the health risks and benefits of occupational solar UV exposure is poor. Actions to reduce the risk of skin cancer have been identified and employers should recognize their responsibility to actively manage these risks. There is evidence for reduced risks for breast, ovarian and colorectal cancer and possibly other cancers linked to solar UV exposure.

SOURCES OF DATA

This narrative review draws on published scientific articles and material designed to assist identifying strategies to protect workers from solar UV exposure.

AREAS OF AGREEMENT

Solar UV exposure can be harmful. Wavelengths in the UVB range are more effective in causing erythema and DNA damage. Solar UV is the main source of vitamin D for most people. Primary and secondary prevention for skin cancer can potentially eliminate these risks but the evidence for effectiveness is limited.

AREAS OF CONTROVERSY

Potential health benefits of UV exposure, particularly for reduced cancer risk. Determining and communicating optimal exposure to maximize health benefits. The risk of non-melanoma skin cancers may be more than doubled for some workers in temperate latitudes.

AREAS TIMELY FOR DEVELOPING RESEARCH

Exposure-response epidemiological studies; studies of the health benefits of occupational UV exposure; studies of the effectiveness of intervention strategies to prevent skin cancer. Use of low-cost UV sensors in workplaces.

UVR Exposure and Prevention of Street Construction Workers in Colombia and Germany

(1) Solar ultraviolet radiation (UVR) poses a major risk factor for developing skin cancer after years of chronic exposure. The irradiation is strongly dependent upon the activity or occupation carried out, but also on the climate conditions at the workplace. Knowledge of both has been tested within the occupational group of road construction workers in Colombia and Germany. (2) The GENESIS-UV measurement system has been used at both locations for consistency. A number of workers in both countries wore an electronic data logging dosimeter for several months to deliver detailed information on UVR exposure. (3) It was found that in a tropical climate, UVR exposure remains constant throughout the year, while in a temperate climate seasonal effects are visible, superimposed by behavioural aspects e.g., in springtime. The daily distribution of the radiation shows a distinct dip, especially in the Colombian data. Derived data show the high fraction of working days exceeding a threshold set by the skin type. (4) Road construction work involves high UVR exposure. In both countries, preventive measures are required to reduce the personal exposure to a minimum. Exceedance of the minimal erythema dose (MED) suggests a possible enhancing effect, especially in fair skinned people. Intercomparison of UVR exposure at workplaces is possible between countries and climate zones, emphasizing efforts for global action against skin cancer.

Probing Different Approaches in Ultraviolet Radiation Personal Dosimetry - Ball Sports and Visiting Parks

Solar ultraviolet radiation (UVR) continues to be a decisive influencing factor for skin health. Besides acute damage (e.g. erythema), chronic light damage is of particular relevance. Skin cancer can develop on the basis of this light damage. Knowledge about irradiation is crucial for the choice of preventive measures, but has so far been incomplete in many occupational and leisure activities. Often a methodological problem in study design is the cause. Here we report on the clarification of two issues. First, further values are to be determined on the way to a comprehensive exposure register of leisure-related activities. Furthermore, it is to be determined to what extent the measurement setting can have an influence on the measurement campaigns. For long-term measurements, football referees were equipped with dosimeters over several months, selective measurements during visits to parks were carried out by on-site recruitment of test persons. It turned out that the choice of method also depends on the expected compliance of the test persons. Long-term measurements of specific activities such as playing football are particularly suitable for observing the course of UV exposure over the year and generating resilient mean values. Point measurements such as visits to parks can also do this if there are enough such events spread over the year. However, they are particularly suitable for such on-site campaigns, as they may be combined with awareness campaigns of the issue of skin cancer. They also allow many measurements to be taken at the same time in one place. Both playing football and visiting parks are associated with high levels of radiation, so specific prevention concepts need to be developed. We were able to determine that the sunburn dose for light skin types was reached or exceeded for both of the investigated activities.

Criteria for Occupational Health Prevention for Solar UVR Exposed Outdoor Workers-Prevalence, Affected Parties, and Occupational Disease

Non-melanoma skin cancer (NMSC) is the most common cancer in western countries. Legislative bodies and stakeholders like WHO and EU strongly promote protection against solar UVR, especially in workers. Occupational health prevention must be introduced as a strong instrument in workers protection also with regard to occupational disease issues. To date, criteria for both occupational health prevention and occupational disease are missing and the identification of risk groups has no metric basis. Here I report a criteria analysis based on the largest comprehensive data set of occupational ultraviolet radiation exposure of outdoor workers. With detailed research on occupation-specific dosimetric measurements of 45.000 measurement days in 176 occupations and sub-occupations, it is possible to map criteria for occupational health prevention specifically and to identify affected occupations. The number of employees affected can be elucidated worldwide. For the first time, a direct link to retrospective occupational disease criteria could be established. Of the 176 occupations and sub-occupations selected for this work, 153 (=87%) exceed the criterion for occupational health prevention and thus need special attention. This includes all occupations with annual exposures of more than 150 SED. Employment figures for the EU and the world yield the total number of affected workers to be 36.1 million and more than 500 million, respectively. These new criteria for occupational health prevention are valid and in good agreement with international research on limit values by WHO and ICNIRP. If applied correctly and consistently, these criteria can prevent occupational disease. It will be possible to identify occupations and sub-occupations that have an urgent need for prevention to avoid chronic skin damage leading to cancer. This research serves as a basis for policy making and clinical risk identification, as well as for daily practice of occupational physicians and employers responsible for risk assesment.