Utility construction workers, who often work outside, are at a high risk for skin cancer. Due to the fact that these same workers could be exposed to more immediate hazards the risk of skin cancer is often ignored. As many of us know, construction workers love to work outside and often intentionally expose themselves to the sun by wearing sleeveless shirts and sometimes no shirt at all just to get a tan. The problem is these same workers do not accept the fact that skin cancer can be life threatening.
Skin cancer is one of the most common cancers. The amount of exposure required to cause skin cancer varies greatly from one person to another. However, the fact is the risk of skin cancer increases with increasing amounts of exposure to the sun.
There are two main groups of skin cancer:
Non-Melanoma Skin Cancer (NMSC) — This often occurs to people who spend a lot of time outside while exposing skin on their arms, legs, neck or head to the sun’s rays. Harmful ultraviolet radiation (even on cloudy days) damages the skin and can lead to a NMSC developing.
There are two types of NMSC: Basal cell carcinoma (BCC) is the most common type of skin cancer. It grows slowly over months and years and may damage nearby tissues and organs if left untreated. Squamous cell carcinoma (SCC) is less common, but grows faster. It may spread to other parts of the body if left untreated. The first sign is often a lump or patch on the skin that doesn’t heal after a few weeks. These lumps are often red and firm while the patches are mostly flat and scaly. Lesions may be crusty, form an ulcer, bleed and be painful. Most NMSC can be treated, often with a simple operation.
Malignant Melanoma — Melanoma is the least common, but most dangerous type of skin cancer. Most skin cancer deaths are from melanoma. It is often fast growing and can spread to other parts of the body where it can form a new cancer. This cancer occurs in the skin cells called melanocytes. These are the cells where the skin pigment melanin is found. The most common sign is the appearance of a new mole or a change in an existing mole. These often have an irregular shape and more than one color. Sometimes they are also itchy or bleed. Surgery can however be successful if the melanoma is caught early.
Protection Factors for Sunscreens and Clothing
SPF stands for Sun Protection Factor. It is a rating for sunscreens or other cosmetic products containing sunscreen. Theoretically, the SPF number indicates how long you can stay in the sun before your skin reddens. Most sunscreens with an SPF of 15 or higher do an excellent job of protecting against UVB. SPF is a measure of a sunscreen’s ability to prevent UVB from damaging the skin. Here’s how it works: If it takes 20 minutes for your unprotected skin to start turning red, using an SPF 15 sunscreen theoretically prevents reddening 15 times longer — about five hours.
Another way to look at it is in terms of percentages: SPF 15 filters out approximately 93 percent of all incoming UVB rays. SPF 30 keeps out 97 percent and SPF 50 keeps out 98 percent. They may seem like negligible differences, but if you are light-sensitive or have a history of skin cancer, those extra percentages will make a difference. And as you can see, no sunscreen can block all UV rays.
But there are problems with the SPF model: First, no sunscreen, regardless of strength, should be expected to stay effective longer than two hours without reapplication. Second, “reddening” of the skin is a reaction to UVB rays alone and tells you little about what UVA damage you may be getting. Plenty of damage can be done without the red flag of sunburn being raised.
Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF 15 or higher as one important part of a complete sun protection regimen. However, most construction workers will not apply sunscreen daily, but should even on cloudy days. A small, unscientific survey of laborers found that only 10 percent used sunscreen on a regular basis, which is significantly lower than the national average.
The Skin Cancer Foundation recommends the use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum sunscreen with an SPF of 30 or higher. One ounce (2 tablespoons) of sunscreen should be applied to exposed skin 30 minutes before going outside and should be reapplied every two hours or immediately after swimming or excessive sweating.
UPF stands for Ultraviolet Protection Factor. It indicates what fraction of the sun’s ultraviolet rays can penetrate the fabric. A shirt with a UPF of 50, for example, allows just 1/50th of the sun’s UV radiation to reach the skin. The higher the UPF, the greater the protection.
According to the Skin Cancer Foundation the best protection from the sun’s harmful UV rays is clothing. It’s pretty obvious that a long sleeve shirt and long pants will cover more skin than short sleeves and shorts. The fabric also makes a difference.
Most fabrics will naturally absorb some UV radiation, but they are not all the same. The fabric can be made of many types of fibers, including cotton, wool and nylon. Synthetic fibers such as polyester, lycra, nylon and acrylic are more protective than cottons. The tighter the knit or weave, the smaller the holes and resulting in less UV getting through. The fabrics weight and density also make a difference.
Check the UV Index Report Daily
When possible, plan work schedules based on the UV index forecast. Managers should check the UV Index before the start of work that will involve employees being exposed to the sun’s rays, even on cloudy days. Ensure workers know what the UV index numbers mean (see UV Index table) so they can protect themselves accordingly. The UV index forecast can be obtained from local weather reports, newspapers and websites such as weather.gov. Establish a system for all employees to receive a daily text message, set up a sign and update it daily, or include an UV index report in the morning crew meeting. The UV index can be used to tell workers on a daily basis when to use sun protection control measures.
Sun Protection Control Measures
Once the risk has been assessed, employers and employees should work together to make changes to minimize the risk. A comprehensive sun protection program should include the introduction of protective measures and controls including:
• Engineering controls, which are measures that reduce exposure to solar UVR by a physical change to the work environment. Providing shade, modifying reflective surfaces and using window tinting on vehicles and equipment are all examples of engineering controls that reduce workplace exposure to direct and indirect sources of solar UVR.
• Administrative controls, which are measures that reduce exposure to solar UVR by a change in work procedure and the way work is organized. Plan work routines so outdoor work tasks are done early in the morning or later in the afternoon when levels of solar UVR are lower. When possible, move work task indoors or into shaded areas. Share outdoor tasks and rotate staff so the same person is not always out in the sun.
• Personal protective equipment and clothing, which are measures that reduce exposure to solar UVR by providing a personal barrier between individual workers and the hazard. Provisions can be made to provide workers with sun safe protective work clothing, hard hats with wide brims and sun shields and safety glasses that provide UVA/UVB protection.
• Sunscreen should always be used with other sun protection measures. It is important to realize that no sunscreen offers 100 percent protection. When providing sunscreens, keep in mind that all sunscreens must carry a sun protection factor (SPF) rating, Broad-spectrum sunscreen filters both UVA and UVB radiation. Chap Stick and similar lip moisturizers also have SDF ratings and should also be used.
Employers should train employees to work safely in the sun. By raising awareness and providing education and training to safety managers, supervisors and employees is essential to the success of a workplace sun protection program. A workplace training program can raise the profile of sun protection as a health and safety issue, improve knowledge and understanding of sun protection measures, dispel common misconceptions about solar UVR and various sun protection measures and provide information to help employees detect the early signs of skin cancer.
The Skin Cancer Foundation (www.skincancer.org), Center for Disease Control and Prevention (www.cdc.gov), Laborers’ Health and Safety Fund of North America (www.lhsfna.org) and other organizations have developed skin cancer awareness programs that focus on incidence, causes and risk factors as well as detection, prevention and treatment. Now is a good time to ensure that utility construction workers have the necessary information, knowledge and sun protection control measures needed to prevent them from getting skin cancer.
A Real Threat
Cheryl Stratos, NUCA’s Director of Marketing, shares her experience with skin cancer:
If you spend time outside with no sun protection, melanoma is a very real consequence. On Nov. 23, 2009, at the age of 45, I was diagnosed with Stage IV Metastatic Melanoma Cancer and given six months to live. It was not the type of reality check anyone wants to have, and staying alive became my new occupation. It only takes one bad burn to increase your chances of having melanoma. Remember to take a few minutes to apply your SPF or wear sun protective clothing when you are out in the field. Just like a hardhat is part of your daily protection, this too could save your life.
Melanoma is one of the fastest growing cancers in the United States and worldwide. For more information, contact the Melanoma Research Foundation at mrf.org or send me an e-mail at firstname.lastname@example.org.
George Kennedy is vice president of safety with NUCA. This article appeared in our sister publication, Utility Contractor.