Episode #111 - Sun and skin cancer

VGS WHO and the International Labour Organization have recently released estimates about how many workers are exposed to sunlight at work, and how many of them get skin cancer, specifically non-melanoma skin cancer as a result of long exposure to sun. How does sun cause skin cancer? Who is at risk and how can you, your employer, and your government keep you safe? Here to talk about it is Doctor Frank Pega. Welcome, Frank. Frank, explain to us how intense exposure to sunlight can cause non-melanoma skin cancer.

FP Outdoor workers regularly work under the intense sun, sometimes for really long periods of time. And sun comprises ultraviolet radiation. When this type of radiation hits skin cells, it can damage their DNA. And that can in turn lead to skin cancer, where these skin cells basically grow uncontrolled. There are two main types of skin cancer. Melanoma is the more deadly type. We looked at non-melanoma, which is the type that is less deadly but much, much more common and a big problem.

Non-melanoma skin cancer commonly appears as either a red firm lump or a flat, scaly patch that doesn't heal for several weeks, so outdoor workers are at a 60% increased risk compared to indoor workers from having a non-melanoma skin cancer. This kind of skin cancer is commonly seen on the face, on the ears, or on the head, but also the arms and the legs where workers are most exposed to the sun. So, for example, imagine a farmer who plants or harvests rice. That worker will be exposed intensively to the sun for a really long time, and the surface of the water that has flooded the fields that the worker standing in will be reflecting back, aggravating the exposure.

VGS So Frank talked to us about how many people get non-melanoma skin cancer as a result of sun exposure at work, and does this depend on what kind of country we live in, whether we are in a low income, middle income or high income country?

FP It's many more people who are working outdoors and who die as a result of non-melanoma skin cancer from this exposure than we could have possibly imagine before we did our estimates. About 1 in 4 workers globally is actually exposed to intense sunlight at work. That's a staggering 1.6 billion people globally.

So these are the farmers in the rice field, the construction workers, the people who are working in the non organized sector for long hours under intense sunlight.

That's correct. So these are outdoor workers who live primarily in low and middle income countries and who are often working in the informal economy where they don't have any health protections that formal employment would afford to them. One in three non-melanoma skin cancer deaths are actually from working under the sun, so that's about 19,000 deaths globally each year. If you work outdoors, you're at a higher risk and we find that the number of people who die from non-melanoma skin cancer in each region per population is almost equal. So it's a global problem. Additionally, it's a growing problem because the numbers have doubled in the last 20 years.

VGS So Frank, what can governments do and what can workers do to protect themselves from long exposure to intense sunlight and from skin cancer?

FP Governments can pass regulations and policies that can prevent outdoor work that is hazardous because it's under the sun. For example, governments can reorganize work, they can require that workers reorganize so that working under the sun has shifted away from solar noon, and therefore away from the intense sun. Governments can also implement requirements that workers are provided with shade when they work outdoors. This is something we've seen a lot. Countries in the Eastern Mediterranean region, and the Western Pacific already have these types of regulations in place.

Additionally, governments can provide public health information. This is very important. They can talk about sun safety protocols and protective measures that can be taken. Also important, as there can be a requirement that workers are provided with protective clothing. They can wear broad brimmed heads, long sleeved shirts, long trousers and also there could be a provision of sunscreen where it's effective and deemed possible. Additionally, it's important that we have functioning health services and systems where skin cancer is prevented and we have workers being regularly checked so that skin cancer can be detected early and can be treated. And finally but importantly, governments can recognize skin cancer from occupational exposure to the sun as an occupational disease and include it in worker's compensation schemes.

VGS Thank you, Frank. That was Science in 5 today. Until next time, then stay safe, stay healthy and stick with science.