Abstract
This survey study examines skin cancer history, skin cancer screening, and sun protection habits among active Florida firefighters.
Firefighters serve in a hazardous occupation and face unique dermal exposures. Recent epidemiologic studies have found an elevated risk for skin cancer among firefighters compared with the general population. Firefighter exposure studies have detected carcinogenic chemicals on firefighter skin and gear following fire-incident response. There is limited research on risk factors and occupational hazards related to skin cancer in the firefighter workforce. We examine skin cancer history, skin cancer screening, and sun protection habits among active Florida firefighters.
Methods
The Annual Cancer Survey (ACS) research project of the Firefighter Cancer Initiative launched with a 127-item comprehensive cancer questionnaire administered via REDCap to a nonprobabilistic sample of firefighters and/or paramedics employed in South Florida. We present ACS data collected during the first 12 months of this cross-sectional, convenience study (http://sylvester.org/firefighters). Firefighters were invited and consented by the study team to complete the ACS using a secure iPad device during their regular work shift. Standardized subjective measures assessing for doctor-diagnosed skin cancer, type of skin cancer, frequency of sunburn, tanning bed use in their lifetime, health insurance status, skin cancer screening behavior, and sociodemographic characteristics, as well as job characteristics, were analyzed. Multivariate and univariate logistic regression models were fitted to predict history of skin cancer and sun protection practices. Adjusted odds ratios (aOR) and unadjusted odds ratios (uOR) were calculated with 95% CIs. This study was approved by the University of Miami institutional review board.
Results
Among the 2505 surveyed firefighters, 2399 (95.8%) completed the survey; mean (SD) age was 41.7 (8.5) years and mean (SD) time of employment as a firefighter was 15.1 (8.2) years (Table 1). Overall, 109 cases of skin cancer were reported, affecting 4.5% of respondents: 17 firefighters (0.7%) had melanoma; 84 (3.5%), nonmelanoma; and 18, unknown skin cancer type. The mean (SD) age of skin cancer diagnosis was 42.2 (6.8) years for melanoma, 38.3 (10.8) years for nonmelanoma, and 42.4 (8.5) years for unknown skin cancer type. In terms of sun protection practices, wearing sunscreen when outdoors was the most commonly reported behavior among all participants and lowest among unknown skin cancer types. Respondents with skin cancer and the overall firefighter sample reported the least use of long pants while outdoors compared with the participants without skin cancer.
Table 1. Skin Cancer and Sun Protection Practices Among a Nonprobabilistic Sample of Florida Firefighters.
| Characteristics | No. (%)a | ||||
|---|---|---|---|---|---|
| All | Skin Cancer Type | No Skin Cancer | |||
| Melanoma | Nonmelanoma | Unknown Type | |||
| Allb | 2399 | 17 (0.7) | 84 (3.5) | 20 (0.8) | 2290 (95.5) |
| Age at diagnosis, mean (SD), y | ND | 42.2 (6.8) | 38.3 (10.8) | 42.4 (8.5) | ND |
| Years as a firefighter, mean (SD) | 15.1 (8.2) | 22.3 (8.9) | 22.5 (8.5) | 21.0 (7.9) | 14.7 (8.0) |
| Sex | |||||
| Male | 2156 (90.0) | 12 (75.0) | 73 (86.9) | 19 (95.0) | 2062 (90.2) |
| Female | 239 (10.0) | 4 (25.0) | 11 (13.1) | 1 (5.0) | 225 (9.8) |
| Ethnicity | |||||
| Non-Hispanic | 1438 (60.6) | 16 (94.1) | 73 (89.0) | 18 (90.0) | 1343 (59.3) |
| Hispanic | 934 (39.4) | 1 (5.9) | 9 (11.0) | 2 (10.0) | 922 (40.7) |
| Skin cancer prevention and sun protection practices | |||||
| Ever used a tanning bed? | |||||
| Yes | 568 (23.8) | 6 (35.3) | 23 (27.4) | 6 (30.0) | 535 (23.5) |
| No | 1817 (76.2) | 11 (64.7) | 61 (72.6) | 14 (70.0) | 1741 (76.5) |
| Skin type | |||||
| More likely to burn | 1464 (63.6) | 16 (94.1) | 81 (96.4) | 18 (94.7) | 1361 (62.1) |
| More likely to tan | 837 (36.4) | 1 (5.9) | 3 (3.6) | 1 (5.3) | 832 (37.9) |
| Ever had full skin check? | |||||
| Yes | 1164 (49.6) | 17 (100) | 82 (97.6) | 19 (95.0) | 1058 (47.3) |
| No | 1183 (50.4) | 0 | 2 (2.4) | 1 (5.0) | 1180 (52.7) |
| Sunburns in past year, mean (SD), No. | 1.6 (2.7) | 1.8 (1.9) | 2.4 (3.1) | 1.2 (1.1) | 1.6 (2.7) |
| Sun protection practicesc | |||||
| Use sunscreenb | 826 (34.4) | 9 (52.9) | 45 (53.6) | 5 (25.0) | 772 (33.7) |
| Wear hatb | 451 (18.8) | 5 (29.4) | 21 (25.0) | 6 (30.0) | 424 (18.5) |
| Wear long-sleeved shirtb | 440 (18.3) | 7 (41.2) | 20 (23.8) | 4 (20.0) | 414 (18.1) |
| Wear long pantsb | 338 (14.1) | 2 (11.8) | 10 (11.9) | 3 (15.0) | 325 (14.1) |
| Stay in shadeb | 713 (29.7) | 4 (23.5) | 26 (31.0) | 6 (30.0) | 679 (29.7) |
Abbreviation: ND, no data.
Column percentages (differences in subtotal due to item nonresponse or missing values in the sample).
Row percentages (differences in subtotal due to item nonresponse or missing values in the sample).
Proportion of firefighters who follow these sun protection practices “always” or “most of the time” when in the sun for more than 1 h.
Non-Hispanic ethnicity (aOR, 3.25; 95% CI, 1.74-6.07) and increased age (aOR 1.07; 95% CI, 1.03-1.11) were significant predictors of a skin cancer diagnosis in the firefighter sample (Table 2). Firefighters with a history of skin cancer were significantly more likely to use sunscreen most of the time or always when outdoors (uOR, 1.91; 95% CI, 1.30-2.81).
Table 2. Multivariable and Univariate Binary Logistic Regression Models Predicting Skin Cancera and Sun Protection Practices in Florida Firefighters.
| Characteristic | Odds Ratio (95% CI) |
|---|---|
| Predicting Skin Cancer Status | |
| Sex | |
| Male | 1 [Reference] |
| Female | 1.14 (0.61-2.12)b |
| Ethnicity | |
| Hispanic | 1 [Reference] |
| Non-Hispanic | 3.25 (1.74-6.07)b |
| Tanning bed use | |
| No | 1 [Reference] |
| Yes | 1.54 (0.97-2.44)b |
| Age, y | 1.07 (1.03-1.11)b |
| Years as a firefighter | 1.03 (0.99-1.07)b |
| Predicting Sun Protection Practicesc | |
| No history of skin cancer | 1 [Reference] |
| Use sunscreen | 1.91 (1.30-2.81)d |
| Wear hat | 1.44 (0.92-2.25)d |
| Wear long-sleeved shirt | 1.41 (0.89-2.21)d |
| Wear long pants | 0.81 (0.45-1.46)d |
| Stay in shade | 1.06 (0.70-1.61)d |
All skin cancer types (melanoma, nonmelanoma, unknown skin cancer type) were aggregated.
Adjusted analysis.
Univariate model predicts reporting sun protection practice always or most of the time when outdoors for more than 1 h for skin cancer status.
Unadjusted analysis.
Discussion
Our results suggest that a high percentage of younger firefighters have skin cancer and that there may be a higher risk for skin cancer among firefighters. This sample had an elevated prevalence of melanoma (0.7%) compared with the Florida adult melanoma prevalence found in other epidemiologic studies (0.011%). Furthermore, the median age of diagnosis for melanoma among the sampled firefighters (42 years) was younger than median age of diagnosis in the general US population (64 years). The increased skin cancer rates and earlier presentation may be attributable to carcinogenic occupational exposures; however, non–work-related ultraviolet light exposure may also contribute. Better understanding of these carcinogens is needed to inform best practices for protection. For most skin cancer screening and sun protection practices, firefighters with a history of skin cancer had higher rates of adherence than firefighters without a history of skin cancer. This firefighter sample showed a higher rate of skin checks compared with state-wide statistics on skin cancer screening. Compared with the US national average, firefighters reported a lower proportion of ever using a tanning bed, yet the rate is still high representing an opportunity for education and behavior modification. Despite the potentially increased skin cancer risk, skin cancer screening and sun protection habits could be improved for firefighters with and without skin cancer diagnoses. Future research is warranted to further investigate skin cancer risk and mortality among firefighters and to identify occupational hazards associated with this excess risk.
References
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