The threat is real: How firefighters can protect against skin cancer
With an increased risk of developing skin cancer, firefighters should follow simple steps to avoid sunburn
It’s common knowledge that firefighters face an increased risk for developing many types of cancer, hence our increased efforts to minimize firefighters’ exposure to the chemicals, chemical compounds and carcinogens found on the fireground. But did you know that skin cancer is one the most common type of cancer that firefighters develop?
Firefighters face unique dermal exposures. While there is limited research on risk factors and occupational hazards related to skin cancer in the firefighter workforce, a recent study out of Florida found an elevated risk for skin cancer among firefighters compared to the general population. The researchers reported the following:
“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).”
Let’s consider the risks, take a closer look at the study, and identify what firefighters can do to prevent skin cancer.
Sunburn is a big deal
Our skin is our body's largest organ by area. This organ gets plenty of exposure to the sun's ultraviolet (UV) rays from an early age for most people. This can create an increased risk later in life. Specifically, according to the Skin Cancer Foundation, a child younger than 5 years old who suffers a significant sunburn increases their risk of developing skin cancer later in life by 50%. Further, if you suffer five or more significant sunburns in your lifetime, you’ve also doubled your chances for developing melanoma.
Sunburn is an inflammatory reaction to UV radiation damage to your skin’s outermost layers, the epidermis and dermis. Physiologically, our bodies rely on melanin – a pigment that gives your skin its color – for defense against the sun’s harmful rays. It does this by darkening your unprotected sun-exposed skin, commonly deemed tanning. Genetics drive the amount of melanin that an individual’s body produces, and that’s why some people get sunburned more easily while others tan.
However, both sunburn and tanning are signs of cellular damage to the skin. For those with lower levels of melanin, prolonged unprotected sun exposure causes skin cells in the epidermis (your skin’s surface) to become red, swollen and painful – aka sunburn. While people with fair skin run the greatest risk of sunburn, anyone can get burned. Even if you don’t typically burn, but rather tan, sun exposure can cause cellular damage that can lead to cancer.
After a sunburn, the body’s immune system kicks into action to rid itself of those damaged epidermal cells by the process of peeling. You should never attempt to help your immune system by manually peeling those dead skin cells. It’s far better – and you’ll heal faster – if you let them slough off naturally.
Increased risk for firefighters
A survey study conducted by the Firefighter Cancer Initiative examined skin cancer history, skin cancer screening, and sun protection habits among active Florida firefighters. Among the 2,399 survey respondents, the mean age was 41.7, and the mean time of employment as a firefighter was 15.1 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%) had nonmelanoma cancer; and 18 had an unknown skin cancer type. The mean age of skin cancer diagnosis was 42.2 years for melanoma, 38.3 years for nonmelanoma cancer, and 42.4 years for the unknown skin cancer type.
In terms of sun protection practices, wearing sunscreen when outdoors was the most common reported behavior among all participants and lowest among those respondents who reported unknown skin cancer types. Respondents with skin cancer and the overall firefighter sample reported the least common form of protection to be the use of long pants while outdoors.
Sun protection PPE
Firefighters should view measures to protect themselves from the sun's rays as PPE. It's just as important as wearing your structural firefighting PPE and SCBA to reduce your risk for developing cancer. Let's look at what PPE options are available.
Sunscreen: This is the most obvious – and most economical – of your options. Many dermatologists recommend that people apply sunscreen daily, just like deodorant, especially for the face and neck, which are among the most common areas where skin cancer develops. Firefighters should apply waterproof sunscreen with an SPF rating of 50 or higher, and they should carry that with them, as sunscreen needs to be reapplied, especially if you’re sweating. Make sure to use sunscreen on the arms, exposed by the short sleeves on work uniform shirts and T-shirts.
Hats: Many firefighters wear hats, but the traditional ball caps are not SPF rated for protection from those UV rays, especially those that use mesh for a portion of the crown. And unless you're wearing sunscreen, your ears and neck are still exposed and unprotected. A far superior headwear option is a wide-brimmed hat with an SPF rating of 50 or greater. (Check the tag to see whether the hat is SPF rated.)
Long-sleeve uniform shirts and T-shirts: Look for shirts with that SPF rating of 50 plus; they're out there in more places than ever. A good option is to wear a lightweight SPF-rated long-sleeve T-shirt under your work uniform shirt or T-shirt because unless those garments have an SPF rating, you're still getting exposure to those cancer-causing rays through the material.
Sun-blocking sleeves: Many professional and amateur athletes who compete outdoors, especially pro golfers, are wearing these pull-on sleeves to protect their arms from the sun.
Two final tips
I’ll leave you with two final tips for protecting yourself from the skin cancer:
- Get familiar with the UV Index, and check it regularly. The UV Index helps us understand our risks related to sunburn, factoring in the season of the year, time of day, and your geographic location. Specifically, the UV Index predicts UV intensity levels on a scale of 1 to 11+, where 1 indicates a minimal risk of overexposure and 11+ means an extremely high risk. Calculated on a next-day basis for dozens of cities across the United States, the UV Index considers a variety of conditions that affect the amount of UV radiation reaching the ground. Tip: You can suffer a sunburn on an overcast day. Up to 80% of the sun’s UV rays can penetrate clouds.
- Find a dermatologist to conduct an annual full-body exam. Plus, learn what developing skin cancer looks like, and conduct regular self-examinations between your annual visits to your skin doctor. For melanoma specifically, a simple way to remember the warning signs is to remember the A-B-C-D-Es:
- Asymmetrical: Does the mole or spot have an irregular shape with two parts that look very different?
- Border: Is the border irregular or jagged?
- Color: Is the color uneven?
- Diameter: Is the mole or spot larger than the size of a pea?
- Evolving: Has the mole or spot changed during the past few weeks or months?
The threat is real
Most of the discussions about firefighters and their increased risk for developing cancer focus on cancers affecting internal organs (e.g., lung, colon, liver), but the risk for firefighters to develop skin cancer is also very real.
The good news: Skin cancer is one type of cancer that can be identified early – through self-examinations and regular exams by a dermatologist – and when detected early has a good prognosis. Further, basal cell and squamous cell carcinomas – the two most common forms of skin cancer – are highly treatable if detected early and treated properly. According to the American Academy of Dermatology Association, the five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99%. The five-year survival rate for melanoma that spreads to nearby lymph nodes is 68%. The five-year survival rate for melanoma that spreads to distant lymph nodes and other organs is 30%.
So, do those self-examinations monthly, and talk to your doctor if you notice changes in your skin, such as a new growth, a sore that doesn’t heal, a change in an old growth, or any of the A-B-C-D-Es of melanoma.