[Author]
Abstract
The present review is aimed at providing an understanding on how the workplace contributes to the development of skin cancer. Five reviews (3 epidemiological data reviews, 1 meta-analysis, and 1 article) obtained from PubMed, involving a total of at least 3479 mortality and morbidity in skin cancer. These studies agreed on the initiating role of the workplace in the development of skin cancers, both malignant mesothelioma (MM) and non-melanoma skin cancers (NMSC), due to chronic exposure to carcinogens such as asbestos (Rushton, 2012; Boffetta, 2004; Romeo, 2004; ), mineral oils (Rushton, 2012), solar radiation (Rushton, 2012; Hannaford-Turner, Elder, Sim, Abramson, Johnson & Yates, 2010; Kutting & Drexler, 2010), and coal tars and pitches (Rushton et al, 2012). These studies also identified specific industries, such as construction (Kutting & Drexler, 2010; Romeo, 2004), electricity generation, and asbestos production as the primary venues for carcinogen exposure, particularly in specific occupations such as carpenters, electricians, and workers involved in electricity generation and asbestos production (Hannaford-Turner, Elder, Sim, Abramson, Johnson & Yates, 2010). Kutting & Drexler (2010) proposed that the control and reduction of carcinogens be implemented as the first-line of defense against skin cancer development, with the use of protective gears and preparations (e.g. sunscreen) as the second-line of defense.
Introduction
The likelihood of thousands of unreported cases of work-related disease exists in any country around the world. Data on occupational diseases are hardly available in countries where no active surveillance in the workplace exists. In response to this demand for data, the International Agency for Research on Cancer (IARC) established the International Register of Persons Exposed to Phenoxy Herbicides and Contaminants in 1984, but reached only ten countries as enrollees to the registry (Markowitz & Steven, 2011).
In 2001, however, the need for a national database on occupational diseases prompted Australia to establish its Surveillance of Australian workplace Based Respiratory Events (SABRE) program in New South Wales (NSW) to determine the incidence of occupational lung diseases in NSW Australia (Hannaford-Turner, Elder, Sim, Abramson, Johnson & Yates, 2010). It launched SABRE in Victoria and Tasmania in 1997.
In Finland, known or suspected occupational diseases must be notified to the Finnish Registry of Occupational Diseases (Karjalainen et al, 2000). The United Kingdom also established the Surveillance of Work related and Occupational Respiratory Disease (SWORD) for the same reason (Meyer et al, 2001). Similar voluntary surveillance schemes also had been established in the United States (Baker, 1989), Canada (Provencher, Labreche & De Guire, 1997), South Africa (Hnizdo, Esterhuizen, Rees & Lalloo, 2001) and Spain (Orriols et al, 2006), underscoring the urgency in documenting occupational diseases such as mesothelioma and non-melanoma skin cancer.
Statistics associated with mesothelioma (asbestos) and melanoma (UV rays) exposure
Skin cancer however is often not considered as occupational disease (Diepgen, Fartasch, Drexler & Schmitt, 2012) despite the fact that it is by far the most common kind of cancer diagnosed due to UV radiation available at work under long-term intense exposure. Recognizing the role of the workplace in the development of skin cancer in employees is urgently needed to orient the attention of both the health authorities and the corporate managers towards prevention, or at least them reduction, of employee exposure to carcinogens already abundant in the workplace.
Using the SWORD database in Great Britain, Ruston et al (2012) noted that 8010 (5.3% of the total cancer deaths could be attributed to occupation. These deaths include those cases involving mesothelioma and NMSC. Of the 1937 registered cancer patients with mesothelioma in 2004, 1937 (91.9%) died a year later. Comparatively, NMSC resulted only to the death of 23 patients (4.5%). In either case, men (97.0%, 6.9% respectively) had more mortalities than women (72.5%, 1.1% respectively). The mesothelioma deaths resulted from exposure to asbestos, while the NMSC cases came from exposures to various kinds of carcinogens, such as mineral oils (902 cases, 31.5% of registered patients with the disease), solar radiation (1541, 53.8%), and coal tars and pitches (475, 16.6%). This is consistent to what Boffetta (2004) found out among residents exposed to asbestos.
In Lazio, Italy, a study (Romeo et al, 2004) covering nine years (2001-2009) noted that 54% of malignant mesothelioma (MM) cases came from long-term exposure to asbestos in the workplace. The largest cases came from workers in the construction industry. Once again, more men (72%) died than women (9%) from the occupational disease. This gender disparity must be due to the preponderance of men working in the industry.
The SABRE scheme in Australia also noted mesothelioma diagnoses in 919 (24%) of newly diagnosed occupational lung disease cases in NSW from June 2001 to December 2008 (Hannaford-Turner, Elder, Sim, Abramson, Johnson & Yates, 2010). It ranked second most frequently reported condition for the period with an estimated 83 cases per million employed male per year. Consistent with the Lazio study, it was most common among workers in the construction industry, such as carpenters and electricians. The study also noted involvement of workers in electricity generation and asbestos product manufacturing.
Kutting & Drexler (2010) noted epidemiological studies reporting significantly more NMSC in men than in women due to occupational exposure. They noted further that lifestyle choices and difference in immunosuppression played a major role in this gender disparity. This indicates that strong immune defense may help protect workers from the dangers posed by carcinogens in the workplace. The same study also noted a strong association of higher risk from squamous cell carcinoma (SCC) and actinic keratosis (AK) with chronic UV exposure, exposing the tendency of men not to use sunscreen at workplace and their very low compliance with the use of protective gears against UV light.
Only 2 % to 12% of people with heavy exposure to asbestos develop pleural cancer. The risk of developing mesothelioma is 10 times higher in people above the age of 60 compared to people younger than 40. Men have 4.5 times higher chances of developing cancer than women. More than 70% of cases develop pleural cancer followed by 30% of cases that develop abdomen (peritoneum) cancer. The median survival rate of an individual diagnosed with Stage I mesothelioma is 21 months. On the other hand, the survival rate in stage IV cases is low (Approx. 12 Months). However, the average survival rate of patients diagnosed with mesothelioma cancer is around 4 months to 12 months. (Romeo et al, 2004)
Jobs that expose workers to cancers such as mesothelioma and melanoma.
Workers in shipbuilding, manufacturing of asbestos textiles, asbestos mining and milling, insulation work in the construction and building trades, drywall removers, demolition, and asbestos removal have high chances of acquiring mesothelioma.
On the other hand, melanoma exposure is associated with workers in polyvinyl chloride manufacturing, painting, mining, and construction industries. There is a high risk of exposure in woodworkers, pesticide workers, miners and painters. Workers in the dye, chemical, and rubber industries are exposed to potential carcinogens like asbestos and ultraviolet radiation.
Workplace environment and its association with cancer
There is no doubt on the role of the workplace in the development of mesothelioma and NMSC among workers. The dangerous levels of carcinogens in the work environments of certain industries such as construction, electricity generation and asbestos production place workers in direct risks against skin cancers as well as other forms of cancers.
Employers and health authorities faced a demand to recognize these dangers and the health hazards these carcinogens bring to the employees, and do something about it.
Employers must find ways to regulate the exposure of workers to carcinogens by instituting effective self-protection programs and by demanding full compliance from the workers. Regulators can monitor compliance by employers to such a self-protection scheme.
Diepgen, Fartasch, Drexler & Schitt (2012) suggested three measures known to be successful in the prevention of NMSC (e.g. cutaneous squamous cell carcinoma, basal cell carcinoma) in outdoor workers. The first demanded changes in workers’ behavior towards exposure to UV radiation based on an awareness of its health impact. The second required that protection from direct UV radiation, such as wearing of suitable clothing, be strictly adhered to. The third involved the regular and correct use of appropriate sunscreens.
Similar measures however can be instituted for workers also exposed to indoor carcinogens particularly in asbestos manufacturing and electricity generation plants.
The workers also have a personal role in taking measures to protect themselves through healthy lifestyle geared at avoiding a situation wherein they will be immunologically compromised, making themselves very susceptible to the harmful effects of the skin carcinogens abounding in the workplace.
Conclusions
The paper demonstrated the health effects of workplace environment and its association with cancer with supportive studies. These studies agreed on the initiating role of the workplace in the development of skin cancers, both malignant mesothelioma (MM) and non-melanoma skin cancers (NMSC), due to chronic exposure to carcinogens such as asbestos (Rushton, 2012; Boffetta, 2004; Romeo, 2004; ), mineral oils (Rushton, 2012), solar radiation (Rushton, 2012; Hannaford-Turner, Elder, Sim, Abramson, Johnson & Yates, 2010; Kutting & Drexler, 2010), and coal tars and pitches (Rushton et al, 2012). These studies also identified specific industries, such as construction (Kutting & Drexler, 2010; Romeo, 2004), electricity generation, and asbestos production as the primary venues for carcinogen exposure, particularly in specific occupations such as carpenters, electricians, and workers involved in electricity generation and asbestos production (Hannaford-Turner, Elder, Sim, Abramson, Johnson & Yates, 2010).
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