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Table 1.  
Skin Cancer and Sun Protection Practices Among a Nonprobabilistic Sample of Florida Firefighters
Skin Cancer and Sun Protection Practices Among a Nonprobabilistic Sample of Florida Firefighters
Table 2.  
Multivariable and Univariate Binary Logistic Regression Models Predicting Skin Cancera and Sun Protection Practices in Florida Firefighters
Multivariable and Univariate Binary Logistic Regression Models Predicting Skin Cancera and Sun Protection Practices in Florida Firefighters
1.
Daniels  RD, Kubale  TL, Yiin  JH,  et al.  Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009).  Occup Environ Med. 2014;71(6):388-397.PubMedGoogle ScholarCrossref
2.
Fent  KW, Eisenberg  J, Snawder  J,  et al.  Systemic exposure to PAHs and benzene in firefighters suppressing controlled structure fires.  Ann Occup Hyg. 2014;58(7):830-845.PubMedGoogle Scholar
3.
Stern  RS.  Prevalence of a history of skin cancer in 2007: results of an incidence-based model.  Arch Dermatol. 2010;146(3):279-282.PubMedGoogle ScholarCrossref
4.
Surveillance Research Program NCI SEER Stat Fact Sheets. Melanoma of the Skin. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. http://seer.cancer.gov/statfacts/html/melan.html. Accessed 10 April 2017.
5.
Fernandez  CA, McClure  LA, LeBlanc  WG,  et al.  A comparison of Florida skin cancer screening rates with those in the rest of the United States.  Arch Dermatol. 2012;148(3):393-395.PubMedGoogle ScholarCrossref
6.
Wehner  MR, Chren  MM, Nameth  D,  et al.  International prevalence of indoor tanning: a systematic review and meta-analysis.  JAMA Dermatol. 2014;150(4):390-400.PubMedGoogle ScholarCrossref
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Research Letter
February 2018

Firefighter Skin Cancer and Sun Protection PracticesEvidence From the Florida Firefighter Cancer Initiative

Author Affiliations
  • 1Division of Environment and Public Health in the Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida
  • 2Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida
  • 3Division of Epidemiology & Population Health Sciences in the Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida
  • 4Department of Dermatology & Cutaneous Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida
  • 5Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida
  • 6Division of Biostatistics in the Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida
JAMA Dermatol. 2018;154(2):219-221. doi:10.1001/jamadermatol.2017.4254

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.1 Firefighter exposure studies2 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.

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).

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%).3 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).4 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.5 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.6 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.

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Article Information

Corresponding Author: Alberto J. Caban-Martinez, DO, PhD, MPH, Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miller School of Medicine, 1120 NW 14th St, Room No. 1025, Miami, FL 33136 (acaban@med.miami.edu).

Accepted for Publication: August 24, 2017.

Published Online: December 13, 2017. doi:10.1001/jamadermatol.2017.4254

Author Contributions: Drs Caban-Martinez and Koru-Sengul had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: Moore, Caban-Martinez, Lee, Koru-Sengul.

Drafting of the manuscript: Moore, Caban-Martinez, Lee, Koru-Sengul.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Moore, Caban-Martinez, Koru-Sengul.

Obtained funding: Lee, Koru-Sengul, Kobetz.

Administrative, technical, or material support: Caban-Martinez, Schaefer-Solle, Koru-Sengul, Kobetz.

Study supervision: Caban-Martinez, Kirsner, Lee, Koru-Sengul, Kobetz.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by State of Florida Appropriation No. 2382A.

Role of the Funder/Sponsor: The funder/sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Daniels  RD, Kubale  TL, Yiin  JH,  et al.  Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009).  Occup Environ Med. 2014;71(6):388-397.PubMedGoogle ScholarCrossref
2.
Fent  KW, Eisenberg  J, Snawder  J,  et al.  Systemic exposure to PAHs and benzene in firefighters suppressing controlled structure fires.  Ann Occup Hyg. 2014;58(7):830-845.PubMedGoogle Scholar
3.
Stern  RS.  Prevalence of a history of skin cancer in 2007: results of an incidence-based model.  Arch Dermatol. 2010;146(3):279-282.PubMedGoogle ScholarCrossref
4.
Surveillance Research Program NCI SEER Stat Fact Sheets. Melanoma of the Skin. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. http://seer.cancer.gov/statfacts/html/melan.html. Accessed 10 April 2017.
5.
Fernandez  CA, McClure  LA, LeBlanc  WG,  et al.  A comparison of Florida skin cancer screening rates with those in the rest of the United States.  Arch Dermatol. 2012;148(3):393-395.PubMedGoogle ScholarCrossref
6.
Wehner  MR, Chren  MM, Nameth  D,  et al.  International prevalence of indoor tanning: a systematic review and meta-analysis.  JAMA Dermatol. 2014;150(4):390-400.PubMedGoogle ScholarCrossref
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