Screening the US Workforce for Skin Cancer: The National Health Interview Survey 1997 to 2003

Caban-Martinez AJ1, Lee DJ1,3, Fleming LE1, LeBlanc WG1,

Chung-Bridges K1,2, Arheart K1, Christ L4,5, & Pitman T1 Departments of Epidemiology & Public Health1 & Family Medicine2, Sylveter Comprehensive Cancer Center3, University of Miami Miller School of Medicine; Odum Institute for Research in Social Science4 and Dept of Sociology5, University of North Carolina at Chapel Hill

Study Website www.rsmas.miami.edu/groups/niehs/nioshThis study was funded in part through a grant from the National Institute of Occupational Safety and Health (NIOSH R01 OH03915)

BACKGROUNDResearch has demonstrated that even among US workers with access to medical care, most healthcare providers do not evaluate occupational exposures and their potential impact on the health of US workers. Substantial evidence has shown a link between ultraviolet (UV) light exposure and various forms of skin cancer. This study explored the prevalence of reported skin examination among US workers with access to medical care, particularly among occupations with high occupational UV exposure.

METHODSThe 2000 National Health Interview Survey Cancer Control Module was used to determine the reported prevalence of receiving a skin examination among current US workers who had visited a healthcare provider in the past 12 months. Approximately 135,000 adults, age 18 years and older, were interviewed from 1997-2003. Survey response rates ranged from 70-80%. Participants were asked: “Have you EVER had all of your skin from head to toe checked for cancer either by a dermatologist or some other kind of doctor?” The possible responses were: ‘‘Yes,’’ ‘‘No,’’ ‘‘Refused,’’ and ‘‘Don’t know.’’ Participants were also asked: ‘‘During the past 12 months, have you had a skin exam by dermatologist or some other kind of doctor?” Due to complex sample survey design, analyses were completed with the SUDAAN package to take into account sample weights and design effects.

CONCLUSIONRegular skin examination by a healthcare provider, particularly among highly UV exposed workers, can be preventative and curative for skin cancer. Furthermore, 18% of workers reported no contact with the health care system in the previous 12 months. This example of lack of preventive care among US workers has substantial implications for their occupational health and for the ultimate cost of their medical care for US society.

RESULTS Study population represented an

estimated 128,480,200 US workers. Average 13% (range 4%-31%) reported receiving a skin examination ever, and 6% in the past year (range 0%-17%) .

In 41 occupations, the groups with typically elevated occupational exposure to UV light were less likely to have received a skin examination than the average US worker, including:

Farm operators & managers (11%) Farm workers & other agricultural

workers (6%) Forestry & fishing occupations

(5%) Construction & extractive trades

(7%) Construction laborers (4%)

These groups also tended to have lower insurance rates relative to the overall workforce.