Skin Cancer and Construction Laborers:

Something New Under the Sun

By Kathleen M. Conlan, MS

Excerpted from The Skin Cancer Foundation Journal, Vol. XXI, 2003. Reprinted with permission.

Mike Cackowski worked 20 years in construction, one of the nation's most dangerous occupations. But it wasn't a fall or a cave-in that ultimately injured him - it was skin cancer, the result of day after day working in the sun.

The Cliffwood, New Jersey man discovered the melanomas before they became a serious health problem. For that he credits the skin cancer awareness program developed by the Laborers' Health and Safety Fund of North America (LHSFNA).

With the sun the primary cause of skin cancer, construction laborers are at high risk of this disease. However, because risk of accidental death and injury on the job is very high and also very immediate, the dangers of skin cancer in this industry were long unappreciated and ignored.

Skin Cancer Risk Factors

Exposure to solar radiation is the single most significant risk factor for the development of skin cancers of all sorts, including deadly melanoma. Data show that outdoor workers are more than twice as likely to suffer from non-melanotic skin cancers as in-door workers.

While women are increasingly entering construction, the vast majority of workers are men. Throughout the U.S. population, men have a 40.9% greater (1.72 vs. 1.22) chance of developing melanoma of the skin than do women. Moreover, as a survey of Americans confirms, younger people, particularly young men, are less likely to use sunscreen than older persons and less likely to use a product with SPF 15 or greater.

A lesser-known potential risk factor is cigarette smoking. Evidence suggests a link between smoking and contracting squamous cell cancer. Smoking also is associated with a poor prognosis for melanoma, especially among males. Unfortunately, the percentage of smokers among blue-collar workers, in general, and Laborers, in particular, is higher than for the general population.

Skin Cancer Breakthrough

In 1994, Dan Rusnak, then business manager of LIUNA Local 169 and a trustee of the Northern Nevada Laborers' Health and Welfare Fund, contacted the LHSFNA about an evident problem. "Through the years, I got to know many members," he says. "The most common health complaints I became aware of were hearing loss and skin cancers. Both of these complaints are common in the older members who have been Laborers for many years."

When Rusnak asked if the Fund was doing anything about skin cancer, the LHSFNA responded by developing a skin cancer awareness program that focuses on the importance of this issue to LIUNA members; its incidence, causes and risk factors; and its detection, prevention and treatment.

New Products, New Interest

Shortly after developing the awareness program, vendors of sun protection products approached the LHSFNA to ask its interest in protective neck flaps and sunscreen in alternative packaging options. Skeptical that Laborers would embrace the "French Foreign Legion" look of the neck flaps or apply lotion of any kind, the Fund, nevertheless, gave both a try. The response was both striking and overwhelming.

The original supply of 50 neck flaps was swallowed up in the first two classes. An order for 100 more flew out the door. Then, the Fund started ordering 3,000-unit batches with the LHSFNA logo imprinted on the back. Today, the Fund distributes 10,000 neck flaps each year, a fraction of the number requested during its spring promotional campaign. Distributed at local union halls and training centers, they are the single most popular item made available by the Fund for the LIUNA membership.

The Fund introduced laborers to sunscreen by distributing small individual packets at Sun Sense classes and through local union halls. The lotion packets were gobbled up. The appeal of packets is that they fit easily in pockets, lunch pails and toolboxes and, therefore, are more readily available for use at work.

Even better received was sunscreen packaged in a wipe-on towellette that also includes insect repellent. Soon, the Fund was deluged with requests for sunscreen for training centers, membership meetings, health fairs, member picnics and even charity tournaments. In 2002, the Fund distributed 25,000 packets of SPF 30 sunscreen, again, only a fraction of what was requested.

Evaluation and Success

The LHSFNA has few direct ways to gauge the overall success of its skin cancer prevention campaign with respect to changing behaviors and preventing skin cancer among construction laborers. Rather, it must rely on a number of indirect measures.

Anecdotal evidence, perhaps, is most telling. According to many Sun Sense instructors, every time a class is taught, someone approaches afterward to talk about an experience with skin cancer or to ask advice about unusual looking spots on his or her body.

Kelly Lapping, director of the Laborers' training center for the Washington, DC area, sat in on a class conducted for members and their families during a health fair. Concerned about what he heard, he approached LHSFNA Occupational Health Nurse, Judy Paul, about some moles. She advised him to see a dermatologist. "The moles were atypical," he says, "When biopsied, they showed evidence of initial change. I consider myself lucky. Now, I get check-ups on a regular basis and encourage my trainees to take advantage of all cancer screening techniques."

"Even after I heard about skin cancer and the sun," recounts Cackowski, the New Jersey Training Fund Director, "I never worried about it because I always tanned easily." Then, one day he noticed that one of the pictures on the LHSFNA-distributed skin cancer bookmark looked a lot like the mole on his chest. "I had it checked out, and, sure enough, it was melanoma. Later, the dermatologist found another one on my back. I'd have never been concerned about that first mole if I hadn't seen the bookmark, and I wouldn't have found the one on my back without the follow-up." Cackowski now includes information about skin cancer in all his general construction classes.

While the products and materials are definitely getting through, the Fund still sees this as an issue that needs ongoing attention and promotion at all levels. Says Clint Taylor, Training Director for the Tony Romolo Training Center (Mt. Sterling, IL), "I never thought a Laborer would pay any attention to sunscreen. Boy, was I ever wrong about that. The older guys really understand because they've heard the stories and seen the evidence. They know it's important to talk about this, especially to the younger guys who think they're invincible. The female apprentices seem to pick up on it quicker than the males."

Now that the issue has been opened for full discussion, the stories of Laborers who have spent their lives working outdoors in construction only to face an anxious retirement, repeated surgery and, sometimes, a sad and painful death due to skin cancer are, unfortunately, commonplace.

By recycling these stories to younger Laborers as warning, supplying neck flaps and sunscreen as incentives and providing information and guidance to modify behavior, the LHSFNA is changing the way LIUNA members think about their futures and the way they act in the face of the sun.

For information about skin cancer, please contact:
The Skin Cancer Foundation, 245 Fifth Avenue, New York, NY 10016
1-800-KSIN490; info@skincancer.org
The Skin Cancer Foundation.