Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes—A Narrative Review
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
- consequences of sun exposure;
- skin cancer prevalence;
- association of outdoor sports with skin cancer incidence;
- available methods of photoprotection with particular emphasis on methods aimed at athletes;
- athletes’ sun-protection knowledge and behavior.
- no English-language version of the publication;
- full text not available;
- full text not available in English;
- publication not addressing the issues described in the inclusion criteria.
3. Results
3.1. Prevalence of Skin Cancer and UV-Induced Skin Lesions in Outdoor Athletes
3.2. Photoprotection in Athletes
3.3. Photoprotection Methods
3.4. Athletes’ Awareness and Application of Possible Photoprotection Methods
3.5. Photoprotection and Skin Cancer Awareness Campaigns Targeting Athletes
4. Conclusions
5. Perspectives
Author Contributions
Funding
Conflicts of Interest
References
- Lahmann, P.H.; Russell, A.; Green, A.C. Prospective Study of Physical Activity and Risk of Squamous Cell Carcinoma of the Skin. BMC Cancer 2011, 11, 516. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Snyder, A.; Valdebran, M.; Terrero, D.; Amber, K.T.; Kelly, K.M. Solar Ultraviolet Exposure in Individuals Who Perform Outdoor Sport Activities. Sport. Med.-Open 2020, 6, 42. [Google Scholar] [CrossRef]
- Moehrle, M.; Koehle, W.; Dietz, K.; Lischka, G. Reduction of Minimal Erythema Dose by Sweating. Photodermatol. Photoimmunol. Photomed. 2000, 16, 260–262. [Google Scholar] [CrossRef]
- De Castro-Maqueda, G.; Gutierrez-Manzanedo, J.V.; Lagares-Franco, C.; de Troya-Martin, M. Sun Exposure during Water Sports: Do Elite Athletes Adequately Protect Their Skin against Skin Cancer? Int. J. Environ. Res. Public Health 2021, 18, 800. [Google Scholar] [CrossRef] [PubMed]
- Moehrle, M. Outdoor Sports and Skin Cancer. Clin. Dermatol. 2008, 26, 12–15. [Google Scholar] [CrossRef] [PubMed]
- Gilaberte, Y.; Trullàs, C.; Granger, C.; de Troya-Martín, M. Photoprotection in Outdoor Sports: A Review of the Literature and Recommendations to Reduce Risk Among Athletes. Dermatol. Ther. 2022, 12, 329–343. [Google Scholar] [CrossRef]
- Wu, S.; Cho, E.; Li, W.Q.; Weinstock, M.A.; Han, J.; Qureshi, A.A. History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies. Am. J. Epidemiol. 2016, 183, 824–833. [Google Scholar] [CrossRef] [Green Version]
- Kaskel, P.; Lange, U.; Sander, S.; Huber, M.A.; Utikal, J.; Leiter, U.; Krähn, G.; Meurer, M.; Kron, M. Ultraviolet Exposure and Risk of Melanoma and Basal Cell Carcinoma in Ulm and Dresden, Germany. J. Eur. Acad. Dermatol. Venereol. 2015, 29, 134–142. [Google Scholar] [CrossRef]
- Morton, S.K.; Harrison, S.L. Slip, Slop, Slap, Slide, Seek and Sport: A Systematic Scoping Review of Sun Protection in Sport in Australasia. Curr. Oncol. 2022, 30, 401–415. [Google Scholar] [CrossRef]
- Wolf, S.T.; Kenney, L.E.; Kenney, W.L. Ultraviolet Radiation Exposure, Risk, and Protection in Military and Outdoor Athletes. Curr. Sports Med. Rep. 2020, 19, 137. [Google Scholar] [CrossRef]
- Leiter, U.; Eigentler, T.; Garbe, C. Epidemiology of skin cancer. Adv. Exp. Med. Biol. 2014, 810, 120–140. [Google Scholar] [CrossRef]
- Price, J.; Ness, A.; Leary, S.; Kennedy, C. Sun-Safety Behaviors of Skiers and Snowboarders on the South Island of New Zealand. J. Cosmet. Dermatol. 2006, 5, 39–47. [Google Scholar] [CrossRef] [PubMed]
- Smith, L.L. Overtraining, Excessive Exercise, and Altered Immunity: Is This a T Helper-1 versus T Helper-2 Lymphocyte Response? Sports Med. 2003, 33, 347–364. [Google Scholar] [CrossRef] [PubMed]
- Ambros-Rudolph, C.M.; Hofmann-Wellenhof, R.; Richtig, E.; Müller-Fürstner, M.; Soyer, H.P.; Kerl, H. Malignant Melanoma in Marathon Runners. Arch. Dermatol. 2006, 142, 1471–1474. [Google Scholar] [CrossRef] [Green Version]
- Rosso, S.; Zanetti, R.; Martinez, C.; Tormo, M.J.; Schraub, S.; Sancho-Garnier, H.; Franceschi, S.; Gafà, L.; Perea, E.; Navarro, C.; et al. The Multicentre South European Study “Helios”. II: Different Sun Exposure Patterns in the Aetiology of Basal Cell and Squamous Cell Carcinomas of the Skin. Br. J. Cancer 1996, 73, 1447. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dozier, S.; Wagner, R.F.; Black, S.A.; Terracina, J. Beachfront Screening for Skin Cancer in Texas Gulf Coast Surfers. South. Med. J. 1997, 90, 55–58. [Google Scholar] [CrossRef] [PubMed]
- Climstein, M.; Doyle, B.; Stapelberg, M.; Rosic, N.; Hertess, I.; Furness, J.; Simas, V.; Walsh, J. Point Prevalence of Non-Melanoma and Melanoma Skin Cancers in Australian Surfers and Swimmers in Southeast Queensland and Northern New South Wales. PeerJ 2022, 10, e13243. [Google Scholar] [CrossRef]
- Climstein, M.; Furness, J.; Hing, W.; Walsh, J. Lifetime Prevalence of Non-Melanoma and Melanoma Skin Cancer in Australian Recreational and Competitive Surfers. Photodermatol. Photoimmunol. Photomed. 2016, 32, 207–213. [Google Scholar] [CrossRef] [Green Version]
- Loria, D.; Matos, E. Risk Factors for Cutaneous Melanoma: A Case–Control Study in Argentina. Int. J. Dermatol. 2001, 40, 108–114. [Google Scholar] [CrossRef]
- Lawler, S.; Spathonis, K.; Eakin, E.; Gallois, C.; Leslie, E.; Owen, N. Sun Exposure and Sun Protection Behaviours among Young Adult Sport Competitors. Aust. N. Z. J. Public Health 2007, 31, 230–234. [Google Scholar] [CrossRef]
- Lichte, V.; Dennenmoser, B.; Dietz, K.; Häfner, H.M.; Schlagenhauff, B.; Garbe, C.; Fischer, J.; Moehrle, M. Professional Risk for Skin Cancer Development in Male Mountain Guides--a Cross-Sectional Study. J. Eur. Acad. Dermatol. Venereol. 2010, 24, 797–804. [Google Scholar] [CrossRef]
- Noble-Jerks, J.; Weatherby, R.P.; Meir, R. Self-Reported Skin Cancer Protection Strategies and Location of Skin Cancer in Retired Cricketers: A Case Study from Membership of the Emu Cricket Club. J. Sci. Med. Sport 2006, 9, 441–445. [Google Scholar] [CrossRef]
- Savoye, I.; Olsen, C.M.; Whiteman, D.C.; Bijon, A.; Wald, L.; Dartois, L.; Clavel-Chapelon, F.; Boutron-Ruault, M.C.; Kvaskoff, M. Patterns of Ultraviolet Radiation Exposure and Skin Cancer Risk: The E3N-SunExp Study. J. Epidemiol. 2018, 28, 27. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gabros, S.; Nessel, T.A.; Zito, P.M. Sunscreens and Photoprotection; StatPearls Publishing: Tampa, FL, USA, 2023. [Google Scholar]
- Taylor, C.R.; Stern, R.S.; Leyden, J.J.; Gilchrest, B.A. Photoaging/Photodamage and Photoprotection. J. Am. Acad. Dermatol. 1990, 22, 1–15. [Google Scholar] [CrossRef]
- Moehrle, M. Ultraviolet Exposure in the Ironman Triathlon. Med. Sci. Sports Exerc. 2001, 33, 1385–1386. [Google Scholar] [CrossRef] [PubMed]
- Moehrle, M.; Heinrich, L.; Schmid, A.; Garbe, C. Extreme UV Exposure of Professional Cyclists. Dermatology 2000, 201, 44–45. [Google Scholar] [CrossRef] [PubMed]
- Rigel, D.S.; Rigel, E.G.; Rigel, A.C. Effects of Altitude and Latitude on Ambient UVB Radiation. J. Am. Acad. Dermatol. 1999, 40, 114–116. [Google Scholar] [CrossRef]
- Adams, B.B. Dermatologic Disorders of the Athlete. Sports Med. 2002, 32, 309–321. [Google Scholar] [CrossRef]
- Pinheiro, M.C.; Reis-Mansur, P.; Gonçalves Da Luz, B.; Pereira, E.; Santos, D. Consumer Behavior, Skin Phototype, Sunscreens, and Tools for Photoprotection: A Review. Cosmetics 2023, 10, 39. [Google Scholar] [CrossRef]
- Kullavanijaya, P.; Lim, H.W. Photoprotection. J. Am. Acad. Dermatol. 2005, 52, 937–958. [Google Scholar] [CrossRef]
- Rai, R.; Shanmuga, S.; Srinivas, C.R. Update on Photoprotection. Indian J. Dermatol. 2012, 57, 335–342. [Google Scholar] [CrossRef] [PubMed]
- Pinnell, S.R.; Yang, H.; Omar, M.; Riviere, N.M.; DeBuys, H.V.; Walker, L.C.; Wang, Y.; Levine, M. Topical L-Ascorbic Acid: Percutaneous Absorption Studies. Dermatol. Surg. 2001, 27, 137–142. [Google Scholar] [CrossRef] [PubMed]
- Tsai, J.; Chien, A.L. Photoprotection for Skin of Color. Am. J. Clin. Dermatol. 2022, 23, 195–205. [Google Scholar] [CrossRef] [PubMed]
- Jinna, S.; Adams, B.B. Ultraviolet Radiation and the Athlete: Risk, Sun Safety, and Barriers to Implementation of Protective Strategies. Sports Med. 2013, 43, 531–537. [Google Scholar] [CrossRef]
- Georgouras, K.E.; Stanford, D.G.; Pailthorpe, M.T. Sun Protective Clothing in Australia and the Australian/New Zealand Standard: An Overview. Australas J. Dermatol. 1997, 38 (Suppl. S1), S79–S82. [Google Scholar] [CrossRef]
- Gambichler, T.; Altmeyer, P.; Hoffmann, K. Role of Clothes in Sun Protection. Recent Results Cancer Res. 2002, 160, 15–25. [Google Scholar] [CrossRef]
- Sk, M.S.; Akram, W.; Mia, R.; Fang, J.; Kabir, S.M.M. Fabrication of UV-Protective Polyester Fabric with Polysorbate 20 Incorporating Fluorescent Color. Polymers 2022, 14, 4366. [Google Scholar] [CrossRef]
- Lim, H.W. Chapter 223. Photoprotection. In Fitzpatrick’s Dermatology in General Medicine, 8e; Goldsmith, L.A., Katz, S.I., Gilchrest, B.A., Paller, A.S., Leffell, D.J., Wolff, K., Eds.; The McGraw-Hill Companies: New York, NY, USA, 2012. [Google Scholar]
- Gambichler, T.; Rotterdam, S.; Altmeyer, P.; Hoffmann, K. Protection against Ultraviolet Radiation by Commercial Summer Clothing: Need for Standardised Testing and Labelling. BMC Dermatol. 2001, 1, 6. [Google Scholar] [CrossRef] [Green Version]
- Gontijo, G.T.; Pugliesi, M.C.C.; Araújo, F.M. Photoprotection. Surg. Cosmet. Dermatol. 2009, 1, 186–191. [Google Scholar]
- Puccetti, G.; Fares, H. A New Approach for Evaluating the Water Resistance of Sunscreens on Consumers: Tap Water vs. Salt Water vs. Chlorine Water. Int. J. Cosmet. Sci. 2014, 36, 284–290. [Google Scholar] [CrossRef]
- Hexsel, C.L.; Bangert, S.D.; Hebert, A.A.; Lim, H.W. Current Sunscreen Issues: 2007 Food and Drug Administration Sunscreen Labelling Recommendations and Combination Sunscreen/Insect Repellent Products. J. Am. Acad. Dermatol. 2008, 59, 316–323. [Google Scholar] [CrossRef]
- Hamant, E.S.; Adams, B.B. Sunscreen Use among Collegiate Athletes. J. Am. Acad. Dermatol. 2005, 53, 237–241. [Google Scholar] [CrossRef]
- de Castro Maqueda, G.; Gutiérrez-Manzanedo, J.V.; González-Montesinos, J.L.; Vaz Pardal, C.; Rivas Ruiz, F.; de Troya Martín, M. Sun Exposure and Photoprotection: Habits, Knowledge and Attitudes Among Elite Kitesurfers. J. Cancer Educ. 2022, 37, 517–523. [Google Scholar] [CrossRef]
- De Castro-Maqueda, G.; Gutierrez-Manzanedo, J.V.; Lagares-Franco, C.; Linares-Barrios, M.; De Troya-Martin, M. Photoprotection Practices, Knowledge and Sun-Related Skin Damage in Spanish Beach Handball Players. PeerJ 2019, 7, e7030. [Google Scholar] [CrossRef]
- Navarrete-De Gálvez, M.; Ruiz Sánchez, J.M.; Navarrete-De Gálvez, E.; Aguilera, J.; Rivas-Ruiz, F.; de Troya-Martín, M.; Herrera-Ceballos, E.; de Gálvez, M.V. Sun Exposure and Protection Habits in Transplant Athletes: An International Survey. Photodermatol. Photoimmunol. Photomed. 2022, 38, 365–372. [Google Scholar] [CrossRef]
- Tenforde, A.S.; Fredericson, M.; Toth, K.E.S.; Sainani, K.L. Sun Protective Behaviors and Attitudes of Runners. Sport 2021, 10, 1. [Google Scholar] [CrossRef]
- Gutiérrez-Manzanedo, J.V.; Vaz Pardal, C.; Blázquez-Sánchez, N.; De Gálvez, M.V.; Aguilera-Arjona, J.; González-Montesinos, J.L.; Rivas Ruiz, F.; De Troya-Martín, M. Ultraviolet Exposure of Competitors during a Tokyo Olympic Sailing Regatta Test Event. Photodermatol. Photoimmunol. Photomed. 2022. [Google Scholar] [CrossRef]
- Wysong, A.; Gladstone, H.; Kim, D.; Lingala, B.; Copeland, J.; Tang, J.Y. Sunscreen Use in NCAA Collegiate Athletes: Identifying Targets for Intervention and Barriers to Use. Prev. Med. 2012, 55, 493–496. [Google Scholar] [CrossRef]
- Buljan, M.; Kolić, M.; Šitum, M.; Šekerija, M.; Franceschi, N. Do Athletes Practicing Outdoors Know and Care About the Importance of Photoprotection? Acta Dermatovenerol. Croat. 2020, 28, 41–42. [Google Scholar]
- Fernández-Morano, T.; de Troya-Martín, M.; Rivas-Ruiz, F.; Fernández-Peñas, P.; Padilla-España, L.; Sánchez-Blázquez, N.; Buendía-Eisman, A. Sun Exposure Habits and Sun Protection Practices of Skaters. J. Cancer Educ. 2017, 32, 734–739. [Google Scholar] [CrossRef]
- Weikert, A.E.; Pagoto, S.L.; Handley, E.; Courtney, J.B.; Brunke-Reese, D.; Conroy, D.E. Golfers’ Interest in Multilevel Sun-Protection Strategies. Int. J. Environ. Res. Public Health 2021, 18, 7253. [Google Scholar] [CrossRef]
- Duarte, A.F.; Nagore, E.; Silva, J.N.M.; Picoto, A.; Pereira, A.C.; Correia, O.J.C. Sun Protection Behaviour and Skin Cancer Literacy among Outdoor Runners. Eur. J. Dermatol. 2018, 28, 803–808. [Google Scholar]
- García-Malinis, A.J.; Gracia-Cazaña, T.; Zazo, M.; Aguilera, J.; Rivas-Ruiz, F.; de Troya Martín, M.; Gilaberte, Y. Sun Protection Behaviors and Knowledge in Mountain Marathon Runners and Risk Factors for Sunburn. Actas Dermosifiliogr. 2021, 112, 159–166. [Google Scholar] [CrossRef] [PubMed]
- Doncel Molinero, D.; Ruiz Paulano, M.; Rivas Ruiz, F.; Blázquez Sánchez, N.; de Gálvez Aranda, M.V.; de Castro Maqueda, G.; de Troya Martín, M. Sun Protection Behaviour and Sunburns in Spanish Cyclists. J. Cancer Educ. 2022, 37, 957–964. [Google Scholar] [CrossRef] [PubMed]
- Cohen, P.H.; Tsai, H.; Puffer, J.C. Sun-Protective Behavior among High-School and Collegiate Athletes in Los Angeles, CA. Clin. J. Sport Med. 2006, 16, 253–260. [Google Scholar] [CrossRef]
- Gutiérrez-Manzanedo, J.V.; De Castro-Maqueda, G.; Caraballo Vidal, I.; González-Montesinos, J.L.; Vaz Pardal, C.; Rivas Ruiz, F.; De Troya-Martín, M. Sun-Related Behaviors, Attitudes and Knowledge among Paralympic Sailors. Disabil. Health J. 2021, 14, 101095. [Google Scholar] [CrossRef]
- Christoph, S.; Cazzaniga, S.; Hunger, R.E.; Naldi, L.; Borradori, L.; Oberholzer, P.A. Ultraviolet Radiation Protection and Skin Cancer Awareness in Recreational Athletes: A Survey among Participants in a Running Event. Swiss Med. Wkly. 2016, 146, w14297. [Google Scholar] [CrossRef] [Green Version]
- Walkosz, B.; Voeks, J.; Andersen, P.; Scott, M.; Buller, D.; Cutter, G.; Dignan, M. Randomized Trial on Sun Safety Education at Ski and Snowboard Schools in Western North America. Pediatr. Dermatol. 2007, 24, 222–229. [Google Scholar] [CrossRef]
- Walkosz, B.J.; Buller, D.B.; Andersen, P.A.; Scott, M.D.; Dignan, M.B.; Cutter, G.R.; Maloy, J.A. Increasing Sun Protection in Winter Outdoor Recreation: A Theory-Based Health Communication Program. Am. J. Prev. Med. 2008, 34, 502. [Google Scholar] [CrossRef] [Green Version]
- Ally, M.S.; Swetter, S.M.; Hirotsu, K.E.; Gordon, J.; Kim, D.; Wysong, A.; Donnelly, L.; Li, S.; Nord, K.M. Promoting Sunscreen Use and Sun-Protective Practices in NCAA Athletes: Impact of SUNSPORT Educational Intervention for Student-Athletes, Athletic Trainers, and Coaches. J. Am. Acad. Dermatol. 2018, 78, 289–292.e2. [Google Scholar] [CrossRef]
References and Year of Publication | Study Design | Number of Group | Mean Age of Participants | Geographical Location | Type of Cancer, UV-Induced Skin Lesions, Sunburns | Disciplines at Risk |
---|---|---|---|---|---|---|
Rosso et al. [15], 1996 | The study recruited cases of BCC and SCC from population-based cancer registries and hospitals in seven southern European regions. A control group was also recruited from the same regions. Sun exposure was assessed using a structured questionnaire that collected information on the duration, season, hours of exposure, and clothing during outdoor activities. | 1549 BCC cases, 228 SCC cases, 1795 controls | ND | Southern Europe (Turin, Italy; Trento, Italy; Ragusa, Italy; Villejuif, France; Creteil, France; Besan, France; Murcia, Spain; Granada, Spain) | BCC | Swimming, sailing, surfing |
Climstein et al. [17], 2022 | Participants in this cross-sectional study were recruited through notices sent to local general practitioners, surf and swim clubs, and the local media. During the study, a questionnaire and full-body screening for skin cancer were conducted. | 94 men, 77 women | 43.9 | Southeast Queensland and Northern New South Wales, Australia | BCC | Swimming, surfing |
SCC | ||||||
Melanoma | ||||||
Climstein et al. [18], 2016 | This cross-sectional observational study used a customizable, commercially available survey directed at Australian surfers to estimate the lifetime incidence of skin cancer. | 1231 men, 117 women | 35.84 | Australia | BCC | Surfing |
Dozier et al. [16], 1997 | The researchers performed a cross-sectional study involving surfers from the Texas Gulf Coast who were interviewed and screened for skin cancer by dermatologists during surfing competitions. | 44 men, 5 women | 29.7 | Galveston, Texas, USA | BCC | Surfing |
Kaskel et al. [8], 2015 | Participants diagnosed with cutaneous melanoma or sporadic basal cell carcinoma within the previous six months to five years were included in the study. Control subjects without any cancer were also included. The study involved interviews, examinations, and standardized questionnaires to compare UV exposure behavior and assess sun sensitivity. | Melanoma patients: 142 men, 149 women; BCC patients: 102 men, 110 women; Controls: 165 men, 164 women | Melanoma patients: Median age at primary diagnosis—55 BCC patients: Median age at primary diagnosis—69 Controls: 57 | Ulm, Germany; Dresden, Germany | BCC | Mountaineering |
Loria et al. [19], 2001 | The study included 101 cases of verified melanoma and 246 controls. Participants were interviewed about demographic and constitutional factors and solar exposure history. | Melanoma cases: 55 men and 46 women Controls: 246 | ND | Buenos Aires, Argentina | Melanoma | Football, rugby, tennis, swimming, cycling, hiking |
Ambros-Rudolph et al. [14], 2006 | The study participants were recruited during the Graz marathon, while the control subjects were recruited during a skin cancer screening campaign in Graz and Styria. The study specifically included white residents of Styria. The participants were interviewed about risk factors for malignant melanoma and their training habits. Additionally, a full-body skin examination was conducted by an experienced dermatologist for all participants undergoing skin cancer screening. | Marathon runners: 166 men, 44 women; Controls: 210 | Marathon runners: 37 Controls: ND | Styria, Austria; Graz, Austria | Melanoma, non-melanoma skin cancer, melanocytic nevi actinic lentigines/solar lentigo | Marathon runners |
Lichte et al. [21], 2010 | The study included 283 male mountain guides and 309 control subjects. They were interviewed about personal and occupational data, UV exposure, photosensitivity, sunburn, sun protection measures, and history of previous skin cancer. They were examined for UV-related skin damage and skin cancer; suspicious lesions were biopsied. | 592 men | 41 | Germany, Switzerland, Austria | Melanoma, solar keratoses/actinic keratosis, Sunburn | Mountain guides |
Noble-Jerks et al. [22], 2006 | The study was based on a self-report questionnaire aimed at retired cricketers. Questions included personal information, playing, employment and medical history, the impact of injuries, training, current physical activity, use of sun protection, and history of skin cancer. | 164 men | 45.2 | Australia | Skin cancer (unspecified) | Cricket |
Price et al. [12], 2003 | Skiers and snowboarders were interviewed via a questionnaire about personal information, sun protection behavior, skin type, skin cancer history, and awareness of educational messages. | 139 men, 87 women | no data | Queenstown, New Zealand | Sunburn | Skiing, Snowboarding |
Lawler et al. [20], 2007 | Field hockey players, soccer players, tennis players, and surfers were asked to complete a self-administered questionnaire concerning demographic information and sun protection habits during sports. The study compared sun protection behaviors by discipline and sex. | 97 men, 140 women | 23.2 | Australia | Sunburn | Surfing, tennis, field hockey, soccer |
References | Year of Publication | No. of Group | Discipline | Mean Time of Exposure | Sunburns | Awareness/Attitude | Application/Methods of Photoprotection |
---|---|---|---|---|---|---|---|
De Castro-Maqueda et al. [45] | 2022 | 72 | kitesurfing | 10.93 years; 13.93 h per week | 84.7% at least 1 sunburn; 43.1% 3 sunburns | 79.2% worried about skin cancer | 79.2% SPF > 15 sunscreen cream; 37.5% SPF > 50 sunscreen cream; only 4.2% reapplied the cream every hour; 40.3% reapplied it after 3 h; 62.5% wear sunglasses; 20.8% wear a long-sleeved shirt and long trousers 50% wear a cap or hat 6.9% avoid the sun (12:00–14:00) |
De Castro-Maqueda et al. [46] | 2019 | 121 | beach handball | 57.5% less than 2 h of sun exposure (Monday to Friday); 31.5% during the weekend | 76.9% at least 1 sunburn | 94.5% of university students (US) and 64.6% of younger students (YS) believe that sunscreen cream prevents aging of the skin; 97.3% of the US and 85.4% of the YS believe that the sun is the leading cause of skin cancer |
68.5% of university students and 66.7% of younger athletes used sunscreen cream (SPF ≥ 30); 52.1% of students and 35.4% of younger players did not reapply it |
Navarrete-De Gálvez et al. [47] | 2021 | 170 | athletes who underwent organ transplantation | 61.3% of athletes had been playing sports for >15 years; 79.5% spent >1–2 h a day outdoors | 28.9% | 72.8% considered sunbathing harmful to their health; 78.3% do not like sunbathing; 87% believe that it is worthwhile to use sunscreen cream; 24.2% were not worried about sunburn | 68.9% sunscreen cream; 67.3% sunglasses; 48.8% hat; 15.7% long-sleeved shirt and long trousers; 42.2% avoid midday sun (12:00–16:00); 58.2% shadow/umbrella |
Tenforde et al. [48] | 2021 | 697 | runners | ran 37.4 ± 17.7 miles per week | ND | 39.2% fear skin cancer; 15.8% fear skin aging; 49% forget to use sunscreen; 17% feel uncomfortable with sunscreen; | 45% sunglasses; 43% avoid midday sun exposure (10:00–14:00); 42% sunscreen on face; 40% wear a hat; 10% run in shade; 7% wear long sleeves |
De Castro-Maqueda et al. [4] | 2021 | 240 | water sports | sailors—4 h 51 min per day; surfers—4 h 35 min per day; windsurfers—3 h 53 min per day | 76.7% 1 sunburn; 27.5% 3+ sunburns | ND | ND |
Gutiérrez-Manzanedo et al. [49] | 2022 | 13 | sailors | mean daily personal UV exposure received was 761.0 ± 263.6 J/m2, 3.0 ± 1.1 minimal erythemal dose and 7.6 ± 2.6 standard erythemal dose (in 3 competition days) | 46.2% 1 sunburn; 23.1% 2 sunburns (in 3 competition days) | ND | 94.2% wear T-shirts; 50.2% shade; 44% wear a hat/cap; 26.1% sunglasses; 11.8% sunscreen |
Wysong et al. [50] | 2012 | 290 | collegiate athletes |
4 h per day; 10 months per year of training outdoors. | 84% 1 sunburn; 28% 4+ sunburns |
96% agreed that sunscreen helps prevent skin cancer; 63% forget to use sunscreen |
more than 50% never used sunscreen; 75% used sunscreen 3 or fewer days/week |
Buljan et al. [51] | 2020 | 95 | triathlon athletes |
30% of participants spent 4 to 6 h per week outdoors; 21% spent more than 10 h outdoors per week | 26% reported previously having severe sunburns with blisters | more than 90% of participants stated it was essential to use sunscreen; however, almost 50% rarely used sunscreen while training, 27% frequently used sunscreen, while only 3% always used sunscreen. | 20% of participants never used sunscreen |
Fernández-Moranoet al. [52] | 2017 | 102 | skaters |
91.6% practiced outdoor sports more than 90 days per year; 6.1% spent this long at the beach; 52.1% practiced outdoor sports for 5 or more hours a day; 43.3% who spent comparable periods at the beach | 56,8% at least one sunburn | 58% of participants learned to protect themselves from the sun; 57% claimed to start protecting themselves | 20% sunglasses; 33% wear a hat/cap; 65.9% long-sleeves; 18.7% sunscreen SPF > 15; 23.3% avoid peak sun |
Weikert et al. [53] | 2021 | 347 | golfers | more than 7.5 h per week | 70% at least one sunburn | 61% believed that golf increased their risk for skin cancer a little or much; 39% of golfers did not believe that golfing increased their risk for skin cancer, including 14% who believed golfing lowers their risk for skin cancer |
59% sunscreen; 65% long-sleeves; 68% wear a hat/cap; 33% shade/umbrella |
Duarte et al. [54] | 2018 | 2445 | runners | 51% spent 4+ hours training outdoors per week | 10% < 45 y.o.; 6% > 45 y.o. | 90% know that melanoma is a malignant lesion; 37% know that basal cell carcinoma is malignant | 30% sunglasses; 17% wear a hat/cap; 12% sunscreen cream; 4% long-sleeves |
García-Malinis et al. [55] | 2020 | 657 | runners | ND | 45.1% | ND |
74.7% sunglasses; 61.9% sunscreen (SPF ≥ 15) 52.2% wear a hat/cap; 7.4% other protective clothing |
Molinero et al. [56] | 2020 | 1018 | cyclists | 67.3% more than 90 days per year while cycling; 59.3% trained for more than 3 h per training session | 45.6% | 61.0% did not examine their skin regularly | 95.5% wear a hat/cap; 92.8% sunglasses; 39.2%sunscreen cream |
Cohen et al. [57] | 2006 | 1006 | collegiate athletes | 16.1 h per week | 20% sunburn with blisters | 95.1% agreed that sun exposure could cause skin cancer; 91.1% of athletes agreed that sun exposure could cause premature aging of the skin; 30.5% of athletes agreed that a white cotton T-shirt adequately protects the skin underneath from sunburn | 37.7% sunscreen cream; 34.7% wear a hat/cap; 27.9% long-sleeved shirts; 38.8% long-sleeved trousers |
Gutiérrez-Manzanedo et al. [58] | 2021 | 56 | paralympic sailors | 8 h per week | 76.8% |
82.1% worried about skin cancer from the sun; excessive sun tanning attitudes (42.9% liked sunbathing, and 57.1% said sunbathing makes them feel well) |
85.7% sunglasses; 83.9% sunscreen cream; 33.9% do not reapply it, and 16.1% reapply it every 1 or 2 h; 75% wear a hat/cap; 28.6% avoid the midday sun |
Christoph et al. [59] | 2016 | 970 | runners | ND | 34.4% experienced severe sunburn before adulthood | ND | ND |
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Kliniec, K.; Tota, M.; Zalesińska, A.; Łyko, M.; Jankowska-Konsur, A. Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes—A Narrative Review. Cancers 2023, 15, 3281. https://doi.org/10.3390/cancers15133281
Kliniec K, Tota M, Zalesińska A, Łyko M, Jankowska-Konsur A. Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes—A Narrative Review. Cancers. 2023; 15(13):3281. https://doi.org/10.3390/cancers15133281
Chicago/Turabian StyleKliniec, Katarzyna, Maciej Tota, Aleksandra Zalesińska, Magdalena Łyko, and Alina Jankowska-Konsur. 2023. "Skin Cancer Risk, Sun-Protection Knowledge and Behavior in Athletes—A Narrative Review" Cancers 15, no. 13: 3281. https://doi.org/10.3390/cancers15133281