Harsh reminder of sun’s impact on health

HARMFUL RAYS Reminding ranchers how and why they should protect themselves

by Managing Editor Stevie Ipsen

Known for their trademark jeans, long sleeved shirts and cowboy hats, it may come as a surprise to some that cattlemen and women are still some of the most at-risk individuals facing the real possibility of skin cancer.

While it isn’t a first-in-line topic that many ranchers consider among their long list of worries, perhaps it should be something more of them are aware of.

According to a 2019 report from the Centers for Disease Control and Prevention (CDC), nearly 5 million people are treated for skin cancer each year in the United States. Agricultural and construction workers (ACWs) may be at increased risk for skin cancer because of high levels of ultraviolet radiation exposure from the sun. This is the first study that uses nationally representative data to assess sunprotection behaviors among ACWs.

Most of the 2,298 agricultural and construction workers studied were male (by industry, 72.4 percent in agriculture and 89.3 percent in construction; by occupation, 66.1 percent in agriculture and 95.6 percent in construction) and non-Hispanic white. About one-third had at least one sunburn in the past year. The prevalence of sunscreen use and shade seeking was low and did not significantly differ among groups, ranging from 15.1 percent to 21.4 percent for sunscreen use and 24.5 percent to 29.1 percent for shade seeking. The prevalence of wearing protective clothing was significantly higher among agricultural workers than among construction workers by industry (70.9 percent versus 50.7 percent) and occupation (70.5 percent versus 53.0 percent).

The aged-old term “farmer’s tan” may no longer be as appealing as it once was and ranchers, both male and female should refrain from shedding layers as the sun’s rays get hot during the day. It is important to keep from exposing any skin to the sun.

A WAKE UP CALL FOR US ALL

There is a popular misnomer that the more pale your skin is, the more deadline the sun’s rays. But as one California family knows all too well, that is not always the case. On July 7, Tulare County friends and family said goodbye to a cowboy they all loved. David Caetano, just 36 years old, passed away on July 1 after a battle with melanoma. Family friend Sally Dudley Baker said what is 48 California Cattleman September2020 speculated to have possibly started as a simple spot on his neck, ultimately took his life.

“Being of Portuguese descent, David was stunning with dark skin, hair and eyes,” Baker said. “For those of us who work daily out in the sun, we need a reminder of the ravages of melanoma. If we can make people aware, maybe David didn’t die in vain.”

Though David’s story is a sad one to tell, perhaps the harsh reality of his situation will inspire other cattlemen and women of all ages to take a proactive approach to their health.

For David, the battle was a whirlwind. His initial symptoms in January 2020 led him to believe he may have strained his back. Despite several weeks of weight loss and at the encouragement from loved ones to see a doctor, David’s initial hospital visit – via ambulance – happened after he passed out at work in late February. From there he was transferred to UC San Francisco to have a stage IV tumor removed from his cerebellum. With follow up treatment, David’s friends and family were hopeful he would beat the deadly disease. But only six months from his initial symptoms, David succumbed to terminal melanoma.

While many mistakingly consider melanoma to be a simple skin cancer that can just be burned or cut off of the surface of the skin, melanoma currently kills just over two people per hour in the United States.

Some other interesting facts that may have spurred David’s decision to seek treatment or implement preventative measures are that: • 1 in 5 Americans will develop skin cancer by age 70. • Half of all adults aged 18-29 report at least one sunburn in the past 12 months. Sustaining five or more sunburns in youth increases lifetime melanoma risk by 80 percent. • When detected early, melanoma has a 99 percent survival rate. • Men age 49 and under have a higher probability of developing melanoma than any other cancer. • From ages 15 to 39, men are 55 percent more likely to die of melanoma than women in the same age group. • Women age 49 and under are more likely to develop melanoma than any other cancer except breast and thyroid cancers.

David’s girlfriend Samantha Hilvers said David’s situation is unique because unlike symptoms one might expect from skin cancer, David’s cancer used a sneak attack on his body.

But stubborn, as many ranchers are, Hilvers said David persisted through the pain, thinking it was only a result of the physically demanding work he did routinely. Following his

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diagnosis, he couldn’t stand to see the herd gathered and not be on horseback with his friends and family working alongside them.

“Back and rib pain, accompanied by decreased appetite were the only real warning signs we had before the tumor in his brain started to bleed which finally lead to him going into the hospital in the end of February,” Hilvers explains. “He worked every single day up until he got admitted and after surgery, and while receiving immunotherapy treatment he was still trying to help out around the ranches with running water and checking fencelines from the cab of his truck.”

It comes as no surprise that the biggest struggle for David throughout his whole cancer journey was having to rely on other people for help.

“He had such a huge and giving heart,” Hilvers says. “He worked hard and treated everyone with respect. He treated their livestock and land with pride, just like he treated his own. You would be hard pressed to find someone that knew him that had anything bad to say.”

Hilvers said David had his own way of pushing everyone he met to be better, and it is her hope that by sharing his story that he can continue to push people to be better.

“Take care of your body and listen to the warning signs it might be giving you. Don’t just push through and think ‘oh this is normal. I need to suck it up and deal with it.’ Be and do better than what you have done in the past. Treat everyone with respect. Take each challenge the day throws at you as they come. And don’t stress over every little thing, that was a big one he worked on teaching me the two years we were dating,” she said.

David’s brother Brian echoed Hilvers’ words and added that sharing David’s story may help others avoid a similar fate.

“Sharing David’s story is now up to us. That is what he would want. Helping others avoid the same tragedy is the least we can do to honor his memory,” said Brian Caetano.

NOT JUST MELANOMA

There are three primary types of skin cancer and each varies in seriousness.

The most common type of skin cancer is basal cell carcinoma (BCC), with an estimated 2.8 million people diagnosed each year. About eight out of 10 skin cancers are basal cell carcinomas (also called basal cell cancers).

These cancers start in the basal cell layer, which is the lower part of the epidermis.

These cancers usually develop on sun-exposed areas, especially the face, head and neck. They tend to grow slowly. It’s very rare for a basal cell cancer to spread to other parts of the body. But if it’s left untreated, basal cell cancer can grow into nearby areas and invade the bone or other tissues beneath the skin.

If not removed completely, basal cell carcinoma can come back (recur) in the same place on the skin. People who have had basal cell skin cancers are also more likely to get new ones in other places.

BCCs often look like open sores, red patches, pink growths, shiny bumps or scars, and are usually caused by a combination of cumulative and intense, occasional sun exposure.

About two out of 10 skin cancers are squamous cell carcinoma (also called squamous cell cancers). These cancers start in the flat cells in the upper (outer) part of the epidermis.

These cancers commonly appear on sun-exposed areas 50 California Cattleman September2020 of the body such as the face, ears, neck, lips and backs of the hands. They can also develop in scars or chronic skin sores elsewhere. They sometimes start in actinic keratoses (described below).

Squamous cell cancers can usually be removed completely (or treated in other ways), although they are more likely than basal David Caetano works at a cattle branding in cell cancers to January 2020, prior to being diagnosed with grow into deeper stage IV melanoma. layers of skin and spread to other parts of the body.

Sometimes this starts out as actinic keratoses, which is a scaly or crusty growth.

Although the vast majority of actinic keratoses remain benign, some studies report that up to 10 percent may advance to squamous cell carcinoma,” according to the American Skin Cancer Foundation.

SCC is the second most common type of skin cancer, and roughly 700,000 are diagnosed with it each year. It is estimated that 2 percent of patients with SCC die from the disease.

Melanoma, as previously mentioned, is the most deadly type of skin cancer, and although it accounts for only 2 percent of cases, it has the highest death rate.

DETECTION

Detecting skin cancer early makes a huge difference in the ability to treat it. Ranchers should perform self-exams on a regular basis. Any bumps, moles or off-looking spots should be checked out by a doctor. Here are some conditions to look out for, especially if you have regular exposure to the sun.

Actinic keratosis (AK), also known as solar keratosis, is a pre-cancerous skin condition caused by too much exposure to the sun. AKs are usually small (less than 1/4-inch across), rough or scaly spots that may be pink-red or flesh-colored. Usually they start on the face, ears, backs of the hands, and arms of middle-aged or older people with fair skin, although they can occur on other sun-exposed areas. People who have them usually develop more than one.

These tend to grow slowly and usually do not cause any symptoms (although some might be itchy or sore). They sometimes go away on their own, but they may come back.

A small percentage of AKs may turn into squamous cell skin cancers. Most AKs do not become cancer, but it can be hard sometimes to tell them apart from true skin cancers, so doctors often recommend treating them. If they are not treated, you and your doctor should check them regularly for changes that might be signs of skin cancer.

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“If you see something that looks like skin cancer, make an appointment to see a dermatologist. The earlier skin cancer is caught and treated, the more likely it can be cured,” according to the American Academy of Dermatology.

Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. “In situ” means that the cells of these cancers are still only in the epidermis (the upper layer of the skin) and have not invaded into deeper layers.

Bowen disease appears as reddish patches. Compared with AKs, Bowen disease patches tend to be larger, redder, scalier and sometimes crusted. Like AK, Bowen disease usually doesn’t cause symptoms, although it might be itchy or sore.

Like most other skin cancers (and AKs), these patches most often appear in sun-exposed areas. Bowen disease can also occur in the skin of the anal and genital areas (where it is known as erythroplasia of Queyrat or Bowenoid papulosis). This is often related to sexually transmitted infection with human papillomaviruses (HPVs), the viruses that can also cause genital warts.

Bowen disease can sometimes progress to an invasive squamous cell skin cancer, so doctors usually recommend treating it. People who have these are also at higher risk for other skin cancers, so close follow-up with a doctor is important.

Keratoacanthomas are dome-shaped tumors that are found on sun-exposed skin. They may start out growing quickly, but their growth usually slows down. Many keratoacanthomas shrink or even go away on their own over ime without any treatment. But some continue to grow, and a few may even spread to other parts of the body. They can be hard to tell apart from squamous cell skin cancer, and their growth is often hard to predict, so many skin cancer experts recommend treating them (typically with surgery).

Preventcancer.org highlights the ABCDEs of melanoma to help people identify possible risks: •“A” stands for asymmetrical. Does the mole or spot have an irregular shape with two parts that look very different? •“B” stands for border. Is the border irregular or jagged? •“C” is for color. Is the color uneven? •“D” is for diameter. Is the mole or spot larger than the size of a pea? •“E” is for evolving. Has the mole or spot changed during the past few weeks or months?

Talk to your doctor if you notice any of these changes in your skin or a new growth, a sore that doesn’t heal, a change in an old growth.

PREVENTION

Protection is the No. 1 key to preventing skin cancer, and there are several ways that cattlemen, women and anyone who spends significant time outdoors can protect themselves from the sun’s damaging rays.

Protection from ultraviolet (UV) radiation is important all year round, not just during the summer or at the beach, like some may assume. UV rays from the sun can reach you on cloudy and hazy days, as well as bright and sunny days. UV rays also reflect off of surfaces like water, cement, sand and snow. While it may seem obvious to an average rancher it is good to remind that indoor tanning (using a tanning bed, booth or sunlamp to get tan) exposes users to UV radiation.

The hours between 10 a.m. and 4 p.m. Daylight Saving Time (9 a.m. to 3 p.m. standard time) are the most hazardous 52 California Cattleman September2020 for UV exposure outdoors in the continental United States. UV rays from sunlight are the greatest during the late spring and early summer in North America.

CDC recommends easy options for protection from UV radiation: • Stay in the shade, especially during midday hours. While this may be impossible for those who make a living outdoors, proper precautions can still be taken. • Wear clothing that covers your arms and legs. • Ranchers are known for their attire, so it should go without saying but wear long sleeves if possible. Long sleeves will protecting your skin from the sun even after sunscreen wears off. Lightweight shirts can help ranchers stay cool as well. • Wear a hat with a wide brim to shade your face, head, ears and neck. Baseball caps are not sufficient, a cowboy hat is much more effective. A hat should protect the top of the head, the ears, much of the face and the neck, which are all areas that see the most sun. And keep in mind that straw cowboy hats with holes in the top can be deceiving and can lead to sunburn on the head, especially on ranchers who may no longer have a full head of hair. This is where sunscreen may still be important. • Wear sunglasses that wrap around and block both UVA and UVB rays. • Use sunscreen and lip balm with a sun protection factor (SPF) of 30 or higher, and both UVA and UVB (broad spectrum) protection. • Examine your skin once a month. Tell your health care professional about any skin changes.

The first line of defense is to make a habit of daily sunscreen use. Sunscreen is marked with SPF, which stands for sun protection factor. There are three classifications: high (30- plus), moderate (12-29) and minimal (2-11).

According to the American Melanoma Foundation, the SPF displayed on the sunscreen label ranges from 2 to as high as 50 and refers to the product’s ability to screen or block out the sun’s harmful rays. For example, if you use a sunscreen with an SPF 15, you can be in the sun 15 times longer than you can without sunscreen before burning.

“Consumers need to be aware that SPF protection does not increase proportionally with an increased SPF number. While an SPF of 2 will absorb 50 percent of ultraviolet radiation, an SPF of 15 absorbs 93 percent and an SPF of 34 absorbs 97 percent,” the foundation explains.

If working outside, ranchers should consider using a water-resistant or waterproof sunscreen. Water-resistant sunscreen should be reapplied every 40 minutes, and waterproof sunscreen every 80, according to the FDA.

“Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by 40 percent and the risk of developing melanoma by 50 percent,” according to the Skin Cancer Foundation. “People who use sunscreen daily show 24 percent less skin aging than those who do not use sunscreen daily.”

As someone who makes a living off mother nature, staying indoors in the heat of the day is not always an option. But it is important to arm yourself with this vital information and take proactive steps to protecting yourself. While it’s true that there are individuals who are more prone to the sun’s damaging effects, it has been proven that no matter your age, gender, skin color or background, skin cancer can impact you. So for the sake of yourself and your loved ones, follow these guidelines and stay educated on this and other issues impacting your heath.