Basal and squamous cell carcinoma risks for golfers: An assessment of the influence of tee time for latitudes in the Northern and Southern hemispheres

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Abstract

This study investigates the influence of tee time to determine the relative basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) risk for weekly single round competition golfers located in the Northern and Southern latitude ranges between 25°, 35°, 45° and 55°. A comparative risk methodology, employing annual erythemally effective ultraviolet (UVE) exposure calculations was used to determine BCC and SCC risk factors for golfers using a regular weekly tee time. Relative risk was found to be proportional to golf tee time with mid morning tee times generally presenting the greatest risk in each latitude range. The greatest contribution toward the risk of developing basal and squamous cell carcinoma was found to occur for golfers beginning weekly rounds mid to late morning, with specific risk factors of 1.47 (BCC) and 1.98 (SCC) in the Northern hemisphere compared with similar maximum risk factors of 1.51 (BCC) and 2.08 (SCC) in the Southern hemisphere occurring at comparable morning tee times. Differences in annual UVE exposure between the golfer and non-golfer were the largest determinant of BCC and SCC risk. Generally, these risks were found to decrease with lower latitude although contribution toward overall risk was influenced strongly by the global time zone of each studied golf course site.

Highlights

► The influence of golf tee time on BCC and SCC risk was calculated. ► Risk was determined for Northern and Southern hemisphere latitudes at 25°, 35°, 45° and 55°. ► Mid morning tee times were found to present the highest risk. ► The highest risk factors for Northern hemisphere golfers were determined to be 1.47 (BCC) and 1.98 (SCC). ► The highest risk factors for Southern hemisphere golfers were determined to be 1.51 (BCC) and 2.08 (SCC).

Introduction

Although a significant number of ultraviolet (UV) radiation studies have been conducted to investigate the exposure influence of various physical parameters, there currently remains limited information available to characterize the impact of personal behavior on exposure and subsequent skin cancer risk [1], [2], [3], [4], [5]. Many studies have detailed personal UV exposures for a range of situations [6], [7], [8]. However for the golfing population group, being placed by necessity in the sun for extended periods of time, there remains limited information on exposure and the related skin cancer risk [9], [10]. To characterize UV exposure risk for a range of expected conditions, UV irradiance models have been used to provide a reasonable first approximation which can be applied to describe the likely exposures for a range of outdoor activities [11], [12], [13], including golf, provided the exposure of the individual is expressed relative to the ambient exposure. In doing this, the factors that influence the UV exposure episodes at any latitude must first be summarized and presented relative to existing numerical techniques that have been used to determine relative skin cancer risk.

Considering a cloud free sky, in which the UV irradiance follows a normal distribution with the time of day, exposures received before and after solar noon will be lower than exposures received during the peak noon period, followed by irradiance reductions caused by absorption by stratospheric ozone, air and atmospheric particulates, the local altitude and slight variations in the earth sun distance caused by the earth’s elliptical solar orbit [14], [15], [16], [17]. The timing and total duration of any playing round has the most significant influence on the total UV exposure received. Whereas, the UV irradiance (W m−2) changes rapidly with the movement of the sun, peaking at solar noon, the total UV exposure (J m−2) is dependent upon the variation of the irradiance in the playing interval and the length of the playing interval itself. The rate at which the peak UV irradiance is reached and the height of the daily UV irradiance curve varies also with latitude and season [18], [19]. These variations will affect skin cancer distributions for golfers as is the case with other population groups which show an increase in incidence with decreasing latitude [20], [21], [22]. Discriminate atmospheric absorption of UVB (280–320 nm) and UVA (320–400 nm) wavelengths for different solar elevations has further implications for erythemally effective UV, which for humans is positively associated with shorter wavelength UVB than UVA radiation [23]. This has been investigated previously with variation in latitude [24], although not specifically for golfers. Variations between stratospheric ozone concentrations in Northern and Southern latitudes further influence erythemal exposure differences between the Southern and Northern hemisphere [25]. The implications for golfers are that erythemally effective ultraviolet (UVE) exposures vary considerably with latitude and at different rates in the Northern and Southern hemispheres due to the strong dependence of the erythemal response to short wavelength UVB radiation and stratospheric ozone concentrations.

Erythemally effective UV has previously been correlated with relative keratinocyte carcinoma risk, where the risk of developing keratinocyte carcinoma has been shown to be dependent upon the annual UVE exposure and the age of the individual [26]. By making relative comparisons, the dependence on the age of the individual can be removed [27], [28]. This technique was recently applied to calculate relative basal and squamous cell carcinoma risk for golfers in southern Queensland compared to office workers [10]. For this research, variations in the annual UVE exposure and the associated relative skin cancer risk is calculated for single round weekly golfers playing in different latitudes in both the Southern and Northern hemispheres. As such, this research is the first global simulation study developed to investigate the influence of personal behavior in a range of different ambient climates for a potentially high risk population group.

Section snippets

Estimates of annual UVE exposure

The duration of any round of golf is an important consideration that needs to be taken into account in determining the annual UVE exposure. This has been accounted for in past research to determine annual exposures [28], [29], [30], [31], [32]. The methodology of Vishvakarman and Wong [28] is modified for this research that assumes an annual UVE exposure is accrued by the summation of exposures received during normal working days in which the individual spends 1.5 h traveling to, from and at

Daily clear sky plots and variation with season and latitude

Fig. 3 shows the modeled daily erythemally effective ambient UV for each 25°, 35°, 45° and 55° approximate latitude for each golf course site in both the Northern and Southern hemispheres. The model is for cloud free cases only.

The choice of date for the beginning of 3 weeks annual leave during which an individual will be exposed to the ambient UVE plotted in Fig. 3 is dependent on the location and habits of individual workers. For this study it was assumed that Southern hemisphere workers took 3

Risk comparisons

Immediately obvious in comparison between Fig. 4, Fig. 5 is the lower relative risk for the development of BCC. This is a direct result of the BAF exponent applied to Eq. (4) of 1.4 for BCC compared to 2.5 for SCC. This factor represents the lower likelihood of the development of BCC with increasing annual UVE exposure in comparison to SCC. The greatest BCC relative risk for the Northern hemisphere golfer was determined for a beginning tee time of 11:00 am at 1.47 (Bordeaux) compared to the

Conclusions

Both BCC and SCC risks for a golfer expressed relative to an individual living in the same location have been presented for eight different golf course sites located in the Northern and Southern hemispheres at approximate latitudes of 55°, 45°, 35°, and 25°. As relative risk estimates, the data presented here does not represent the overall risk for the development of the disease with respect to latitude as the development of skin cancer is very much dependent upon skin and phenotype, the

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