Exerc Med > Volume 2; 2018 > Article |
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Author | Year | Descriptive Analysis | |
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Holman CDJ et al [7] | 1983 | • | Ultraviolet radiation (UVR) dosimetry field study carried out in Western Australia in Autumn |
• | Proportion of ambient UVR exposure at several anatomical sites investigated in five occupations and nine outdoor recreational activities | ||
• | Both environmental and behavioural factors were of importance in determining overall levels of exposure and distribution by site | ||
• | Golf associated with relatively more UVR exposure than fishing, tennis, pool swimming, cricket and gardening. | ||
Hanke CW et al [14] | 1985 | • | Study examining point-prevalence of skin cancer and potential risk factors in group of self-selected female golfers in USA |
• | 51 professional golfers and 142 amateur golfers evaluated | ||
• | Average age of 28.4 years (professionals) versus 54.5 years (amateurs) | ||
• | Based on number of years played and hours of golf per day, professionals exposed to 5x more sunlight than amateurs | ||
• | No statistically significant difference in proportion of professional and amateur golfers with actinic keratosis (7/51 versus 20/142) or basal cell carcinoma (BCC) (4/51 versus 11/142). | ||
• | Average age at diagnosis of BCC considerably less in professionals (25.5 years) versus amateurs (51.4 years) | ||
• | Likelihood of developing skin cancer related to eye and hair colour | ||
Herlihy E et al [8] | 1994 | • | UVR dosimetry field study carried out in Hobart, Tasmania in summer 1991 |
• | UVR exposure measured using UV dosimeters attached to seven anatomical sites, in 94 subjects engaged in 6 different outdoor activities | ||
• | Concurrent behavioural and environmental observations made using diaries and monitoring station recorded ambient UVR levels | ||
• | Tennis, sailing, and golf were the three activities that had the highest proportions of ambient UVR | ||
• | Time of day engaged in golf affected level of exposure – highest between 11am and 3pm | ||
Thieden E et al [9] | 2005 | • | UVR dosimetry study set in Denmark |
• | Subjects carried UVR dosimeter in wristwatch which measured continuously time-related UVR doses (in Standard Erythema Doses (SEDs)*) | ||
• | Subjects also completed sun exposure behaviour diaries | ||
• | Estimated yearly UVR doses calculated based on personal and ambient measurement | ||
• | Subjects were 285 Danish volunteers with apparently healthy skin, including 24 adult amateur golfers from single golf club. | ||
• | Daily erythemally effective UVR exposure ranged from 0.7 SED to 3.7 SED in golfers | ||
• | Golfers had the highest median percentage of the ambient UVR in the whole study population, which included “sun worshippers” and gardeners. | ||
Sung H et al [10] | 2006 | • | UVR dosimetry field study carried out in Midwestern USA in August and October |
• | Measurement of cumulative UVR exposure (measured as proportion of ambient UVR exposure) to specific body sites in seven subjects during play (average 4.5 hours). | ||
• | Effects of clothing in reducing UVR exposure examined. | ||
• | Shoulders, back, back of neck and posterior arms were exposed to more UVR than the front of the body. | ||
• | Study showed the importance of clothing in reducing UVR transmission to skin. | ||
• | Common golf attire of limited value in protecting the back of neck. | ||
Dixon HG et al [15] | 2008 | • | Cross-sectional observational field survey of teenagers and adults at leisure during summer weekends between 11am and 3pm in Melbourne, Australia from 1992-2002 |
• | Apparent decline in clothes cover among recreational golfers from 1992-2002. | ||
Downs NJ et al [11] | 2009 | • | UVR dosimetry field study set in Queensland, Australia |
• | UVR exposure measured using dosimeters placed on forearm, upper back and vertex of 2 golfers playing in the same region, but under different atmospheric conditions, during a 7-month period extending from summer to winter. | ||
• | Subjects always played between 1500 and 1730 for 2-2.5 hours | ||
• | Both erythemal and vitamin D effective UVR exposure measured | ||
• | Non-melanoma skin cancer risk calculated using estimated cumulative annual UV exposure based on dosimeter readings (numerous assumptions made) | ||
• | Calculated relative risk of non-melanoma skin significantly greater in persons playing a weekly round of golf compared with office workers that do not play. | ||
• | At this latitude, golfers appear to be able to receive sufficient vitamin D effective exposures during play in winter. | ||
• | Greatest level of exposure recorded at vertex, then upper back (neck) | ||
Perry A et al [16] | 2010 | • | Study examining sun protection practices of golf event spectators, set in USA |
• | 407 subjects recruited to this questionnaire study (mostly middle-aged, white women) | ||
• | At baseline, self reported sun protection practices generally poor | ||
• | Demonstration of pre-existing ‘photodamage’ using a UV reflectance unit (non-validated tool) appeared to slightly increase subject’s level of intent to wear a hat and sunscreen in the future, but did not effect their perceived risk of skin cancer. | ||
Downs NJ et al [12] | 2011 | • | Study used global climatology and statistical modelling to estimate the relative risk of non-melanoma skin cancer for weekly, single round competition golfers playing at different latitudes. |
• | Relative risk of NMSC was found to be proportional to golf tee time, with mid morning tee times generally presenting the greatest risk in each latitude range. | ||
• | Golfers playing at lower latitudes have higher UVR exposure, thus an increased NMSC risk | ||
• | Study is limited by a number of assumptions including sky conditions, course geography, individual player clothing/behaviour and skin cancer risk factors aside form UVR exposure | ||
Ysasi GG et al [13] | 2014 | • | UVR dosimetry field study carried out in Spain during winter (January) |
• | Seven male players carried dosimeters on their caps and wrists during play across eight days (cloudless days only selected) | ||
• | Play between hours of 10:00 and 15:00 (average 4.5 hours) | ||
• | UVR exposure higher at head position compared with wrist | ||
• | Mean daily UVR exposure was 2.07 SED in head position and 1.62 in wrist position | ||
• | At this latitude, golfers with skin types I & II ** can be exposed to potentially harmful levels of UVR during play in winter | ||
Del Boz J et al [17] | 2015 | • | Study examining feasibility and effectiveness of a targeted skin cancer prevention and early detection campaign in golfers and golf-course workers. |
• | Study carried out across 6 golf clubs in Southern Spain in summer | ||
• | 195 recreational golfers and 89 outdoor golf-course workers had interview and skin examination | ||
• | Following examination and education, participants asked re intention to change behaviour | ||
• | A third of golfers reported at least one golf-related sunburn episode in the previous year | ||
• | On physical examination, lesions clinically suspicious for skin cancer (not histologically confirmed) identified in 10.3% of golfers and 3.4% of outdoor golf-course workers. Lesions identified clinically as actinic keratosis in 40% of golfers and 10.1% of outdoor golf-course workers. | ||
• | Prevalence in age-matched controls in the same region was not reported | ||
• | The campaign rated positively by 99.4% of the participants; 93.9% stated that they intended to improve their sun exposure habits and 93.4% said that they planned to examine their skin more frequently |
1 SED is equivalent to an erythemal effective radiant exposure of 100 Jm-2. The International Commission on Non-Ionising Radiation Protection has proposed UVR exposure limits depending on skin phototype.
I – very sensitive, always burn, never tan, melano-comprimised
II – moderately sensitive, high risk of sunburn, achieve light tan, melano-compromised
III – moderately insensitive, moderate risk of sunburn, achieve medium tan, melano-competent
IV – insensitive, low risk of sunburn, achieve dark tan, melano-competent
V – insensitive, very low risk of sunburn, natural brown skin, melano-protected
VI – insensitive, extremely low risk of sunburn, natural black skin, melano-protected
Considerations for golfers | • Avoid sunburn (especially children, adolescents and those with other risk factors for skin cancer) [1,22]. |
• Individuals should recognise their skin type and what levels of UV exposure lead to sunburn [1,12,18]. | |
• Where possible, those with fair skin should play outwith times when the most harmful UVB radiation levels are highest (approx. 11am – 3pm depending on latitude) [7,11]. | |
• Golfers should be prepared for all weather eventualities and conscious of UV exposure in cloudy or shaded conditions [11,12]. | |
• A wide-brimmed hat, clothing and sunglasses provide the most effective protection against UVR and should be used in combination with sunscreen on uncovered sites [9,14]. | |
• Sunscreen should be SPF 30 or above with five star UVA protection rating and applied liberally and regularly (every 2-3 hours) especially if sweating. | |
• The back of neck and ears are particularly susceptible to solar damage and should not be forgotten when selecting clothing and applying sunscreen [9,10,12]. | |
• Golfers should be aware of their increased risk of skin cancer and know how to identify the common forms of the disease, seeking medical attention early. | |
Considerations for golf facilities | • Golf clubs may look after their members and staff by stocking photo-protective products and displaying golf-orientated health promotion material and advice on detecting skin cancer early [16]. |
Considerations for the golfing industry | • To promote the use of active sun protection [16]. |
• To increase public messaging for players and spectators on the potential risks of excessive UVR exposure. | |
• To consider using an influential public figure to aid health promotion through campaigns. |