Soldiers who served in the glaring desert sunlight of Iraq and Afghanistan returned home with an increased risk for skin cancer, due not only to the desert climate but also a lack of sun protection. These findings were published in the Journal of Investigative Dermatology (2015; doi:10.1038/jid.2015.238).

“The past decade of United States combat missions, including operations in Iraq and Afghanistan, have occurred at a more equatorial latitude than the mean center of the United States population, increasing the potential for ultraviolet irradiance and the development of skin cancer,” said first author Jennifer Powers, MD, of Vanderbilt University Medical Center in Nashville, Tennessee.

Several factors contributed to the increased risk, including not only the desert and more equatorial latitudes, but also the length of sunlight exposure day to day, and, among many service members, a lack of training regarding the dangers of sun exposure and limited access to sunscreen.

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For the study, Powers and her colleagues analyzed anonymous survey data from 212 veterans regarding sun exposure and protection during their last deployment.

Only 13% of participants said they routinely used sunscreen, and 87% reported their sunscreen use as sporadic or sometimes. Moreover, only 23% of veterans indicated the military had made them very aware of the risks for skin cancer.

The authors found that 77% of respondents spent 4 or more hours per day working in bright sun and 63% had sunburn at least once during deployment.

The authors also assessed the availability of sun protection gear, including sunscreen, shade structures, hats, and sunglasses, from which they calculated a Sun Protection Availability Score. They found that working more than 6 hours in the sun was associated with lower Sun Protection Availability Scores.

Although military personnel deployed overseas may often have survival priorities other than avoiding sun exposure, Powers notes that the study indicates a potential deficiency for access to sun protection that could translate to long-term health risks.

“Our study has identified factors that put veterans at risk for skin cancer, including melanoma, but we need to better understand the ‘why’ of sun protection in the field,” Powers said. “There is a suggestion that there are times when the lack of availability was associated with lack of use. Understanding how to provide practical and effective sun protection to servicemen and -women in warm climates is the next step.

“This study demonstrates room for improvement for skin cancer prevention and early detection in the military population, including possible screening of higher-risk personnel,” she said.

The authors note that 80% of responses to the survey relied on recall of events that occurred more than 1 year ago. As a majority of the participants were Army veterans, they also suggest that future studies should include national samples representing other military branches.