Skin cancer burden among migrant and seasonal farmworkers in the United States: prevalence and risk factors

Migrant and seasonal farmworkers (MSFW) are essential workers greatly contributing to the American agricultural infrastructure but are frequently overlooked within the healthcare system. There are rampant health inequities impacting migrant farmworkers in the United States, particularly chronic diseases, environmental occupational exposures including enhanced sun exposure, and musculoskeletal issues secondary to occupationally-sustained injuries. While the precise demographic composition of MSFW has geographic variance in the U.S., there is a disproportionately higher number of MSFW who are Hispanic, further adding to the inequities experienced by this population. Given the high degree of time spent outdoors and health inequities already faced by migrant farmworkers, this review sought to better understand the burden of skin cancer on this population. A review of Pubmed was conducted with a combination of the following keywords: migrant farmworker, seasonal farmworker, skin cancer, melanoma, squamous cell, carcinoma, and basal cell carcinoma. There were 122 records identified from the literature review. Upon preliminary review, 110 were excluded based on exclusion criteria. The remaining 12 that were included were reviewed for matching inclusion criteria: (1) published in English and (2) discussed skin cancer burden and risk factors for skin cancer among migrant and seasonal farmworkers in the United States. In total, 7 manuscripts met inclusion criteria. Approximately 43% of included papers (n = 7) primarily surveyed migrant farmworkers and found participants were exposed to direct sunlight upwards of 8 hours daily with limited engagement with sun protection measures such as sunscreen and hat use. One study found that one-third of farmworkers surveyed have never had a skin examination completed. Data on skin cancer prevalence and screening methodologies in this population is sparse. Due to a known relationship between agricultural workers and sun exposure and risk factors for skin cancer, the risk for skin cancer is likely elevated in this population. This population is also subject to inequities when accessing health services for prevention and treatment efforts. In conjunction with decreased knowledge regarding risk factors for skin cancer and preventative methods, it is likely that migrant and seasonal farmworkers are at a heightened risk of not only developing skin cancers but less likely at having such malignancies detected early in the disease course. Significantly more data is needed to understand precisely how skin cancer impacts migrant farmworker populations to guide public health interventions aimed to enhance health literacy, sun protection habits, and increased access to dermatologists and dermatologic care.