The maritime industry, a cornerstone of global trade, heavily depends on the physical and mental well-being of its seafarers. However, a significant yet often overlooked threat to their health is cancer, which is exacerbated by tobacco use, including social smoking, e-cigarettes, and smokeless forms. This article examines the prevalence of cancer among sea staff, the role of tobacco consumption, advances in cancer screening, and preventive strategies rooted in evidence-based practices.
Cancer Prevalence Among Seafarers
Cancer comprises a group of diseases characterized by the uncontrolled proliferation of abnormal cells. Among seafarers, the likelihood of developing cancer is influenced by occupational exposures, lifestyle choices, and the logistical challenges of healthcare access during extended voyages.
Epidemiological studies highlight lung, oral, and oesophageal cancers as the most prevalent types among sea staff, directly associated with tobacco use. Additionally, exposure to occupational carcinogens such as asbestos, benzene, and ultraviolet radiation further heightens their vulnerability. Reports from the International Labour Organization (ILO) and International Maritime Organization (IMO) underscore the urgent need for targeted interventions in this high-risk group.
The Role of Tobacco Use and E-Cigarettes
Tobacco use remains a primary modifiable risk factor for cancer among seafarers. Social smoking, prevalent due to the camaraderie of shared breaks and the isolation of maritime life, contributes significantly to cancer risk. Even occasional smoking exposes individuals to over 70 carcinogens found in tobacco, damaging DNA and impairing immune responses.
The rise of e-cigarettes, often marketed as a safer alternative, has introduced new complexities. While e-cigarettes eliminate some harmful chemicals present in traditional tobacco, they are not risk-free. Studies suggest that the aerosols produced by e-cigarettes contain toxic substances that may contribute to lung and cardiovascular diseases. Furthermore, the use of e-cigarettes can perpetuate nicotine addiction, increasing the likelihood of transitioning to traditional smoking.
Smokeless tobacco products, often considered safer, pose their own risks. Chewing tobacco is a known contributor to oral and oesophageal cancers, as emphasized by reports from organizations like the Sailors’ Society. Addressing these misconceptions is vital for effective prevention.
Advances in Cancer Screening
Modern tools have revolutionized early cancer detection, offering hope for timely intervention:
- Low-Dose Computed Tomography (CT): Particularly effective for early-stage lung cancer detection among smokers.
- Oral Cancer Detection Techniques: Visual inspections supplemented by fluorescence imaging identify pre-cancerous lesions.
- Biomarker-Based Blood Tests: Screening for markers like PSA (prostate-specific antigen) or CA-125 facilitates early diagnosis.
- Carcinoembryonic Antigen (CEA): A valuable biomarker in detecting and monitoring certain cancers, such as colorectal and lung cancers. Elevated CEA levels can indicate early malignancies or recurrence, enabling timely intervention.
Key points about CEA and smoking:
- Baseline Increase: Smokers tend to have higher baseline levels of CEA compared to non-smokers
- Clinical Implication: While evaluating elevated CEA levels in a smoker, it’s important to differentiate between smoking-related elevation and potential malignancy
Smoking and CEA Testing:
- Smoking Cessation: Advising patients to stop smoking can help in more accurate monitoring of CEA levels over time
- Clinical Judgment: Persistent or significantly elevated levels, despite cessation, should warrant further investigation.
- Telemedicine Platforms: Enable remote consultations with oncology specialists, bridging gaps in healthcare access during voyages.
The Importance of Good Quality PEME
A robust Pre-Employment Medical Examination (PEME) system is vital for early detection of cancer risks among seafarers. High-quality PEMEs not only evaluate fitness for duty but also integrate comprehensive health assessments, including advanced cancer screenings. Effective PEMEs should:
- Include routine cancer screening tests for high-risk individuals
- Assess occupational exposures to carcinogens like asbestos and benzene
- Provide personalized counselling on lifestyle factors, including smoking cessation
Evidence-Based Preventive Strategies
Preventive measures are central to mitigating cancer risks among sea staff. Key strategies include:
- Educational Initiatives: Collaborate with welfare organizations to raise awareness about tobacco and e-cigarette risks as well as cancer prevention.
- Smoking and Vaping Cessation Support: Provide access to nicotine replacement therapies, behavioural counselling, and peer support networks.
- Regulatory Frameworks: Enforce smoke-free and vape-free zones aboard vessels and establish stringent guidelines to minimize occupational carcinogen exposure.
- Regular Health Screenings: Encourage seafarers to undergo routine check-ups during port visits to facilitate early detection.
- Promoting Healthy Lifestyles: Advocate for balanced diets, regular physical activity, and stress management to enhance overall resilience:
- Balanced Diets: Provide nutritious meal options on board, focusing on fruits, vegetables, whole grains, and lean proteins. For example, serving meals with fresh salads, grilled fish, or legumes can improve overall health.
- Regular Physical Activity: Incorporate simple exercise routines that seafarers can perform in confined spaces, such as bodyweight exercises, resistance bands, or yoga. Group fitness challenges can also motivate participation.
- Stress Management: Offer resources such as mindfulness apps, relaxation techniques, or counseling services. Designating quiet spaces for relaxation or meditation on vessels can further support mental well-being.
Practical Steps to Quit Tobacco and E-Cigarettes
Quitting tobacco and e-cigarettes is a challenging but essential step toward cancer prevention. Evidence-based approaches include:
- Goal Setting: Establish a quit date and prepare mentally for the transition
- Behavioural Interventions: Identify triggers and develop alternative coping mechanisms
- Pharmacological Support: Utilize nicotine patches, gums, or prescription medications to ease withdrawal symptoms
- Support Systems: Leverage group therapy and peer encouragement for sustained motivation
- Monitoring Progress: Celebrate milestones and reassess strategies as needed
Cancer among sea staff represents a critical health challenge that warrants immediate attention. By addressing the role of tobacco use and e-cigarettes, leveraging modern screening technologies, and implementing preventive measures, we can significantly reduce cancer incidence in this vulnerable population. Good quality PEMEs, combined with ongoing health education and regulatory frameworks, are instrumental in safeguarding seafarers’ health. Insights from organizations like the Sailors’ Society, the American College of Pathology, and the ILO provide a robust foundation for actionable strategies. Collaborative efforts across stakeholders will ensure safer seas and healthier seafarers.
Marex Media