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Cutaneous melanoma in Swedish women: Occupational risks by anatomic site
Abstract
Background
Few occupational studies have addressed melanoma in women. Accordingly, our aim was to identify occupations with higher risk of cutaneous melanoma, overall and by site, in Swedish female workers.Methods
All gainfully employed Swedish women were followed-up from 1971 to 1989, using Death/Cancer Registers. Occupational risk ratios adjusted for age, period, town size, and geographic zone were computed for each site. Risk patterns for different sites were then compared.ResultsHigh risks were observed among educators, bank tellers, dental nurses, librarians/archivists/curators, horticultural workers, and hatmakers/milliners. Telephone operators and textile workers had increased risk, mainly in the leg. Other occupation-specific site excesses were also found. Upper-limb risks were correlated with head/neck and thorax, though these two sites were not associated. Legs registered a special pattern, with a moderate correlation with upper limbs or thorax, and no correlation with head/neck.Conclusions
Some occupations with possible exposure to arsenic/mercury displayed increased risk. The generalized excess risk among hatmakers/milliners warrants further attention. The weak correlation between legs and other sites suggests site specificity in melanoma risk factors. Am. J. Ind. Med. 2005. © 2005 Wiley-Liss, Inc.
... Few studies collected data on the exposure, but rather on the type of occupation, producing possible exposure misclassification and making hard to interpret their results. For example, the identification of an increased risk of melanoma in hat making women was hypothesised to be related to mercury use, as well as the higher risk in dental operators (Pérez-Gómez et al. 2005). Also, horticultural female workers-but not farmers-were found to have increased risk of melanoma, which was interpreted as the consequence of potential exposure to pesticides containing arsenic (Pérez-Gómez et al. 2005). ...
... For example, the identification of an increased risk of melanoma in hat making women was hypothesised to be related to mercury use, as well as the higher risk in dental operators (Pérez-Gómez et al. 2005). Also, horticultural female workers-but not farmers-were found to have increased risk of melanoma, which was interpreted as the consequence of potential exposure to pesticides containing arsenic (Pérez-Gómez et al. 2005). Besides this, a systematic review suggested enhanced risk of melanoma among workers in petroleum and automobile industry, engine operators and printers, which may be associated with exposure to aromatic hydrocarbons, such as benzene, as well as workers exposed to ionising radiation, including radiation workers, dentists and cockpit personnel (Fortes and de Vries 2008). ...
Background
Melanoma is mainly caused by sunlight radiation, but other environmental risk factors are not well known. We investigated the association between cutaneous melanoma and occupational exposure to arsenic, mercury and UV radiation.MethodsA hospital-based case–control study was conducted in the inpatient wards of IDI-San Carlo Rome, Italy, including 304 incident cases of cutaneous melanoma and 305 frequency-matched controls. Detailed sociodemographic, clinical and host-related factors were collected, and all participants were physically examined using dermoscopy and following standard protocol for recording pigmented lesions. Four experts assessed exposure to arsenic, mercury and UV radiation based on occupational history. A multidimensional variable was created for each risk factor, by combining intensity and probability of exposure. Multivariable logistic regression models were run to calculate odds ratios (OR) and 95% confidence intervals (CI) of the association between exposure to these agents and melanoma.ResultsA total of 5.4% of the cases vs 2.4% of the controls were exposed to arsenic (OR = 3.12; 95% CI = 1.10–8.86 for high probability and high exposure to arsenic) after controlling for sex, age, smoking status, number of nevi, phototype and history of sunburns in childhood/adolescence. Occupational exposure to mercury and UV radiation was not associated with the risk of melanoma.Conclusions
Subjects exposed to arsenic at the workplace may be at increased risk of developing cutaneous melanoma in comparison to subjects not exposed to this agent. Further studies should be designed to investigate occupational exposure to arsenic and mercury and melanoma and confirm the findings are warranted.
... Our findings may be explained by contaminants in fish, such as polychlorinated biphenyls, dioxins, arsenic and mercury [21][22][23]. Higher fish intake is associated with higher level of body burden of each of these contaminants [24][25][26][27], which are associated with higher risk of skin cancer [28][29][30][31][32][33][34][35][36][37][38]. Previous epidemiological studies suggested positive associations between plasma levels of polychlorinated biphenyls, dietary polychlorinated biphenyls, and their risk of melanoma [28,29], between arsenic exposure and risk of skin cancer [30][31][32][33], and between mercury exposure and risk of melanoma [34]. ...
... Previous epidemiological studies suggested positive associations between plasma levels of polychlorinated biphenyls, dietary polychlorinated biphenyls, and their risk of melanoma [28,29], between arsenic exposure and risk of skin cancer [30][31][32][33], and between mercury exposure and risk of melanoma [34]. A few studies in occupational settings reported a positive association between occupational mercury exposure and risk of melanoma [35,36]. One cross-sectional study observed a positive association between blood mercury levels and risk of non-melanoma skin cancer among the general population in the US [37]. ...
Purpose
Prior epidemiological studies evaluating the association between fish intake and melanoma risk have been few and inconsistent. Few studies distinguished different types of fish intake with risk of melanoma.
Methods
We examined the associations between intake of total fish and specific types of fish and risk of melanoma among 491,367 participants in the NIH-AARP Diet and Health Study. We used multivariable-adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
During 6,611,941 person-years of follow-up with a median of 15.5 years, 5,034 cases of malignant melanoma and 3,284 cases of melanoma in situ were identified. There was a positive association between higher total fish intake and risk of malignant melanoma (HR = 1.22, 95% CI = 1.11–1.34 for top vs. bottom quintiles, ptrend = 0.001) and melanoma in situ (HR = 1.28, CI = 1.13–1.44 for top vs. bottom quintiles, ptrend = 0.002). The positive associations were consistent across several demographic and lifestyle factors. There were also positive associations between tuna intake and non-fried fish intake, and risk of malignant melanoma and melanoma in situ. However, fried fish intake was inversely associated with risk of malignant melanoma, but not melanoma in situ.
Conclusions
We found that higher total fish intake, tuna intake, and non-fried fish intake were positively associated with risk of both malignant melanoma and melanoma in situ. Future studies are needed to investigate the potential biological mechanisms underlying these associations.
... Exposure to some of these metals, like chromium (Cr), are considered a risk factor for numerous cancers and have been classified as a carcinogen by the International Agency for Research on Cancer (IARC) (14). Exposure to trace elements, including Cr, iron (Fe), mercury (Hg), selenium (Se), and zinc (Zn), have been hypothesized to play a role in both carcinogenesis of the skin and prevention of skin cancer, but evidence is limited (15)(16)(17)(18)(19)(20)(21)(22). A recent review examining published epidemiologic literature about trace element exposure and risk of skin cancer concluded that too little data existed to draw any conclusions about exposure to Cr, Fe, and Zn and risk of skin cancer (22). ...
... A cohort study in Swedish women found that dental nurses were at higher risk of melanoma (RR =1.71 [95% CI 1.21-2.42]) than the whole population (19). That study also reported elevated melanoma risk among female hat makers (RR=2.62 [95% CI 1.41-4.88]) ...
Background: Few epidemiologic studies have investigated trace element exposure and skin cancer risk.
Methods: Toenail levels of mercury, selenium, chromium, iron, and zinc were measured from 6,708 women in the Nurses' Health Study (1984–2012) and 3,730 men in the Health rofessionals Follow-up Study (1986–2012) with data from prior nested case–control studies. articipants were free of skin cancer at toenail collection and followed for incident basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) of skin cancer associated with the elements in each study. We calculated pooled multivariable HRs using a fixed-effects model. During 26 to 28 years of follow-up, 2,433 BCC, 334 SCC, and 130 melanoma cases were documented.
Results: Higher toenail mercury levels were associated with risk of BCC [pooled HR for top vs. bottom quintiles = 1.34 (95% CI, 1.18–1.52), trend < 0.0001]. Similar direct associations were found with risks of SCC [pooled HR for top vs. bottom quartiles = 1.41 (95% CI, 1.03–1.94), trend = 0.04] and melanoma [pooled HR for top vs. bottom quartiles = 1.88 (95% CI, 1.12–3.16), trend = 0.02]. Chromium was positively associated with BCC in women only. No associations were found between other metals and skin cancer risk.
Conclusions: Our prospective data found that increased toenail mercury concentrations were associated with increased skin cancer risk.
Impact: If our novel findings are confirmed, mercury may play a role in skin carcinogenesis.
... Outdoor workers are exposed over many years to high levels of solar ultraviolet (UV) radiation 11 and are at risk for skin cancer, 12 especially NMSC. An elevated risk of melanoma with outdoor occupations has also been observed, 12,13 and melanoma mortality produced US$66.9 billion in productivity losses from 1990 to 2008 in the United States. ...
... Outdoor workers are exposed over many years to high levels of solar ultraviolet (UV) radiation 11 and are at risk for skin cancer, 12 especially NMSC. An elevated risk of melanoma with outdoor occupations has also been observed, 12,13 and melanoma mortality produced US$66.9 billion in productivity losses from 1990 to 2008 in the United States. 14 The NMSC prevention is a priority due to its high prevalence, 15 recurrence, and treatment and lost productivity costs. ...
Purpose
To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial.
Design
A randomized pretest–posttest controlled design with 2-year follow-up was conducted in 2010 to 2013.
Setting
Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation.
Participants
Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts).
Intervention
Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group.
Measures
Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition.
Analysis
Policy scores were analyzed with logistic and Poisson regression models using imputation.
Results
At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ² = 31.29, P < .01; intent to treat: χ² =73.79, P < .01) and stronger (χ² = 24.50, P < .01; intent to treat: χ² = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased (P < .05).
Conclusion
The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.
... The sun is con-sidered responsible for almost 65% of cases [6], mainly through intermittent exposure [7] during summer holidays, something that tends to be more usual among persons having a higher socio-economic class [2] and residing in larger towns [8]. Sun-bed use [9] has also been related to increased CM risk; and other lifestyle-related exposures in which social class might differ, such as occupation [10,11], tobacco or alcohol use [12], diet [13], or contraceptive use [14], have been studied as possible modifiers of melanoma risk, albeit with inconclusive results. ...
... We also found a weaker association between melanoma and social class among women, where some heterogeneity also appeared. The risk excess found in transport and communication sector in lower limbs cannot probably be attributed to socioeconomic differences, and might be related with the higher incidence observed in specific occupations, such as motor-vehicle or tram drivers and telephone operators [11]. ...
Cutaneous melanoma (CM) is a cancer usually associated with high socio-economic level in the literature. Few studies have, however, assessed this relationship by gender and site or the association between CM and rurality.
A major-sized historical occupational Swedish cohort comprising 2,992,166 workers was used to estimate relative risk of cutaneous melanoma, broken down by gender and anatomical site, for occupational sectors (as a proxy of socio-economic class) and rurality. To this end, Poisson models were fitted for each site in men and women, including occupational sector and town size, with adjustment for age, period of diagnosis and geographical area as possible confounding factors.
White collar workers presented a marked increased of risk in men in all melanoma cases, as well as in trunk, upper and lower limbs. This pattern was less clear for women, in which some heterogeneity appeared, as low risks in lower socioeconomic sectors in trunk, or risk excesses in white collar workers in lower limbs did not achieve statistical significance. Males also showed significant differences in risk by rural/urban distribution, but in women this association was limited to CM of lower limb. Risk of CM of head/neck did not vary by occupational sector or town size, thus depicting a specific epidemiological profile, which proved common to both sexes.
While differences in risk between men and women could suggest greater homogeneity in UV-exposure behaviour among women, the uniform risk pattern in head and neck melanoma, present in both sexes, might support the coexistence of different aetiological pathways, related to anatomical site.
... Other studies analyzing mercury and skin cancer are limited and were conducted in occupational settings (Rhee et al. 2020). Among these, Pérez-Gómez et al. (2005) investigated the risk of cutaneous melanoma by occupation in Swedish women. Occupations known to have high mercury exposure, including dental nurses and hatmakers were found to have an increased risk. ...
Worldwide, skin cancer affects millions of people yearly and is broadly classified into melanoma and nonmelanoma types of skin cancer. The toxicity of metals to human health is a public and clinical health problem due to their widespread use in tools, machinery, and appliances as well as their widespread distribution in the air, water, and soil. Arsenic is a carcinogenic metalloid and available in the Earth's crust. Polycyclic aromatic hydrocarbons (PAHs) are toxic to humans, and incomplete combustion of fossil fuels is the main source of PAHs. Human populations exposed to metals from various sources can lead to various diseases including cancer. Limited studies are conducted to simultaneously assess the correlation of multiple arsenic, PAHs, metals with the occurrence of skin cancer. This study aimed to analyze the association between six PAHs compounds, seven types of arsenic, and fourteen metals from urine specimen with skin cancer in US adults. We performed a cross-sectional analysis using data from a total of 14,716 adults from the National Health Examination and Nutrition Survey (NHANES) database for three cycles ranging from 2011-2012 to 2015-2016. Specialized weighted complex survey logit regressions were conducted. Linear logit regression models using only main effects were performed first to identify the correlation between the selected demographic and lifestyle variables and melanoma, nonmelanoma, and unknown types of skin cancer. A second set of linear, main-effects logit regression models were constructed to examine the correlation between melanoma, nonmelanoma, and other types of skin cancers and seven types of arsenic (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylacrsonic acid, and total arsenic), six PAHs (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxyphenathrene, and 1-hydroxypyrene), and fourteen metals (barium, cadmium, cobalt, cesium, molybdenum, manganese, lead, antimony, tin, strontium, thallium, tungsten, uranium, and mercury) when adjusted for the selected covariates. The statistical analysis was conducted using R software, version 4.0.4. A marginal positive significant correlation between total arsenic and nonmelanoma was observed. This study identified a significant positive association between barium, cadmium, cesium, mercury, tin, and melanoma development. Cesium showed a significant positive statistical association for nonmelanoma, and thallium showed a borderline significant statistical association for nonmelanoma. A statistically significant positive association was found between cadmium and an unknown type of skin cancer. The findings of this study indicated a statistically significant positive association between skin cancer and barium, cadmium, cesium, tin, mercury, and thallium. Further studies are recommended in humans to refute or confirm these findings.
... However, low socioecono-mic groups were diagnosed at more advanced stages and had lower survival rates 26 . In regard to UV exposure as a causal factor, male workers in Sweden who were exposed to artificial UV sources developed melanomas on the trunk, and females exposed to arsenic/mercury had increased risk 27,28 . In Asia, acral melanoma is the most common form of melanoma and exposure to sunlight is not a risk factor 29 . ...
Background:
Traumatic events are thought to be a cause of acral melanoma. However, little is known about the role of mechanical trauma or physical stress in the development of acral melanoma.
Objective:
In our study, we evaluated the frequency of trauma, physical stress, and occupation in patients with acral melanoma and aimed to identify any pathological correlates of these factors.
Methods:
We conducted a retrospective study of 313 acral melanoma patients from Chonnam National University Hospital. We mapped melanoma-developed anatomical sites of acral areas and assessed patients' history of trauma, physical stress, and occupation.
Results:
Among the 313 acral melanoma patients, many reported a traumatic event (84 of 313; 26.8%) or physical stress (91 of 313; 29.1%) before the melanoma developed. The most common anatomical sites in these patients were on the borders of the foot (136 of 313; 43.5%). Trauma was more commonly associated with the fingernails and toenails than other sites. The frequency of each type of physical stress depended on the site of the lesion. Farmer and fisherman were the most common occupations (130 of 313; 41.5%) of the acral melanoma patients.
Conclusion:
Our results demonstrate that traumatic events, physical stress, and certain occupations are common in acral melanomas. Further studies are needed to establish whether these are risk factors for acral melanomas.
... 3 Unprotected exposure to ultraviolet (UV) radiation is a major risk factor for all types of skin cancer. 4 Outdoor workers are often exposed over many years to high levels of solar UV radiation 5 and are at risk for skin cancer of all types 4,6 , which is exacerbated by workers' general reticence toward sun protection. 5,7,8 Melanoma mortality produced US$66.9 billion in productivity losses during 1990-2008 in the United States. ...
Objective:
Economic evaluation of an intervention promoting adoption of occupational sun protection actions by Colorado public sector employers.
Methods:
Randomized controlled trial with 2-year follow-up conducted during 2010 to 2013. Thirty-three intervention and 30 attention-control worksites in final economic sample. Twenty-four-month intervention of personal contacts, training, and materials. Intervention delivery micro-costed. Costs of implemented actions from employer self-report.
Results:
Twenty-four-month intervention costs: 1,732). Worksite costs: 1,777). Per-employee costs: 56 worksites. Materials cost: 181). Intervention worksites implemented 72 nontraining sun protection actions post-Sun Safe Workplaces (SSW) (mean = 2.18). Control worksites implemented 39 actions (mean = 1.30). Total costs to intervention worksites of implementing the 72 post-SSW actions: 2,747). Control worksite costs: 2,216). Per-employee implementation costs are comparable to other worksite health interventions.
Conclusion:
SSW expanded adoption of sun protection actions at a reasonable per-employee cost.
... Only studies that explicitly investigated exposure to the mineral itself were included. For example, mercury was excluded from this review because it only has been studied indirectly with regard to occupations with possible exposure and risk of melanoma (23,24). Only minerals with literature suggesting a possible biological mechanism for risk of skin cancer were included. ...
Exposure to environmental trace elements has been studied in relation to many cancers. However, an association between exposure to trace elements and skin cancer remains less understood. Therefore, we conducted a systematic review of published epidemiologic literature examining the association between exposure to trace elements, and risk of melanoma and keratinocyte carcinoma in humans. We identified epidemiologic studies investigating exposure to arsenic, cadmium, chromium, copper, iron, selenium, and zinc and risk of skin cancer in humans. Among the minerals, arsenic, selenium, and zinc had more than 5 studies available. Exposure to arsenic was associated with increased risk of keratinocyte carcinoma, while too few studies existed on melanoma to draw conclusions. Exposure to selenium was associated with possible increased risk of keratinocyte carcinoma. Studies of zinc and skin cancer were case-control in design and were found to have inconsistent associations. The data on the association between cadmium, chromium, copper, and iron and risk of skin cancer remain too sparse to draw any conclusions. In summary, epidemiologic studies on exposure to trace elements and cutaneous malignancies are limited. Studies with larger sample sizes and prospective designs are warranted to improve our knowledge of trace elements and skin cancer.
... Dentists, dental professionals, dental staff, and dental students are occupationally and chronically exposed to mercury released from dental mercury amalgam, and researchers and clinicians have raised concerns about the safety of dental personnel who work with dental mercury amalgam (Cooper et al. 2004 ;de Oliveira et al. 2010 ;Duplinsky and Cicchetti 2012 ;Echeverria et al. 1995 ;Fabrizio et al. 2007 ;Goodrich et al. 2013a , b ;Herber et al. 1988 ;Hilt et al. 2009 ;Kanerva et al. 1999 ;Karahalil et al. 2005 ;Lee et al. 2001 ;Lönnroth and Shahnavaz 1995 ;Martin et al. 1995 ;Moen et al. 2008 ;Ngim et al. 1992 ;Nimmo et al. 1990 ;Nylander et al. 1989 ;Parsell et al. 1996 ;Pérez-Gómez et al. 2005 ;Richardson 2003 ;Richardson et al. 2009 ;Rowland et al. 1994 ;Shapiro et al. 1982 ;Sikorski et al. 1987 ;Warwick et al. 2013 ;Zahir et al. 2005 ). This includes mercury released during hygiene, cleaning, and polishing procedures. ...
All dental amalgam fillings contain approximately 50 % elemental mercury by weight. Concerns about health risks due to continual emissions of mercury vapor from this tooth restorative material have been addressed by dentists, scientists, and government authorities worldwide and have resulted in a range of recommended practices and regulations. By reviewing articles collected by a literature search of the International Academy of Oral Medicine and Toxicology (IAOMT) database and the PubMed database, we identify health risks associated with dental mercury amalgam. We present the science of potential harm as applicable to the general population, pregnant women, fetuses, children, and dental professionals. We specifically address genetic predispositions, mercury allergies, Alzheimer’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and other health conditions pertinent to dental mercury exposure. We conclude that reviews and studies of dental amalgam mercury risk should assess biocompatibility with special consideration for all populations and all risk factors.
... Eine Reihe von Substanzen kann ebenfalls Hautkrebs auslösen. Zu nennen sind Arsenverbindungen (z.B. in Pestiziden) (Pesch et al. 2002;Chen et al. 2003;Perez-Gomez et al. 2005), v.a. für die nicht-melanotischen Erkrankungen und polyzyklische Kohlenwasserstoffe (Perez-Gomez et al. 2004); strittig ist die ätiologische Bedeutung anderer Substanzen wie z.B. ...
AIM OF THE STUDY: The association between occupational exposure to UV radiation and skin cancer (malignant melanoma, squamous cell cancer, and basal cell cancer) is analyzed on the basis of the data of the Rhineland-Palatinate Cancer Registry. Methods: Male as well as female patients with malignant melanoma of the skin (total n=3.239), squamous (n=5.041) or basal cell carcinoma of the skin (n=20.714), diagnosed between 1998 and 2003 were compared with patients with other malignancies. As a second reference group, male patients with skin cancer were compared with patients with prostate cancer. Patients suffering simultaneously from skin cancer and other malignancies were allocated to the "case group". Age-adjusted odds ratios and 95% confidence intervals were calculated for outdoor occupations (construction workers, wine-growers, farmers, gardeners, and forestry workers) versus white-collar or production workers (excluding outdoor workers) using logistic regression analysis. Histologic melanoma-subtypes were analysed separately. RESULTS: For malignant melanoma, no significantly elevated risks could be found among occupational groups potentially exposed to UV; male patients with malignant melanoma worked more rarely in building professions. In the analysis of histologic melanoma subtypes, superficial spreading melanoma presented lower risks for male construction workers and increased risks for female wine-growers. Female farmers showed an increased risk of lentigo maligna melanoma. Significantly elevated risks of squamous cell cancers of the skin were found among male as well as female farmers and wine-growers and among male construction workers. For basal cell skin cancer, the risk elevations of male gardeners (compared with other malignancies), of male construction workers (compared with prostate cancer) and of female wine-growers were of borderline statistical significance. Female farmers showed a significantly elevated risk of basal cell skin cancer. DISCUSSION AND CONCLUSION: In accordance with the literature, the analysis of the Rhineland-Palatinate Cancer Registry data revealed significantly elevated risks of squamous cell cancer of the skin, but not of malignant skin melanoma. The present study allows no reliable conclusions on the occupational risks for individual melanoma sub-types; further research is required in this area. For basal cell skin cancer, we found slightly elevated risks for some UV-exposed occupations. Major limitations of the study lie in the lack of knowledge concerning non-occupational UV-exposure, lack of information on the exact occupational activities and the cumulative amount of occupational UV-exposure and the incompleteness of the occupational data (occupational data was available for only about half of the cancer patients). It should be noted that more than 95% of diagnosed cases of skin cancer are reported to the Rhineland-Palatinate Cancer Registry. Therefore, cancer-registry data might assist data acquisition in analytic epidemiologic studies further clarifying the association between occupational as well as non-occupational risk factors and skin cancer.
... In addition, formaldehyde, an antimicrobial drug used for intra-channel dressings in endodontics [Lewis and Chestner, 1981], has also been included in IARC Group 1 A as being carcinogenic to humans (IARC\WHO, 2013). Other chemicals and metals to which dentists experience long-term exposure, with debatable carcinogenic effects, include nitrous oxide, which is used in short-term anesthesia [Szymanska, 2001], and mercury, which is used to prepare amalgam to fill dental cavities [Perez-Gomez et al., 2005]. ...
Background
Previous studies have variably shown excess risks of elected cancers among dentists.Methods
National Brazilian mortality data were used to obtain mortality patterns among dentists between 1996 and 2004. Cancer mortality odds ratios (MORs) and cancer proportional mortality ratios for all cancer sites were calculated, using the general population and physicians and lawyers as comparison groups.ResultsFemale dentists from both age strata showed higher risks for breast, colon-rectum, lung, brain, and non-Hodgkin lymphoma. Compared to physicians and lawyers, higher MOR estimates were observed for brain cancer among female dentists 20–49 yr. Among male dentists, higher cancer mortality was found for colon-rectum, pancreas, lung, melanoma, and non-Hodgkin lymphoma. Higher risk estimates for liver, prostate, bladder, brain, multiple myeloma and leukemia were observed among 50–79 yr old male dentists.DiscussionIf confirmed, these results indicate the need for limiting occupational exposures among dentists in addition to establishing screening programs to achieve early detection of selected malignant tumors. Am. J. Ind. Med. © 2014 Wiley Periodicals, Inc.
... Um estudo do tipo casocontrole realizado entre bombeiros nos EUA observou um risco elevado em desenvolver câncer de pele 72 . Um estudo observou um aumento no risco de câncer de pele em mulheres empregadas como educadoras, caixas de banco e comissárias de bordo, e outro estudo revelou um aumento no risco de câncer de pele em dentistas, bibliotecários, trabalhadores horticultores 73,74 . ...
Exposure to carcinogenic substances is known in most work environments, and many of these were classified as from epidemiological studies on working populations. The objective of this study is an integrative review on the main carcinogens at work environment as well as the main topographies affected by these substances. Survey was conducted in the databases Medline and Lilacs, whose term has been "câncer ocupacional" and "occupational cancer". It was observed that the articles point to the fact that it is likely that exposure to environmental/occupational to chemicals in general is also contribute to the disease population, without any relationship between cause and effect is established. The diffusion of chemicals does not occur exclusively through the known forms of pollution. It is therefore of paramount importance to build a surveillance system that meets these injuries two main objectives: to identify and control work environments where there is potential exposure to carcinogenic agents and systematization of information necessary to conduct epidemiological studies, whether exploratory or analytical.
... 6 The disease is also more frequent among affluent socioeconomic classes 7 and in urban settings, 6 a finding that has been linked to travel habits to sunny countries. Other lifestyle-related and environmental exposures, such as occupation, 5,8 tobacco, drug or alcohol use, 9 diet and tea ⁄coffee drinking, 10 and contraceptive use, 11 have been studied as possible modifiers of melanoma risk, albeit with inconclusive results. ...
Recent research on cutaneous malignant melanoma (CMM) points to the coexistence of several biological pathways linked to the anatomical site of the lesion, which could lead to this neoplasm. Although the different anatomical distribution of CMM by sex is usually attributed to gender-specific patterns of sun exposure, it has been suggested that an alternative explanation might lie in gender-specific site susceptibility.
This paper aimed at analysing the age distribution of CMM by site and sex to gain in-depth knowledge of differences between the sexes.
Using a large Swedish cohort comprising 2 992 166 workers, Poisson models were fitted to estimate age-specific incidence rates by site and sex, duly adjusted for several factors that might account for changes in environmental exposures (period, birth cohort, socioeconomic level, latitude and rurality).
Incidence rates were 17.4 cases per 100 000 person-years in men and 16.5 in women. Sex differences were particularly striking for CMM of the trunk, where both crude and adjusted incidence rates displayed a steady increase with age in men, but reached a plateau in women at around four cases per 100 000 person-years from the 40-45-year age group (perimenopausal period) upwards. There was an almost fivefold increase in the sex ratio for this body site between the younger and older age groups, a difference which could not be attributed to period or cohort effects.
If different aetiological pathways can be assumed to lead to melanoma, then disparities between men and women, particularly in CMM of the trunk, suggest that a possible interaction between site and sex should be borne in mind.
Introduction
Knowledge on the health of greenspace workers is scarce, even though they are exposed to many occupational hazards. The aim of this study was to analyze mortality by cause, prevalence of some non-cancer diseases, and incidence of the main cancers among greenspace workers.
Methods
A sub-cohort of greenspace workers was formed within the AGRICAN cohort. Demographic information, health characteristics and self-reported diseases at enrollment were described separately in terms of frequencies (%), median and Interquartile Range (IQR) for greenspace workers, farmers, and other non-agricultural workers. Causes of death and cancer incidence were identified through linkage with cancer registries from enrollment (2005–2007) to 2015. Hazard ratio (HR) and 95% Confidence Intervals [95% CI] were estimated using Cox proportional hazard regression with age as the underlying timescale.
Results
The sub-cohort included 6247 greenspace workers who were higher proportion men, younger and more frequently smokers than farmers and non-agricultural workers. Male and female greenspace workers reported more history of allergic diseases; and males, more history of depression. Compared to other workers male greenspace workers showed a non-significant higher mortality from ischemic cardiological diseases (HR = 1.14 [0.81–1.60]). Incidence was higher in male greenspace workers than farmers for overall cancer (HR = 1.15 [1.04–1.27]), cancer of the prostate (HR = 1.21 [1.02–1.44]), thyroid (HR = 2.84 [1.26–6.41]), testis (HR = 3.98 [1.50–10.58]) and skin melanoma (HR = 2.15 [1.33–3.47]). Non-significant increased risks were also found for sarcomas, larynx and breast. In women, risk of breast cancer was higher in greenspace workers than in farmers (HR = 1.71 [1.17–2.50]).
Conclusions
Whereas greenspace workers have often been included with other pesticide applicators in epidemiological studies, our analyses highlighted the differences between these two populations. They demonstrate the need to study them separately and to investigate more thoroughly the role of specific occupational exposures such as pesticides as well as the effect on women.
The present study aims to review epidemiological and experimental toxicology studies published over the last two decades linking mercury (Hg) exposure and carcinogenesis, with a special emphasis on the potential underlying mechanisms. While some epidemiological studies have observed a strong association between environmental/occupational Hg exposure levels, measured in blood, toenail, and hair, and cancer risk and mortality, others failed to reveal any association. In experimental models, high-dose Hg exposure has been linked with cytotoxicity, whereas low-dose exposure was posited to induce proliferative responses in both normal and cancerous cells by interference with estrogen receptor, ERK1/2, JNK, NADPH-oxidase and, potentially, Nrf2 signaling. Combined with reduced apoptosis and pro-survival signaling upon low-dose Hg exposure, accumulation of DNA lesions in cells may predispose to an increased risk of malignant transformation. In addition, the pro-oxidant activity of Hg species may induce oxidative DNA modifications and inhibits DNA repair mechanisms. Furthermore, epigenetic effects of Hg exposure seem to contribute to the carcinogenic activity, although the particular mechanisms have yet to be characterized. Therefore, even after 20 years of research, one cannot consider Hg as a non-carcinogenic agent, whereas specific mechanisms of Hg-induced toxicity may promote carcinogenic risk.
Context
The greenspace sector includes a broad range of occupations: gardeners, landscapers, municipal workers, maintenance operators of public facilities, golf-course employees and other sports facilities, horticulturists, plant and tree nursery workers etc. The health impact of occupational pesticide exposure has mainly been studied among farmers. Other professionals such as greenspace workers are also extremely exposed, presenting specific exposure features (practices, types of pesticide used). The aim of this review was to summarize epidemiological literature that examine the relationship between pesticide exposure and the risk of cancer and long-term health effects in greenspace workers.
Method
Six main groups of greenspace workers were identified and examined through a systematic literature review based on PubMed and Scopus. The studies were then grouped according to their design, health outcomes and the type of population studied.
Results
Forty-four articles were selected among the 1679 identified. Fifteen studies were conducted exclusively among greenspace workers, while ten also studied these workers with other pesticide applicators. Six were cohorts from the general population in which greenspace workers were identified. Elevated risks were found in several studies for leukaemia, soft-tissue sarcoma, multiple myeloma, non-Hodgkin lymphoma and Parkinson's disease.
Discussion
The majority of studies used rough parameters for defining exposure such as job titles which could lead to the misclassification of exposure, with the risk of false or positive negative conclusions. Health outcomes were mainly collected through registries or death certificates, and information regarding potential confounders was often missing.
Conclusion
The review identified only 15 studies conducted exclusively among greenspace workers. Elevated risk was found for several sites of cancer and Parkinson's diseases. Further epidemiological research is needed, conducted specifically on these workers, to better characterize this population, its exposure to pesticides and the related health effects.
Background
Occupational sun protection is recommended by government health authorities. Sun safety policies and predictors of managers’ reports of sun safety actions were assessed.
Methods
Written policies from 21 state departments of transportation (DOTs) enrolled in a randomized trial to test methods for scaling‐up an occupational sun safety intervention were coded for sun safety content at baseline. Managers (n = 1113) supervising outdoor workers reported on sun safety actions in a baseline survey.
Results
Twenty state DOTs (95.2%) have a policy with at least one sun protection component. Sun safety training was increased at workplaces with a written sun safety policy (p < 0.001) and unwritten standard procedures on sun protection (p < 0.001). Reported sun safety actions were highest where there was a written sun safety policy (p < 0.001) and unwritten standard procedures on sun protection (p < 0.001).
Conclusions
Policies are essential for the implementation of employee sun safety. There is room for improvement in existing policies of state DOTs.
Background:
Some studies have reported increased incidence or mortality of lung and brain cancers associated with occupations involving potential mercury exposure. Epidemiological evidence related to skin cancer is also limited.
Objectives:
To investigate the association between blood mercury (Hg) levels and nonmelanoma skin cancer (NMSC).
Methods:
We used National Health and Nutrition Examination Survey data from 2003 to 2016. The exposures were blood total (tHg), inorganic (iHg) and methylmercury (MeHg). The outcome was a self-reported diagnosis of NMSC. We included participants aged ≥ 20 years who had information on blood mercury and sociodemographic factors. We conducted a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of NMSC associated with quartiles of blood Hg, after adjusting for the sociodemographic factors and survey year.
Results:
The number of participants was 29 413; mean age was 49 years and 52% were female. Compared with those with a tHg ≤ 0·47 μg L-1 (Q1), those with a tHg > 1·74 μg L-1 (Q4) had nearly double the odds of NMSC (OR 1·79, 95% CI 1·19-2·71; Ptrend = 0·004). Similarly, those in the highest quartile of MeHg (> 1·44 μg L-1 ) had 1·7 times greater odds of NMSC (OR 1·74, 95% CI 1·13-2·70; Ptrend = 0·01) than those in the lowest quartile (≤ 0·21 μg L-1 ). iHg levels were nonsignificantly positively associated with NMSC (Ptrend = 0·08).
Conclusions:
We found that higher blood tHg and MeHg levels were associated with a higher prevalence of NMSC.
Background:
Outdoor workers experience chronic exposure to harmful ultraviolet radiation (UV) elevating their risk for skin cancer.
Methods:
A controlled randomized trial promoted the adoption of workplace sun safety policy and employee education at 98 public organizations in Colorado. A 2-year follow-up study with 68 organizations assessed the association of senior manager awareness of sun safety policies and implementation of sun safety actions.
Results:
Senior managers' awareness of existing sun safety policies, but not their personal sun protection behaviors, predicted implementation of sun safety actions including the number of sun protection messages and sun protection items in the workplace and increased communication about sun safety to employees.
Conclusions:
Organizational adoption of sun safety policy must include efforts to broadly inform a workplace's senior management to ensure the policies are actually implemented and provide support for sun protection behaviors by outdoor workers to reduce UV exposure and skin cancer risk.
Bakgrunn: Kvikksølveksponering hos tannhelsepersonell henger primaert sammen med bruken av amalgam i tannlegepraksis. I Norge har det vaert for-bud mot bruk av kvikksølv til tannfyllinger siden 2008. Overgangsbestemmel-sene som tillot bruk av amalgam på spesielle indikasjoner opphørte 31.12. 2010. Metode: Kunnskapssenteret har oppsummert tilgjengelig forskning om kvikk-sølveksponering og helseutfall av slik eksponering blant tannhelsepersonell. Vi gjorde et systematisk litteratursøk i databaser den 12. desember 2010 og kontak-tet også fagmiljøene i Norge for å innhente forskningslitteratur. Fra 981 identi-fi serte referanser inkluderte vi 134 artikler. Hovedfunn: • Tannhelsepersonell i Norge ble i varierende grad eksponert for kvikksølv på 1960-, 1970-og 1980-tal-let. Det er påvist høyest eksponering på 1960-tallet. • Kvikksølvkonsentrasjonen i urin og i andre vevsprøver var generelt høyere hos tannhelsepersonell enn hos grupper av ikke-eksponerte, både i nordiske og internasjonale studier. • Tann-legeassistenter hadde stort sett høyere konsentrasjon av kvikksølv i urin enn tannleger. • Seks studier som rapporterte 64 helseutfall for tannle-Kvikksølveksponering hos tannhelsepersonell Rapport fra Kunnskapssenteret nr 02–2011 Systematisk kunnskapsoversikt (fortsetter på baksiden)
This chapter discusses the occupational carcinogens that women may face on various jobs. Women in agricultural work may have exposure to pesticides, fertilizers, fuels and exhausts, solvents, and other potential carcinogens and experience increased risks of lymphatic and hematopoietic tumors, similar to those of men employed in agriculture. Brain cancer was excessive in studies of female farmers in the United States and in China. Hispanic women who were farm workers had excess cancers of the stomach, liver, gallbladder, and cervix. Occupational exposure to herbicides was linked to ovarian cancer in a case-control study in Italy. Jobs in the service industries are not usually thought of as hazardous, but many of these jobs have exposures to potential carcinogens. Cosmetologists and beauticians may be exposed to hair dyes, hair sprays, formaldehyde, and some solvents. Jobs in the manufacturing industries have potential for exposure to a wide variety of carcinogens. Excess cervical cancer has also been observed among waitresses.
Evidence of social determinants of disease and awareness of the impact of these factors on outcomes continues to increase. Social determinants includes both socioeconomic and lifestyle factors. This review examines the interface between SES and lifestyle and their effects on melanoma incidence and mortality. Lifestyle factors including occupation, occupational exposures, BMI, marital status, smoking, recreational sun exposure, and tanning were explored as they have a known relationship with melanoma.A remarkable association of socioeconomic status with melanoma incidence and prognosis has been acknowledged worldwide. Melanoma incidence is increased in higher socioeconomic status (SES) populations, especially amongst the highly educated, while lower SES populations present with later stage disease at time of diagnosis and display greater mortality. The aforementioned lifestyle factors are also related to SES, and have been shown internationally to affect melanoma incidence and mortality. This comprehensive systematic review suggests that lifestyle factors including occupation, occupational exposure, obesity, recreational sun exposure, and tanning may explain the relationship between SES and melanoma.This article is protected by copyright. All rights reserved.
To review the evidence on nurses' health systematically.
Nurses are one of the most important resources of a health system. They are subjected to biological, socio-economic, cultural and health system factors that determine their health. Although mental and physical health problems seem to prevail among nurses, literature is often contradictory. The literature on health styles, health behaviours and self perceived health of nurses is also unclear.
Systematic review of experimental and observational studies on nurses' health.
Forty-three databases searched. 2692 references identified as of potential interest; 187 studies included. Only the results from studies on physical health are presented. No meta-analysis was possible. The Scottish Intercollegiate Guidelines Network system was used to rate evidence.
Nurses were at greater risk of musculoskeletal injuries and more prone to blood-borne pathogens infections than other health care workers. They were at greater risk of breast cancer than other female health care workers. Nurses in hospitals were more at risk of tuberculosis. They did not have excess risk of cancer in general, Hodgkin's disease, stomach, colon, rectum, pancreatic, ovary, kidney, brain or thyroid cancer or of lymphosarcoma. They have a higher prevalence of occupational allergies than clerical workers.
Nurses suffer more from musculoskeletal disorders which is consistent with the nature of nursing work. They are at greater risk of acquiring tuberculosis, particularly if they work in pulmonary, medicine or Human Immunodeficiency Virus wards which might be due to repeated contact with infected patients. Nurses are also more prone to blood-borne pathogens infections which might be explained by exposure while working. The proneness to occupational allergies can be explained by exposure to a series of chemical agents.
Without sound knowledge on nurses' health and it is not possible to develop specific occupational health programmes.
What do we currently know about the occupational and environmental causes of cancer? As of 2007, the International Agency for Research on Cancer (IARC) identified 415 known or suspected carcinogens. Cancer arises through an extremely complicated web of multiple causes, and we will likely never know the full range of agents or combinations of agents. We do know that preventing exposure to individual carcinogens prevents the disease. Declines in cancer rates-such as the drop in male lung cancer cases from the reduction in tobacco smoking or the drop in bladder cancer among cohorts of dye workers from the elimination of exposure to specific aromatic amines-provides evidence that preventing cancer is possible when we act on what we know. Although the overall age-adjusted cancer incidence rates in the United States among both men and women have declined in the last decade, the rates of several types of cancers are on the rise; some of which are linked to environmental and occupational exposures. This report chronicles the most recent epidemiologic evidence linking occupational and environmental exposures with cancer. Peer-reviewed scientific studies published from January 2005 to June 2007 were reviewed, supplementing our state-of-the-evidence report published in September 2005. Despite weaknesses in certain individual studies, we consider the evidence linking the increased risk of several types of cancer with specific exposures somewhat strengthened by recent publications, among them brain cancer from exposure to non-ionizing radiation, particularly radiofrequency fields emitted by mobile telephones; breast cancer from exposure to the pesticide dichlorodiphenyltrichloroethane (DDT) before puberty; leukemia from exposure to 1,3-butadiene; lung cancer from exposure to air pollution; non-Hodgkin's lymphoma (NHL) from exposure to pesticides and solvents; and prostate cancer from exposure to pesticides, polyaromatic hydrocarbons (PAHs), and metal working fluids or mineral oils. In addition to NHL and prostate cancer, early findings from the National Institutes of Health Agricultural Health Study suggest that several additional cancers may be linked to a variety of pesticides. Our report also briefly describes the toxicological evidence related to the carcinogenic effect of specific chemicals and mechanisms that are difficult to study in humans, namely exposures to bis-phenol A and epigenetic, trans-generational effects. To underscore the multi-factorial, multi-stage nature of cancer, we also present a technical description of cancer causation summarizing current knowledge in molecular biology. We argue for a new cancer prevention paradigm, one based on an understanding that cancer is ultimately caused by multiple interacting factors rather than a paradigm based on dubious attributable fractions. This new cancer prevention paradigm demands that we limit exposure to avoidable environmental and occupational carcinogens, in combination with additional important risk factors like diet and lifestyle. The research literature related to environmental and occupational causes of cancer is constantly growing, and future updates will be carried out in light of new biological understanding of the mechanisms and new methods for studying exposures in human populations. The current state of knowledge is sufficient to compel us to act on what we know. We repeat the call of ecologist Sandra Steingraber: "From the right to know and the duty to inquire flows the obligation to act."
Data regarding the effects of oral contraceptive use on women's risk of melanoma have been difficult to resolve. We undertook a pooled analysis of all case–control studies of melanoma in women completed as of July 1994 for which electronic data were available on oral contraceptive use along with other melanoma risk factors such as hair colour, sun sensitivity, family history of melanoma and sun exposure. Using the original data from each investigation (a total of 2391 cases and 3199 controls), we combined the study-specific odds ratios and standard errors to obtain a pooled estimate that incorporates inter-study heterogeneity. Overall, we observed no excess risk associated with oral contraceptive use for 1 year or longer compared to never use or use for less than 1 year (pooled odds ratio (pOR)=0.86; 95% CI=0.74–1.01), and there was no evidence of heterogeneity between studies. We found no relation between melanoma incidence and duration of oral contraceptive use, age began, year of use, years since first use or last use, or specifically current oral contraceptive use. In aggregate, our findings do not suggest a major role of oral contraceptive use on women's risk of melanoma.
British Journal of Cancer (2002) 86, 1085–1092. DOI: 10.1038/sj/bjc/6600196 www.bjcancer.com
© 2002 Cancer Research UK
An incidence study of malignant melanoma of the skin (MMS), conducted previously among the workers of four plants of a large telecommunications industry located in Montreal, Canada, showed a standardised incidence ratio of 2.7 (95% confidence interval (95% CI) 1.3-5.02) for the years 1976 to 1983. To describe more precisely the magnitude of the problem a mortality study was started among the same population (n = 9590) for the same period (1976-83). At the end of 1983, 9180 workers were alive, 261 were dead, and 149 (1.5%) were not traced. Standardised mortality ratios (SMRs) for all causes of death were surprisingly low for men (SMR = 0.57; 95% CI 0.50-0.64) and women (SMR = 0.56; 95% CI 0.37-0.82). The SMRs for major causes of death were also less than expected. These results may be explained by a pronounced selection bias (healthy worker effect) and by the short duration of follow up (eight years). For MMS, two deaths occurred among men (SMR = 2.00; 95% CI 0.24-7.22) and one among women (SMR = 4.81; 95% CI 0.12-26.78). A third man who died of MMS was miscoded as having a primary pulmonary melanoma. Including this case increased the SMR for MMS to 3.00 (95% CI 0.62-8.77; p = 0.08). Polyvinyl chloride and polychlorinated biphenyls were used in the plants and some of the workers did soldering. A planned case-control study will investigate other possible exposures at work.
An analysis of the incidence of malignant melanoma according to occupation is presented using data from two national cancer registries. The data relate to 3991 cases of cutaneous malignant melanoma, 662 cases of ocular melanoma, and 179 cases of noncutaneous, non-ocular melanoma in subjects aged 15-64 in England and Wales diagnosed from 1971 to 1978 and to 5003 cases of cutaneous malignant melanoma diagnosed from 1961 to 1979 in Sweden in subjects born between 1896 and 1940. Professional workers of both sexes in both countries experienced an excess incidence of cutaneous malignant melanoma. An excess of ocular melanoma and of non-cutaneous, non-ocular melanoma also existed for this group in England and Wales. Pharmacists, medical doctors, and dentists had a high incidence of cutaneous melanoma in both countries and were represented three times when listing the top 20 occupations in both countries and both genders. Combining the data from cutaneous malignant melanoma over both sexes and both registries the occupations with the highest incidence ratios (expressed as a percentage) were: airline pilots, incidence ratio (IR) = 273, (95% confidence limits 118-538); finance and insurance brokers IR = 245 (140-398); professional accountants IR = 208 (134-307); dentists IR = 207 (133-309); inspectors and supervisors in transport IR = 206 (133-304); pharmacists IR = 198 (115-318); professionals not elsewhere classified IR = 196 (155-243); judges IR = 196 (126-289); doctors IR = 188 (140-248); university teachers IR = 188 (110-302); and chemists IR = 188 (111-296). No particular exposure in the workplace seemed to link these groups and only a few worked in high technology environments. Many of the highest risk groups have in common a high level of education. In England and Wales and in Sweden this might correlate particularly with foreign travel abroad was more unusual than it is now, but evidence on present and past exposure to sun by occupation is needed to clarify the reasons for the association.
A retrospective cohort study of 2918 workers in the telecommunications industry in Sweden recorded the cancer morbidity for the period 1958-79. Cases of cancer were collected from the Swedish Cancer Registry for this period and information on work characteristics was collected for the entire period of employment. The total cancer morbidity was as expected. There was no excess risk of lung cancer but an excess risk of malignant melanoma of the skin was detected (SMR = 2.6, 12 cases). This excess risk was particularly associated with work environments where soldering was practised. Estimates of the SMR became larger with the assumption of a longer induction/latency period.
The aetiology of malignant melanoma is not wholly explained by exposure to sunshine. The present of arsenic in the soil has been suggested as a possible causative factor. Geographical clustering of malignant melanoma cases in the South Western Region is demonstrated for males and this clustering is associated with the distribution of arsenic in the soil. No evidence of geographical clustering is however found for females. This suggests possible sex-specific differences in the aetiology of malignant melanoma and indicates the need for further study of the association with arsenic.
In a population-based, matched case-control study from southern Sweden of 400 patients with a first diagnosis of malignant melanoma and 640 healthy control subjects aged 15-75 years, the association between commonly prescribed drugs, alcohol, smoking and malignant melanoma was evaluated. In addition, the relation between reproductive and hormonal factors and melanoma in women was studied. It was found that certain specific types of prescribed drugs, i.e. beta-blockers, hydralazines and benzodiazepines, may increase the risk of melanoma development. However, these associations were diminished, at least for benzodiazepines, after controlling for host factors. As these findings are unconfirmed, and may be due to chance or confounding, further studies are warranted. The risk of malignant melanoma was not influenced by alcohol consumption or smoking habits. Our results do not suggest an association between oral contraceptives and melanoma. Furthermore, reproductive factors were not independent risk factors for melanoma. However, increasing number of live births seemed to be protective (P for trend = 0.01). There is a need for further research to be able to draw firm conclusions on the relation between number of live births and melanoma. The results based on histopathological re-examinations and those based on tumour registry data were essentially the same.
An analysis of the relationship between the anatomic site of cutaneous melanoma, sun exposure, and phenotype was conducted in 355 women with histologically confirmed superficial-spreading melanoma and in 935 control subjects. The most frequent site for superficial-spreading melanoma was the leg. However, when major sun-related and phenotype risk factors were examined by site, risk ratios were lowest for melanomas that occurred on the leg. A history of frequent sunburns during elementary or high school, increased number of self-assessed large nevi, and blond hair were more strongly associated with melanoma sites other than the leg. Tumors on the trunk were more likely than tumors at other sites to be associated with histological evidence of a preexisting nevus. Results of this work indicate that associations between melanoma phenotypic factors may differ by anatomic site.
Associations between occupational exposures and the occurrence of cutaneous melanoma were examined as part of a large population based case-control study of 19 cancer sites.
Cases were men aged 35 to 70 years old, resident in Montreal, Canada, with a new histologically confirmed cutaneous melanoma (n = 103). There were two control groups, a randomly selected population control group (n = 533), and a cancer control group (n = 533) randomly selected from among subjects with other types of cancer in the large study. Odds ratios for the occurrence of melanoma were calculated for each exposure circumstance for which there were more than four exposed cases (85 substances, 13 occupations, and 20 industries) adjusting for age, ethnicity, and number of years of schooling.
Significantly increased risk of melanoma was found for exposure to four substances (fabric dust, plastic dust, trichloroethylene, and a group containing paints used on surfaces other than metal and varnishes used on surfaces other than wood), three occupations (warehouse clerks, salesmen, and miners and quarrymen), and two industries (clothing and non-metallic mineral products).
Most of the occupational circumstances examined were not associated with melanoma, nor is there any strong evidence from previous research that any of those are risk factors. For the few occupational circumstances which were associated in our data with melanoma, the statistical evidence was weak, and there is little or no supporting evidence in the scientific literature. On the whole, there is no persuasive evidence of occupational risk factors for melanoma, but the studies have been too small or have involved too much misclassification of exposure for this conclusion to be definitive.
This report presents 20 years' of cancer incidence data by occupational group for the Nordic populations. The study covers the 10 million people aged 25-64 years at the time of the 1970 censuses in Denmark, Finland, Norway, and Sweden, and the 1 million incident cancer cases diagnosed among these people during the subsequent 20 years. The project was undertaken as a cohort study with linkage of individual records based on the personal identification numbers used in all the Nordic countries. In the 1970 censuses, information on occupation for each economically active member of the household was provided in free text in self-administered questionnaires. The data were centrally coded and computerized in the statistical offices. Norway, Sweden, and Finland used the Nordic Classification of Occupations, while Denmark used a national coding scheme. However, all the data could be reclassified into 53 occupational groups and 1 group of economically inactive persons. Person-years at risk were accumulated from 1 January 1971 until the date of emigration, date of death or 31 December 1987 in Denmark, 1989 in Sweden, 1990 in Finland, and 1991 in Norway. The 4 countries all had nationwide registration of incident cancer cases during the entire study period. All incident cancer cases during the individual risk periods were included in the analysis. Despite minor differences between the countries, the International Classification of Diseases, 7th revision, formed the core basis for the diagnostic coding in all 4 countries. For the present study the incident cancer cases have been classified into 35 broad diagnostic groups. The observed number of cancer cases in each group of persons defined by country, gender, and occupation was compared with the expected number calculated from the age-, gender-, and period-specific person-years and the incidence rates for the national population. The result has been presented as a standardized incidence ratio (SIR), defined as the observed number of cases divided by the expected number and multiplied by 100. In the tables of this report, all the SIR values for which the upper limit of the 95% confidence interval is below 100 are printed in green and all those for which the lower limit of the confidence interval is above 100 are printed in red. For all cancers combined, the study showed a wide variation among the men, from an SIR of 79 for farmers to 159 for waiters. The occupations with the highest SIR values also included seamen and workers producing beverages and tobacco. Among the women the SIR values varied from 83 for gardeners to 129 for tobacco workers. Low SIR values were found for farmers and teachers. Outdoor workers such as fishermen and gardeners had the highest risk of lip cancer, while the lowest risk was found among indoor workers such as physicians and artistic workers. Almost all pleural cancers are associated with asbestos exposure. Accordingly, plumbers, welders, mechanics, and seamen were the occupations with the highest risk. There was also an excess risk of pleural cancer in the occupational group of technical, chemical, physical, and biological workers, including, among others, engineers and chemists potentially exposed to asbestos. The wood workers included in the present study had the highest risk of nasal cancer. Most studies of nasal cancer have shown increased risks associated with exposure to wood dust, both for those in furniture making and for those exposed exclusively to soft wood. Nickel refinery workers are also known for their high risk of nasal cancer. In the present study they were included in the occupational group of smelting workers. Lung cancer was the most frequent cancer among men in the present study. Tobacco smoking is the major risk factor for this disease, but occupational exposures also play an important role. Waiters and tobacco workers had the highest risk of lung cancer. Miners and quarry workers also had a high risk of lung cancer, which may be related to
Exposures to extremely low frequency (ELF) magnetic fields have not been documented extensively in occupations besides the work environments of electric or telephone utilities. A 1980-1993 study of childhood acute lymphoblastic leukemia (ALL) in Québec, Canada, gathered detailed information about the occupations of 491 mothers of ALL cases and mothers of a similar number of healthy controls. This information was combined with published data on the intensities of ELF magnetic fields associated with sources or work environments to estimate ELF magnetic field exposures for a wide range of jobs commonly held by women. Estimated exposures for 61 job categories ranged from 0.03 to 0.68 microT; the 25th, 50th, and 75th percentiles were 0.135, 0.17, and 0.23 microT, respectively. By job category, the most highly exposed jobs (>0.23 microT) included bakery worker, cashier, cook and kitchen worker, electronics worker, residential and industrial sewing machine operator, and textile machine operator. By work environment, the most highly exposed job categories were electronics worker in an assembly plant (0.70 microT) and sewing machine operators in a textile factory (0.68 microT) and shoe factory (0.66 microT). These results provide new information on expected levels of exposure in a wide range of jobs commonly held by women.
Background. For more than 200 years, it has been known that exposure incurred during worklife can lead to increased cancer risk. In Switzerland, only mortality risks by occupation have been studied systematically so far. Five of the eight Swiss regional cancer registries, covering approximately 40% of the Swiss population, record the occupation for cancer patients systematically. Based on these incidence data, the current study presents an overview of cancer risk patterns by socioeconomic status and occupation in Switzerland. Materials and methods. The study comprised all male patients ≥ 25 years of age with invasive cancer recorded in the cantons of Basel, Geneva, St Gall, Vaud, and Zurich. The study included 58 134 incident cancer cases for the period 1980-1993, the length of participation varying by registry. Because of the lack of concordance in both the definition and sources of information on occupation between the census and incident case data, population denominators were not available. Consequently, analyses were performed by the case-referent approach, considering the cancers of interest as cases and all other cancers as referents. The odd ratios for cancer were adjusted for age, registry, type of residence area, and nationality. Socioeconomic status was represented by an indicator based on the grouping of occupations by their alleged status. With the use of this indicator, socioeconomic variations in cancer risk and residual occupational variation after adjustment for socioeconomic status were calculated. Results and discussion by site. Large socioeconomic differences in cancer risks were observed. Risks of tobacco- and alcohol-related cancers correlated negatively with socioeconomic status. On the contrary, risks of melanoma and other cancers of the skin, colon, prostate, testis, and kidney were associated with a high socioeconomic status. In general, adjustment for socioeconomic status attenuated the range of the occupation-specific risks. Farmers had the highest risk of lip cancer; indoor occupations typically showed a lower risk. This finding fits the actual knowledge on lip cancer etiology. Elevated risk for upper aerodigestive cancers was observed among workers with easy access to alcoholic beverages at the workplace, such as cooks, and generally also in occupations related to construction. Professionals and teachers showed a particularly low risk. After adjustment for socioeconomic status, increased risks appeared for artistic occupations. The higher risks of stomach cancer were observed for farmers and workers in the building and chemical industries. White-collar occupations typically showed lower risks. After adjustment for socioeconomic status, only the excess risk for chemical workers persisted. Slightly elevated risks for colon cancer were generally found for sedentary occupations, such as engineers, entrepreneurs, managers and teachers, in contrast to lower risks for farmers and construction workers. The highest risks for liver cancer were observed for workers in hotel and catering and for cooks and plasterers. Adjustment for socioeconomic status enhanced the elevated risk for dentists. Very high relative risks for sinonasal cancer were observed for leather workers, joiners, and cabinetmakers and, to a lesser extent, for turners. The sinonasal cancers were mainly adenocarcinomas among wood-exposed workers and tumors of epidermal origin among turners. High risks were observed for lung cancer in all the blue-collar occupations. Low risks were found for farmers, teachers, and health and science professionals. After socioeconomic status was accounted for, the excess risk persisted for bricklayers, foundry workers, and machinists. Pleural cancer risk was strongly increased for trades related to stone and earth and, to a lesser extent, for joiners and cabinetmakers. Elevated risks were also seen in other occupations known to be exposed to asbestos, such as for electrotechnical and railway workers. An elevated risk for bone cancer was observed for railway-related workers, evoking a role of chlorophenoxy herbicide exposure. A clear excess of Kaposi's sarcoma was observed for artists, hairdressers, and male nurses and related occupations. The propensity of homosexuals to choose certain occupations probably explains these risks. Higher risks of melanoma of the skin were observed for architects, engineers, managers, lawyers, and physicians. Risk was elevated for melanomas of the skin and neck among farmers and for melanoma of the trunk among watchmakers. With regard to squamous-cell skin carcinoma, the highest risk was observed for farmers, and it was also limited to the head and neck. Risk was also elevated for machinists and locomotive engineers. The risk of basal-cell skin cancer was elevated for engineers, teachers, and health and science professionals. Risk was generally low for blue-collar occupations. A better diagnostic ascertainment among the well-educated may explain part of the observed patterns. The results for ocular cancer, mainly eye melanoma, were very similar to those for skin melanoma. The risk of prostatic cancer was moderately elevated among entrepreneurs, managers, and law, security and teaching professionals. Life-style correlating with socioeconomic status, rather than occupation, seems to be relevant for this tumor. This finding seems also to apply to testicular cancer. Penile cancer risk was increased among artists. A cluster of bladder cancers was observed for mechanics, policemen, occupations related to cleaning, and hairdressers. Risk was low in agricultural occupations. An elevated risk of thyroid cancer was observed for farmers and physicians. The risk for farmers concerned follicular types, which probably reflects previous iodine deficiency in Switzerland. The risk of non-Hodgkin's lymphoma was elevated for white-collar occupations. After adjustment for socioeconomic status, a higher risk appeared for butchers and farmers. Higher risks of leukemia were observed for graphic arts workers, locomotive engineers, physicians, and chemists. Results and discussion by occupation. In order to avoid overinterpretations for the multitude of results, a priori hypotheses based on the literature on expected associations between occupation and cancer risk served as a basis for the critical evaluation of the risks found. Farmers presented higher risks of lip cancer, head and neck melanoma, thyroid cancer, and soft-tissue sarcoma. Also observed was a cluster of four bone sarcomas among horticulturists. Butchers and related occupations presented a slight excess of non-Hodgkin's lymphomas and chronic lymphocytic leukemia. A strong excess of sinonasal cancer and a slight excess of leukemia were observed for leather and fur workers. As expected, stone and earth trade workers experienced a strong excess risk of pleural mesothelioma and an almost doubled risk of lung cancer. The almost twofold risk of lung cancer among foundry workers persisted after socioeconomic status was accounted for. These workers also experienced about a threefold excess risk of pleural mesothelioma and acute leukemia. Electricians showed an excess of pleural mesothelioma and lung cancer. Also observed was about a twofold increased risk of acute leukemia and biliary duct cancer. Joiners and cabinet-makers experienced a strong excess of sinonasal cancer and pleural mesothelioma. A slight excess of leukemia was observed for the whole group of graphic art workers. Reassuringly, no elevated risks were observed for lymphatic or hematopoietic cancers among chemical workers. Machinists and professional drivers experienced an elevated risk of lung cancer. Also documented was an excess of esophageal cancers. Locomotive engineers showed an excess risk of leukemia, and other railway workers had a doubled risk of pleural mesothelioma and about a threefold increased risk for bone cancer. Hotel and restaurant managers were at a high risk for all alcohol-related cancers. Chimney sweeps presented an excess risk of squamous-cell lung carcinoma. Hairdressers experienced a slight elevated risk for bladder cancer. Physicians had an excess of basal-cell carcinoma and melanoma and a lower risk of cancer at ill-defined sites. They also experienced higher risks of thyroid cancer and leukemia. Professors and teachers experienced a slight excess of myeloma. Both non-Hodgkin's lymphoma and leukemias were elevated for chemists. Also observed was an excess of uncommon cancers, such as bone and peritoneal cancers. Conclusions. This study presents the results of the first systematic analysis of incidence data on socioeconomic and occupational variations of cancer risks in the Swiss cancer registries. Despite limitations linked to occupational definitions, lack of national coverage, and statistical approach, this study provides interpretable results for additional research and public health surveillance.
To examine the relation between gastric cancer and occupation among men and women gainfully employed in 1970 in Sweden for the period 1971-89 and, more specifically, to evaluate whether any excess of incidence of gastric cancer had also occurred among the subcohort of people reporting the same occupation in 1960 and 1970.
In both sexes and cohorts, relative risks adjusted for age, period of diagnosis, and geographical risk area were computed for occupational codes specified at one, two, or three level (occupational sector, occupational group, and occupation, respectively). Relative risks were calculated with all other occupations as reference and then, to take socioeconomic status into account, solely other occupations within the same occupational sector were used.
Among men, occupations with increased risk included miners and quarrymen, construction and metal processing workers, supporting the possible causative role of dusty environments in stomach cancer. In men, the results also provide support for increased risks among electrical and mechanical engineers, fishermen, petrol station workers, motor vehicle drivers, butchers and meat preparers, dockers, freight handlers, launderers and dry cleaners. Furthermore, it is worth noting interesting results for women, whose occupational risks have been studied less. Excess risks were found for practical nurses, cashiers, bank employees, engineering and electronic industry workers, food industry, housekeeping and cleaning workers. Due to the many occupations studied, several significant associations may be expected by chance.
The study is explorative but provides support for the relations suggested previously between occupational exposure to dusty environments and stomach cancer, together with some new high risk occupations which should be further studied.
To investigate cancer incidence in workers exposed to high levels of extremely low frequency magnetic fields (ELF-MF).
A cohort based on the engineering industry was established. Industries assumed to use resistance welding in production were chosen in order to increase the prevalence of high exposed subjects and to reduce the influence of confounding factors. All men and women employed in these branches during 1985-94 were selected, 537 692 men and 180 529 women. Occupation, based on census information from 1980, 1985, and 1990, was linked to a job exposure matrix on ELF-MF. Four exposure groups were used by stratifying on mean workday ELF-MF exposure, using the lowest exposure group as reference. Cancer incidence was obtained by linkage to the Swedish Cancer Registry.
Men in the very high exposure group showed an increased incidence of tumours of the kidney, pituitary gland, and biliary passages and liver; for these cancer sites an exposure-response relation was indicated. Women in the very high exposure group showed an increased incidence of astrocytoma I-IV, with a clear exposure-response pattern. An association was suggested in the high exposure group only, for cancer of the corpus uteri and multiple myeloma. Decreased risks in the very high exposure group among men were found for cancer of the colon and connective tissue/muscle.
The results on cancer of the liver, kidney, and pituitary gland among men are in accordance with previous observations. Regarding brain tumours and leukaemia, the outcome for women provided further support of an association. The hypothesis of a biological mechanism involving the endocrine system was partly supported.
A study of all newly incident melanoma patients in British Columbia in 1991–1992 was undertaken to test the hypothesis raised by an earlier study, which showed that in younger patients the incidence rate of melanoma per unit area of skin was higher on intermittently exposed skin areas than on continuously exposed areas. Using 1,033 patients and a more detailed body site categorisation than was previously possible, our results confirmed that in both men and women under age 50 the highest melanoma density was on the back. At ages over 50, the greatest density occurred on fully exposed sites, such as the face, though the dorsum of the hand and forearm, likely also to have high exposure, show very low melanoma densities. Differences between males and females correlate well with differences in likely exposure patterns. These results were seen for all invasive cutaneous melanomas combined; the patterns were similar for subtypes and for both invasive and in situ melanoma, with the exception of lentigo maligna melanoma (LMM), which occurs almost exclusively on the face, even at younger ages. Comparison with the earlier study (1976–1979) shows that the age-standardised rates for melanoma excluding LMM have increased by 60%, with the greatest proportional increase being at younger ages; in the recent data, the age-standardised rate for intermittently exposed sites exceeds that for usually exposed sites. Our results confirm that intermittent sun exposure has a greater potential for producing melanoma than continuous exposure at ages below about 50, though at older ages melanoma is more common on body sites with continuous sun exposure. Int. J. Cancer 78:276–280, 1998.© 1998 Wiley-Liss, Inc.
There are few studies on cancer risks among female farmers, particularly on breast cancer and cancer in female genital organs. We have conducted a cohort study of cancer risk among 50,682 women with occupations in agriculture according to the Swedish 1970 census. The cohort was followed up in the nationwide, population-based, Cancer-Environment Register from 1 January 1971 until death or until 31 December 1987. Expected number of cases was based on annual cancer incidence in five-year age groups. The standardized incidence ratio (SIR) was computed as the ratio between observed and expected number of cases. A total of 4,474 cases of cancer were observed in the cohort from 1971 until 1987 cf 5,273 expected, resulting in a significantly decreased SIR of 0.85 (95 percent confidence interval [CI] = 0.82-0.87). SIR for breast cancer was significantly decreased (0.83, CI = 0.78-0.88), as was the SIR for cervix uteri (0.40, CI = 0.31-0.50). For the other female genital organs, SIR was close to one. Other cancer sites with significantly decreased SIRs were: colon (0.90, CI = 0.81-1.00); rectum (0.86, CI = 0.74-1.00); lung (0.46, CI = 0.37-0.57); kidney (0.81, CI = 0.68-0.97); urinary organs (0.57, CI = 0.45-0.72); connective tissue and muscle (0.62, CI = 0.39-0.95); and non-Hodgkin's lymphomas (0.78, CI = 0.63-0.96).
Aims: To investigate cancer incidence in workers exposed to high levels of extremely low frequency magnetic fields (ELF-MF).
Methods: A cohort based on the engineering industry was established. Industries assumed to use resistance welding in production were chosen in order to increase the prevalence of high exposed subjects and to reduce the influence of confounding factors. All men and women employed in these branches during 1985–94 were selected, 537 692 men and 180 529 women. Occupation, based on census information from 1980, 1985, and 1990, was linked to a job exposure matrix on ELF-MF. Four exposure groups were used by stratifying on mean workday ELF-MF exposure, using the lowest exposure group as reference. Cancer incidence was obtained by linkage to the Swedish Cancer Registry.
Results: Men in the very high exposure group showed an increased incidence of tumours of the kidney, pituitary gland, and biliary passages and liver; for these cancer sites an exposure–response relation was indicated. Women in the very high exposure group showed an increased incidence of astrocytoma I–IV, with a clear exposure–response pattern. An association was suggested in the high exposure group only, for cancer of the corpus uteri and multiple myeloma. Decreased risks in the very high exposure group among men were found for cancer of the colon and connective tissue/muscle.
Conclusions: The results on cancer of the liver, kidney, and pituitary gland among men are in accordance with previous observations. Regarding brain tumours and leukaemia, the outcome for women provided further support of an association. The hypothesis of a biological mechanism involving the endocrine system was partly supported.
Occupational mortality from cutaneous malignant melanoma was evaluated for deaths occurring in British Columbia from 1950–1978 by using age standardised proportional mortality ratios (PMR). For males, significantly elevated PMRs for melanoma were seen in managers and owners, accountants, architects, chemical engineers, and gardeners and nursery workers. Female school teachers were also at elevated risk of death from cutaneous melanoma.
Background:
The incidence of malignant melanoma is increasing rapidly. The risk for development of malignant melanoma has been reported to be higher in persons of higher socioeconomic status.
Methods:
This case-control study explores the relation between occupation and malignant melanoma relative risk through analysis of data collected by the American Cancer Society. A total of 1.2 million people were enrolled in a study of lifestyles and environmental factors in relation to mortality from cancer and other diseases. A total of 2780 persons had a history of malignant melanoma when the study began or developed malignant melanoma during the 6-year study follow-up period. The controls were matched for age, sex, race, and geographic location on an approximately 1:3 basis to persons selected from the remaining people enrolled.
Results:
In men, malignant melanoma risk was significantly higher in high-paying versus low-paying occupations (odds ratio [OR], = 1.58; P < 0.001) and in white-collar versus blue-collar occupations (OR = 1.33; P < 0.001). No significant conclusions could be drawn for women. No significant difference in risk was noted between those with indoor versus outdoor occupations. Among specific occupational exposures, only exposure to X-rays significantly raised malignant melanoma risk (OR = 1.37; P = 0.002).
Conclusion:
Upper pay scale and white-collar occupations significantly increase the risk for development of malignant melanoma.
The relationship between dietary habits and subsequent risk of cutaneous malignant melanoma (CMM) was studied in 25,708 men and 25,049 women aged 16-56 years attending a Norwegian health screening in 1977-1983. Linkage to the Cancer Registry of Norway and the Central Bureau of Statistics of Norway ensured a complete follow-up until December 31, 1992. Diet was recorded through a semi-quantitative food-frequency questionnaire at the time of screening, and 108 cases of CMM were identified during follow-up. Use of cod liver oil supplementation and intake of polyunsaturated fat were associated with significant increased risk and drinking coffee with significant decreased risk of CMM in women. Adjusting for height, body mass index, body surface area, education, smoking or occupational or recreational physical activity did not change the results. No significant association was found between the incidence of CMM and any of the dietary factors in men. Important aspects are residual confounding by sun exposure and social class, as well as concern with multiple comparisons. Int. J. Cancer 71:600-604, 1997. © 1997 Wiley-Liss, Inc.
The mortality profile of female nurses and teachers in British Columbia (BC) was examined using age-standardized proportional mortality ratios (PMRs) calculated for the period 1950–1984. Lowered overall mortality among nurses was seen for degenerative heart disease and for cerebrovascular accidents. Significantly elevated PMR values were observed for cancer of the breast and ovary in nurses of age 20–65 years. PMRs were significantly elevated for cancer of the pancreas and leukemia among those age 20 years and older. Elevated values were also observed for motor vehicle accidents and suicide among nurses in both age groups.
Lower than expected mortality from degenerative heart disease and cerebrovascular accidents was seen in working age teachers (age 20–65 years). However, elevated PMRs were detected for carcinoma of the colon, breast, endometrium, brain, and melanoma. Among those 20 years and over, significantly elevated PMRs were also observed for cancers of the ovary and other digestive organs. Elevated PMRs were found for motor vehicle and aircraft accidents.
Mortality from cirrhosis of the liver was lower than anticipated in both teachers and nurses.
A number of significant PMRs declined when deaths of “homemakers” were withdrawn from the comparison group used to generate PMR values, suggesting that risk of death from various causes among women working outside the home differ from those seen in women who are predominantly in the home.
The relationship between tumour incidence rate and habitation patterns was investigated in 3289 patients registered between 1959 and 1968 as cutaneous malignant melanoma in the Swedish Cancer Registry. A linear correlation analysis between latitude and melanoma incidence rate in various regions showed a coefficient, r, was -0.74, which implies a decreasing incidence with increasing latitude. This result supports the hypothesis that ultraviolet irradiation is the predominant cause of melanoma. However, considerable deviations from the regression line were seen in some regions. Moreover, a comparison between town and country indicated melanoma incidence increased with population density, an increase not explained by overdiagnosis and thus not in agreement with the working hypothesis of UV-irradiation as the predominant cause of melanoma. Increase of foreign travel, as estimated by passport issue, may explain the overrepresentation of melanoma in some regions namely city and county of Stockholm, city of Malmö and Göteborg county. As foreign travel in Sweden generally means sunshine trips, this town versus country paradox may also be explained on the basis of increased irradiation, as may the anomalies observed in some counties. A regression analysis of the epidemiological index for UV-irradiation and melanoma incidence, adjusted for foreign travel, demonstrated a close agreement with the results of the latitude gradient analysis.
Although sun exposure is believed to be associated causally with cutaneous melanoma, the high incidence on less sun-exposed areas such as the back, as well as on chronically exposed sites such as the face, suggests that the association with sunlight is less straightforward than for other skin cancers. To explain this enigmatic site distribution, a theory of site-dependent susceptibility of melanocytes to malignant transformation is proposed. As possible evidence, all melanomas diagnosed in the state of Queensland, Australia, over a one-year period were surveyed for histologic evidence of benign melanocytic nevus cells adjacent to the melanoma, and analyzed according to anatomic distribution. Results showed a regional variation in the proportion of melanomas with adjacent nevi not explicable by regional variation in nevus density, which suggests that there is a varying susceptibility of nevi to malignant change. Given that nevus cells are equivalent to melanocytes, this finding would support the hypothesis that melanocytes at-large have a differential response to the mitogenic stimulus of sunlight according to anatomic site.
Southern travelling habits were recorded for 127 melanoma patients from southern parts of Sweden (the 56th latitude), 55 thyroid cancer patients, 100 non-Hodgkin's patients and 794 healthy controls from the same region. Melanoma patients were found to travel significantly more often south of the 45th latitude, as compared with patients with non-Hodgkin's lymphoma or thyroid carcinoma (RR = 2.2 for a difference of + 10 trips), and with the healthy controls (RR = 1.4 for a difference of + 10 trips). Considering men and women separately, the difference was significant only for men. Patients with melanoma had a higher educational level than the tumour controls and the healthy controls (p < 0.001 and p < 0.001 respectively). There was a significant correlation between high travelling frequency and high education. An increased risk related to southern travelling was present for patients with melanoma on the extremities and head and neck, as well as for patients with truncal melanoma. These findings support the concept that acute exposure to sunburn may be a risk factor for malignant melanoma.
Although the sun remains the main source of ultraviolet radiation (UVR) exposure in humans, the advent of artificial UVR sources has increased the opportunity for both intentional and unintentional exposure. Intentional exposure is most often to tan the skin. People living in less sunny climates can now maintain a year-round tan by using sunbeds and solaria emitting principally UVA radiation. Another reason for intentional exposure to artificial UVR is treatment of skin diseases, notably psoriasis. Unintentional exposure is normally the result of occupation. Outdoor workers, such as farmers, receive three to four times the annual solar UV exposure of indoor workers. Workers in many industries, eg, photoprinting or hospital phototherapy departments, may be exposed to UVR from artificial sources. One group particularly at risk is electric arc welders, where inadvertent exposure is so common that the terms "arc eye" or "welders flash" are often used to describe photokeratitis. In addition to unavoidable exposure to natural UVR, the general public is exposed to low levels of UVR from sources such as fluorescent lamps used for indoor lighting and shops and restaurants where UVA lamps are often used in traps to attract flying insects.
A case-control approach has been used to examine mortality from five cancers--oesophagus, pancreas, cutaneous melanoma, kidney, and brain--among young and middle aged men resident in three English counties. The areas studied were chosen because they include major centres of chemical manufacture. By combining data from 20 years it was possible to look at local industries with greater statistical power than is possible using routine national statistics. Each case was matched with up to four controls of similar age who died in the same year from other causes. The occupations and industries recorded on death certificates were coded to standard classifications and risk estimates derived for each job category. Where positive associations were found the records of the cases concerned were examined in greater detail to see whether the risk was limited to specific combinations of occupation and industry. The most interesting findings to emerge were risks of brain cancer associated with the production of meat and fish products (relative risk (RR) = 9.7, 95% confidence interval (CI) 2.6-36.8) and with mineral oil refining (RR = 2.9, CI 1.2-7.0), and a cluster of four deaths from melanoma among refinery workers (RR = 16.0, CI CI 1.8-143.2). A job-exposure matrix was applied to the data but gave no strong indications of further disease associations. Local analyses of occupational mortality such as this can usefully supplement national statistics.
Oral contraceptives now taken regularly by millions of women produce may cutaneous side effects. This review discusses those which seem clearly related to the taking of the medication— melasma, acne, genital moniliasis, photosensitivity, telangiectasis, herpes gestationis, and alopecia— and those in which the association is probable— namely, erythema nodosum, purpura, and the lupus erythematosus syndrome.
Reported association with other conditions, including alopecia areata, hypertrophic gingivitis, and malignant melanoma, is discussed, although the putative evidence for the relationship between these diseases and oral contraceptives seems adequately explainable by chance.
The possible mechanisms of the various side effects is discussed, and, where appropriate, therapeutic modalities are outlined.
Between the early 1960s and the late 1980s, the incidence of melanoma increased at a rate of 3-7% per year in populations of mainly European origin. Corresponding trends were observed in mortality. Higher rates of increase in incidence were observed in a few populations (eg 8.9% per year in Hawaii whites). With the exception of Japan and possibly Puerto Rico, incidence rates of melanoma have remained stable in the few populations of mainly non-European origin for which reliable incidence data were available. A comparison of age specific trends in incidence and mortality in populations of mainly European origin showed two general patterns: a continuous increase in incidence in all age groups but with moderation or cessation of the previous rising trend in mortality in younger people in more recent time periods (eg Canada, continental USA, Denmark and the UK) and recent moderation or cessation of both incidence and mortality trends in younger people (eg New Zealand and, possibly, Hawaii whites). The first of these two patterns appeared to be the most common. Studies of site specific trends in incidence in 13 populations indicate that the highest rates of increase have generally been for melanomas on the trunk and the lowest for those on the head and neck. There is weak evidence to suggest that the rate of increase on the lower limbs has been greater in women than in men. Studies of incidence trends in the 1980s by thickness of melanoma in seven populations show that relative and absolute incidence has increased most for the thinnest melanomas and least for the thickest lesions. Increasing detection, earlier diagnosis and a real rise may together explain the increase in incidence of melanoma. The increases in mortality suggest that incidence has really increased, and the recent moderation in mortality trends may be explained by improved survival from melanoma due, most likely, to increasingly early diagnosis. In some populations, it may also indicate that the incidence increases are coming to an end. The disproportionately increasing incidence of thin melanoma, the divergence between incidence and mortality trends and the recent sharp increases in incidence in some populations suggest that earlier diagnosis or greater detection of less aggressive melanomas may have contributed to the incidence trends. A progressive change from predominantly occupational to predominantly recreational patterns of sun exposure is the most likely cause of increasing real incidence of melanoma in populations of mainly European origin.
There are few studies on cancer risks among female farmers, particularly on breast cancer and cancer in female genital organs. We have conducted a cohort study of cancer risk among 50,682 women with occupations in agriculture according to the Swedish 1970 census. The cohort was followed up in the nationwide, population-based, Cancer-Environment Register from 1 January 1971 until death or until 31 December 1987. Expected number of cases was based on annual cancer incidence in five-year age groups. The standardized incidence ratio (SIR) was computed as the ratio between observed and expected number of cases. A total of 4,474 cases of cancer were observed in the cohort from 1971 until 1987 cf 5,273 expected, resulting in a significantly decreased SIR of 0.85 (95 percent confidence interval [CI] = 0.82-0.87). SIR for breast cancer was significantly decreased (0.83, CI = 0.78-0.88), as was the SIR for cervix uteri (0.40, CI = 0.31-0.50). For the other female genital organs, SIR was close to one. Other cancer sites with significantly decreased SIRs were: colon (0.90, CI = 0.81-1.00); rectum (0.86, CI = 0.74-1.00); lung (0.46, CI = 0.37-0.57); kidney (0.81, CI = 0.68-0.97); urinary organs (0.57, CI = 0.45-0.72); connective tissue and muscle (0.62, CI = 0.39-0.95); and non-Hodgkin's lymphomas (0.78, CI = 0.63-0.96).
This article presents the preliminary results of a follow-up study (1950-1992) of 1,146 subjects (person-years = 30,954; 23,055 for women) receiving compensation for mercury poisoning. In a province of Tuscany in central Italy, severe exposure to mercury occurred during fur hat production. A deficit in all causes of mortality was observed in both sexes, whereas mortality due to cancer was slightly higher than expected. Mortality from stomach cancer was significantly elevated for men and women. A significant excess of lung cancer was observed in women only. Whereas the excess of stomach cancer probably reflects elevated rates in the study area rather than exposure to mercury, the excess of lung cancer mortality does appear to be related to mercury exposure. Smoking habits or other exposures at work do not seem to explain the excess of lung cancer.
Normal human melanocytes were cultured selectively with F12 culture medium supplemented with growth hormones, phorbol ester and 1% of fetal calf serum. The estrogen receptors were analyzed using hydroxylapatite-column assay with tritiated 17-beta-estradiol as the binding ligand. Phenol red- free medium was used when the changes in cell numbers, melanin content and tyrosinase were assessed after incubating with physiological concentration of 17-beta estradiol (10(-12) and 10(-9) M). It was found that the melanocytes contained both cytosol (5.42 +/- 1.11 fmol/mg protein) and nuclear (59.13 +/- 17.12 fmol/mg protein) estrogen receptor. In response to estradiol, the cell number increased but both the melanin content and the tyrosinase activity decreased in a dose related pattern. These data suggested the presence of estrogen receptor with biological function in normal human melanocytes.
Several studies have reported excesses of risk of melanoma in specific industries. Data from a case-control study in The Netherlands, including 140 cases with a cutaneous melanoma and 181 controls with other types of malignancy, were used to evaluate whether the reported associations with these specific industries could be reproduced. Adjustment for characteristics of pigmentation and exposure to sunlight was made. Increased risks of cutaneous melanoma were found for subjects who had ever worked in the electronics industry (odds ratio (OR) = 2.03, 95% confidence interval (95% CI) 0.63-6.62), in the metal industry (OR = 2.61, 95% CI 0.96-7.10), and in the transport and communication branch (OR = 1.92, 95% CI 0.84-4.35). These ORs were adjusted for age, sex, education, hair colour, tendency to burn, freckling, and exposure to sunlight. No increased risks were seen for workers in the chemical industry, the textile industry, and among health care workers. Analyses according to duration and latency of exposure did not give consistent results, but existing patterns may be obscured by the imprecision of the estimates.
A population-based linked-registry was used to evaluate incidence of malignant melanoma of the skin among Swedish men by industry and occupation. There were 3850 cutaneous melanoma cases identified in the 19-year follow-up of men employed in 1960. New associations were observed for men employed in the breweries and malt-processing industry and in shoe fabrication from leather and skins. Several findings supported associations previously reported in other countries, including an excess risk among workers in basic chemical production and the printing industry and among professional, technical, and white-collar workers. Risk overall was not increased among farmers, despite a significant excess of melanoma of the face, neck, and scalp. Although this linked registry analysis lacked information about specific agents, duration of employment, and occupational and recreational sun exposures, it did provide leads for new associations and confirmed previous ones. Nevertheless, because of these limitations, etiologic clues must be interpreted cautiously.
A case-control analysis of cancer registry data was used to examine the hypothesis that occupational exposure to sunlight influences the risk of melanoma. Occupation at diagnosis was available for 3,527 cutaneous melanomas and 53,129 other cancers identified by the Los Angeles County (California, United States) Cancer Surveillance Program among non-Spanish-surnamed White males aged 20 to 65 years between 1972 and 1990. Occupational exposure to sunlight was assessed by blinded expert coding of job titles as indoor, outdoor, and mixed indoor/outdoor. Relative to indoor occupations, proportionate odds ratios (OR) adjusted for age, level of education, and birthplace were 1.16 (95 percent confidence interval [CI] = 1.07-1.27) for indoor/outdoor occupations and 1.15 (CI = 0.94-1.40) for outdoor occupations. However, increasing levels of the education or training required for the occupation was associated more strongly with increased melanoma occurrence (ORs adjusted for age, occupational sun exposure, and birthplace, were 1.0, 1.63, 2.09, 2.23, and 2.99 for low-skill occupation, high school, college, postgraduate, and doctoral levels, respectively). Analysis of melanoma occurrence by job titles confirmed a clear variation by the required education or training level but not by the category of occupational sunlight exposure. The findings suggest that lifestyle factors associated with higher levels of education may be more important determinants of melanoma risk than characteristics of the work environment.
Mortality studies have suggested that workers in the printing industry may have a higher incidence of malignant melanoma. The aim of this study was to assess the incidence of malignant melanoma among lithographers.
A cohort of 837 lithographers, born in 1933-1942, was followed in the Danish Cancer Register from 1974 to 1989.
Five cases of malignant melanoma were found, with 1.5 expected (relative risk 3.4, 95% confidence interval 1.2-7.5).
Many known and suspected carcinogens are used in the printing industry. Hydroquinone, used for photographic development, may be implicated in the observed increase in risk, as it causes depigmentation and changes in melanocytes in the skin.
The relationship between dietary habits and subsequent risk of cutaneous malignant melanoma (CMM) was studied in 25,708 men and 25,049 women aged 16-56 years attending a Norwegian health screening in 1977-1983. Linkage to the Cancer Registry of Norway and the Central Bureau of Statistics of Norway ensured a complete follow-up until December 31, 1992. Diet was recorded through a semi-quantitative food-frequency questionnaire at the time of screening, and 108 cases of CMM were identified during follow-up. Use of cod liver oil supplementation and intake of polyunsaturated fat were associated with significant increased risk and drinking coffee with significant decreased risk of CMM in women. Adjusting for height, body mass index, body surface area, education, smoking or occupational or recreational physical activity did not change the results. No significant association was found between the incidence of CMM and any of the dietary factors in men. Important aspects are residual confounding by sun exposure and social class, as well as concern with multiple comparisons.
A study of all newly incident melanoma patients in British Columbia in 1991-1992 was undertaken to test the hypothesis raised by an earlier study, which showed that in younger patients the incidence rate of melanoma per unit area of skin was higher on intermittently exposed skin areas than on continuously exposed areas. Using 1,033 patients and a more detailed body site categorisation than was previously possible, our results confirmed that in both men and women under age 50 the highest melanoma density was on the back. At ages over 50, the greatest density occurred on fully exposed sites, such as the face, though the dorsum of the hand and forearm, likely also to have high exposure, show very low melanoma densities. Differences between males and females correlate well with differences in likely exposure patterns. These results were seen for all invasive cutaneous melanomas combined; the patterns were similar for subtypes and for both invasive and in situ melanoma, with the exception of lentigo maligna melanoma (LMM), which occurs almost exclusively on the face, even at younger ages. Comparison with the earlier study (1976-1979) shows that the age-standardised rates for melanoma excluding LMM have increased by 60%, with the greatest proportional increase being at younger ages; in the recent data, the age-standardised rate for intermittently exposed sites exceeds that for usually exposed sites. Our results confirm that intermittent sun exposure has a greater potential for producing melanoma than continuous exposure at ages below about 50, though at older ages melanoma is more common on body sites with continuous sun exposure.
To study the carcinogenicity of inorganic mercury in humans.
We studied the mortality from cancer among 6784 male and 265 female workers of four mercury mines and mills in Spain, Slovenia, Italy and the Ukraine. Workers were employed between the beginning of the century and 1990; the follow-up period lasted from the 1950s to the 1990s. We compared the mortality of the workers with national reference rates.
Among men, there was no overall excess cancer mortality; an increase was observed in mortality from lung cancer (standardized mortality ratio [SMR] 1.19, 95 percent confidence interval [CI] 1.03-1.38) and liver cancer (SMR 1.64, CI 1.18-2.22). The increase in lung cancer risk was restricted to workers from Slovenia and the Ukraine: no relationship was found with duration of employment or estimated mercu ry exposure. The increase in liver cancer risk was present both among miners and millers and was stronger in workers from Italy and Slovenia: there was a trend with estimated cumulative exposure but not with duration of employment, and the excess was not present in a parallel analysis of cancer incidence among workers from Slovenia. No increase was observed for other types of cancer, including brain and kidney tumours. Among female workers (Ukraine only), three deaths occurred from ovarian cancer, likely representing an excess.
Exposure to inorganic mercury in mines and mills does not seem strongly associated with cancer risk, with the possible exception of liver cancer; the increase in lung cancer may be explained by co-exposure to crystalline silica and radon.
Occupational causes of cancer have not been well-evaluated among women. An increase in the number of women in the work force in jobs with potentially hazardous exposures during the past few decades raises the question as to whether there is a need to enhance our efforts in this area. The inability to evaluate occupational causes of female gynecologic tumors in studies of men, plus the potential for variation in outcome responses between men and women because of gender-based exposure and susceptibility differences, underscore the need for investigations specifically focused on women. Investigations of occupational exposures and cancer risk among women may require design considerations that differ somewhat from studies of men. Issues to consider include the impact of studying outcomes with high survival (e.g., breast cancer), gender-specific exposure patterns and toxicokinetic processing of some chemicals, special limitations in the use of the general population as the referent, and the need to control for established risk factors for gynecologic tumors.
Based on 1,596,959 men and 806,278 women, site-specific cancer incidence during 1971 through 1984 was analyzed in relation to occupational magnetic field exposure. The objective was to explore potential associations for cancer diseases beyond those extensively studied before (leukemia and brain tumors).
Exposure was assessed from Census information on occupations that were linked to a job exposure matrix based on measurements. In a basic analysis, three levels of exposure were used. In addition, subjects with a more definite low exposure were compared with an aggregate of occupations with more definite exposures.
Observed associations were weak and there were no evident exposure-response relationships. For all cancer, an approximate 10% increase in risk was seen in the medium and high exposure groups. Several types of cancer were associated with exposure among men, including cancer of the colon, biliary passages and liver, larynx and lung, testis, kidney, urinary organs, malignant melanoma, non-melanoma skin cancer, astrocytoma III-IV. For women, associations were seen for cancer of the lung, breast, corpus uteri, malignant melanoma and chronic lymphocytic leukemia.
In the analysis of occupations with a more definite exposure, the most notable finding for men was an increased risk of testicular cancer in young workers, and for women a clear association emerged for cancer of the corpus uteri. The outcome suggests an interaction with the endocrine/immune system.
The association between arsenic ingestion and cancer has been documented for more than a century. Previous studies showed that the carcinogenic effects of arsenic on the urinary system are cell-type specific. To evaluate whether this is also true for skin cancers, we conducted an ecological study in 243 townships in Taiwan.
The arsenic exposure was assessed on the basis of measurement reports from a previous survey, and cases of skin cancer were identified using the information gathered by the National Cancer Registry Program. We analyzed the data by regression models using multiple variables to describe the exposure status, and an urbanization index was also included in the models to adjust for the effects of urbanization.
A total of 2369 patients with skin cancer, comprising 1415 men and 954 women, were registered between 1 January 1980 and 31 December 1989. Among the three major cell types of skin cancer, squamous cell carcinoma and basal cell carcinoma appear to be associated with ingestion of arsenic. Such an association was not observed for malignant melanoma.
The results suggested that the carcinogenicity of arsenic on skin is cell-type specific, which is compatible with the findings in previous studies on urinary cancers.
Background For more than 200 years, it has been known that exposure incurred during worklife can lead to increased cancer risk. In Switzerland, only mortality risks by occupation have been studied systematically so far. Five of the eight Swiss regional cancer registries, covering approximately 40% of the Swiss population, record the occupation for cancer patients systematically. Based on these incidence data, the current study presents an overview of cancer risk patterns by socioeconomic status and occupation in Switzerland. Materials and methods The study comprised all male patients ≥ 25 years of age with invasive cancer recorded in the cantons of Basel, Geneva, St Gall, Vaud, and Zurich. The study included 58 134 incident cancer cases for the period 1980-1993, the length of participation varying by registry. Because of the lack of concordance in both the definition and sources of information on occupation between the census and incident case data, population denominators were not available. Consequently, analyses were performed by the case-referent approach, considering the cancers of interest as cases and all other cancers as referents. The odd ratios for cancer were adjusted for age, registry, type of residence area, and nationality. Socioeconomic status was represented by an indicator based on the grouping of occupations by their alleged status. With the use of this indicator, socioeconomic variations in cancer risk and residual occupational variation after adjustment for socioeconomic status were calculated. Results and discussion by site Large socioeconomic differences in cancer risks were observed. Risks of tobacco- and alcohol-related cancers correlated negatively with socioeconomic status. On the contrary, risks of melanoma and other cancers of the skin, colon, prostate, testis, and kidney were associated with a high socioeconomic status. In general, adjustment for socioeconomic status attenuated the range of the occupation-specific risks. Farmers had the highest risk of lip cancer; indoor occupations typically showed a lower risk. This finding fits the actual knowledge on lip cancer etiology. Elevated risk for upper aerodigestive cancers was observed among workers with easy access to alcoholic beverages at the workplace, such as cooks, and generally also in occupations related to construction. Professionals and teachers showed a particularly low risk. After adjustment for socioeconomic status, increased risks appeared for artistic occupations. The higher risks of stomach cancer were observed for farmers and workers in the building and chemical industries. White-collar occupations typically showed lower risks. After adjustment for socioeconomic status, only the excess risk for chemical workers persisted. Slightly elevated risks for colon cancer were generally found for sedentary occupations, such as engineers, entrepreneurs, managers and teachers, in contrast to lower risks for farmers and construction workers. The highest risks for liver cancer were observed for workers in hotel and catering and for cooks and plasterers. Adjustment for socioeconomic status enhanced the elevated risk for dentists. Very high relative risks for sinonasal cancer were observed for leather workers, joiners, and cabinetmakers and, to a lesser extent, for turners.
In response to concerns about cancer stemming from drinking water contaminated with ammonium perchlorate and trichloroethylene, we assessed observed and expected numbers of new cancer cases for all sites combined and 16 cancer types in a California community (1988 to 1998). The numbers of observed cancer cases divided by expected numbers defined standardized incidence ratios (SIRs) and 99% confidence intervals (CI). No significant differences between observed and expected numbers were found for all cancers (SIR, 0.97; 99% CI, 0.93 to 1.02), thyroid cancer (SIR, 1.00; 99% CI, 0.63 to 1.47), or 11 other cancer types. Significantly fewer cases were observed than expected for cancer of the lung and bronchus (SIR, 0.71; 99% CI, 0.61 to 0.81) and the colon and rectum (SIR, 0.86; 0.74 to 0.99), whereas more cases were observed for uterine cancer (SIR, 1.35; 99% CI, 1.06 to 1.70) and skin melanoma (SIR, 1.42; 99% CI, 1.13 to 1.77). These findings did not identify a generalized cancer excess or thyroid cancer excess in this community.
Paclitaxel is a recent antineoplastic agent that belongs to the taxane family. Its activity has been demonstrated in advanced and refractory ovarian, breast, lung, and head and neck cancer. Adverse cutaneous reactions to paclitaxel have been reported, namely bullous fixed drug eruption, onycholysis, acral erythema, erythema multiforme, and pustular eruption. We report the first case of scleroderma-like changes after paclitaxel administration. A 63-year-old patient presented with an edematous and infiltrated erythema of the head, neck, axillae, and left hand 10 days after administration of paclitaxel and paraplatin for primitive peritoneal cancer. Cutaneous lesions improved after a change from paclitaxel to cyclophosphamide. Cutaneous lesions recurred 3 months later, after reintroduction of paclitaxel, and progressively evolved to cutaneous sclerosis. Skin biopsy showed a dermal fibrosis. Biologic tests revealed no autoimmunity. Scleroderma-like lesions of this patient were reminiscent of previously reported cases that occurred after administration of docetaxel, which also belongs to the taxan family. Thus, scleroderma-like syndromes seem to represent a unique cutaneous adverse event caused by taxanes.