Is occupational solar ultraviolet irradiation a relevant risk factor for basal cell carcinoma? A systematic review and meta-analysis of the epidemiological literature

ArticleinBritish Journal of Dermatology 165(3):612-25 · May 2011with37 Reads
DOI: 10.1111/j.1365-2133.2011.10425.x · Source: PubMed
Abstract
The most important risk factor for basal cell carcinoma (BCC) is ultraviolet (UV) radiation. It is reasonable to assume that outdoor workers with a long history of work-related UV exposure are at increased risk of developing BCC. To analyse systematically the epidemiological literature concerning the evidence of an association between occupational UV exposure and BCC risk in outdoor workers. Systematic literature review of cohort studies and case-control studies providing data on occupational UV exposure and BCC occurrence. PubMed (up to 28 January 2011) was searched, supplemented by hand searching and consultation of experts in the field. The association between occupational UV exposure and BCC risk is presented as odds ratios (ORs). A random-effects meta-analysis and sensitivity analysis including meta-regression on study-specific covariates were performed. Twenty-four relevant epidemiological studies (five cohort studies, 19 case-control studies) were identified. Twenty-three studies reported sufficient data to be included in the meta-analysis. The pooled OR for the association between outdoor work and BCC risk was 1·43 (95% confidence interval 1·23-1·66; P = 0·0001). Studies adjusting for sex (P < 0·0001) and individual nonoccupational UV exposure (P = 0·014) showed a significantly stronger association of occupational UV exposure and BCC risk. Meta-regression revealed a significant inverse relationship between occupational UV radiation exposure and BCC risk with latitude (P = 0·015). Published epidemiological literature indicates that outdoor workers are at significantly increased risk for BCC. This finding is highly relevant for health policy to stimulate the implementation of effective prevention strategies.
    • "BCC represents 80% of non-melanoma skin cancers and is the most common cancer among Cau- casians [16, 17] . Bauer et al. showed an increased frequency of BCC in people with occupations involving excessive sun exposure (farm laborers, fishermen, sailors, builders, pilots of aircraft) [18] . Up to 80% of all the lesions are found on the head and neck (30% nose, cheek 22%, 15% forehead, periorbital 5%, 4% scalp, neck 4%, etc.) [19] The pathogenesis of basal cell carcinomas involves the following factors: "
    [Show abstract] [Hide abstract] ABSTRACT: Basal cell carcinoma (BCC) is a malignant tumor with slow extension and local malignancy, with an exceptionally rare metastatic potential. BCC incidence is continuously increasing and there are geographical variations, the highest values being reported in Australia. The following are involved in BCC pathogenesis: actinic radiation, ionizing radiation, genetic factor, chemical carcinogens, immunosuppression, smoking etc. Actinic radiation is the main etiologic factor. There are multiple mechanisms of photocar-cinogenesis, without being fully elucidated yet. Changing the attitudes towards the sun (tanning fashion), increased life expectancy and the presence of immunosuppression (organ transplant, HIV / AIDS) are factors that will further contribue to the increased incidence of BCC. Open Access Article carcinom bazocelular, epidemiologie, factori de risc Rezumat Carcinomul bazocelular (CBC) este o tumoră cu extensie lentă şi malignitate locală, având potențial excepțional de rar de metastazare. Incidența CBC este în continuă creștere și există variații geografice, cele mai mari valori ra-portându-se în Australia. În etiopatogenia CBC sunt implicaţi următorii facto-ri: radiaţiile actinice, radiaţiile ionizante, factori genetici, carcinogeni chimici, imunodepresia, fumatul etc. Radiațiile actinice reprezintă principalul factor etiologic. Mecanismele intime ale fotocarcinogenezei sunt multiple, fără a fi încă elucidate. Modificarea atitudinii față de soare (moda bronzării), creșterea speranței de viață și circumstanțele prezenței imunodepresiei (transplant de organe, infecția HIV/SIDA) sunt factori care vor contribui în continuare la creșterea incidenței CBC.
    Full-text · Article · Mar 2016 · Journal of photochemistry and photobiology. B, Biology
    • "Outdoor workers, including most ecological workers, spend time outdoors increasing exposure to ultraviolet light [41]. Since the ecological workers described in this paper are mainly outdoors working with natural and managed ecosystems, UV exposure is an occupational risk, predisposing such workers to higher rates of both basal and squamous cell carcinoma compared with indoor workers [42,43]. These cancers and the underlying keratosis are being recognized as compensable occupational diseases [44]. "
    Article · Jan 2016 · Journal of photochemistry and photobiology. B, Biology
    • "Skin and eye UVR exposure limits have been recommended for working situations [1] . These limits (≤1.3 SED/8 h working day) are often exceeded, especially among outdoor workers2345678910, who have also been found to have an increased risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)111213. Several studies throughout the world have tried to map people's UVR exposure. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The main risk factor for skin cancer is ultraviolet radiation (UVR). Farming families living in rural areas with easy outdoor access may experience excessive UVR exposure. Differences between countries in latitude, altitude and sun behaviour could result in different personal UVR exposures. However, no studies have examined this until now. Objectives: To determine personal UVR exposure in work and leisure situations among farming families in Europe. Methods: Prospective cohort study of farmers, their partners (spouses) and children in Denmark (DK), Poland (PL), Austria (AT), and Spain (ES) from 2009 to 2011. Personal UVR exposure and sun behaviour were recorded by dosimetry and diaries. Results: Farmers' average daily UVR exposure on working days ranged from 1.4 SED (DK, AT) to 2.7 SED (ES). Corresponding figures for partners were: 0.6 SED (DK) to 1.9 SED (PL), and for children (day-care/school days): 0.7 SED (ES) to 1.3 SED (PL). Discussion and conclusions: Farmers' UVR exposure was comparable to that of outdoor workers in previous studies and exceeded the recommended UVR exposure limits on 36% (DK, AT), 29% (PL) and 56% (ES) of their working days. Attention to sun protection for outdoor workers across Europe in preventing UVR-induced skin cancer is still needed.
    Full-text · Article · Oct 2015
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