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

Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
British Journal of Dermatology (Impact Factor: 4.28). 05/2011; 165(3):612-25. DOI: 10.1111/j.1365-2133.2011.10425.x
Source: PubMed


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.

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    • "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 workers [2] [3] [4] [5] [6] [7] [8] [9] [10], who have also been found to have an increased risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) [11] [12] [13]. "
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    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 · Journal of photochemistry and photobiology. B, Biology
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    • "Given the primary role of early and long-term sun exposure in BCC, outdoor workers—particularly farmers—are at much greater risk of developing BCC. Indeed, outdoor workers are 43 % more likely to develop BCC (Bauer et al. 2011). However, as one recent review reported (Kearney et al. 2014), studies on farm workers, sun safety behaviour , and skin cancer are scant. "
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    ABSTRACT: Introduction Skin cancer is the most commonly diagnosed cancer type worldwide, and 80 % of skin cancers are basal cell carcinoma (BCC). The main risk factor for developing BCC is exposure to ultraviolet radiation (UVR), particularly high-dose exposure at a young age. Outdoor workers, particularly farmers, are at high risk of developing BCC. However, studies of BCC in this population are scant. Objective To comprehensively evaluate all cases of BCC of the head and neck region treated during the years 2007–2013 at our hospital in Poland, and to compare the tumour characteristics in farmers to non-farmers. Materials and methods Retrospective analysis of 312 patients treated for head and neck BCC during the study period (2007–2013). Results Most patients (198 cases; 63 %) were males, with 114 females (37 %). Median age was 73 years (range 32–96 years). The most common tumour location was the nose and cheek (114 pts; 37 %) followed by the auricle (82 pts; 26 %), lips (54 pts; 18 %), scalp (26 pts; 8 %), and eye (36 pts; 12 %). The most common disease stage on presentation was stage T2 (104 pts, 33 %), followed by stage T1 (79 pts; 25 %), stage T3 (89 pts; 28 %), and stage T4 (40 pts; 14 %). By occupation, farmers accounted for 33 % of all patients (102 of 312 pts). The most common tumour localisations in the farmer subgroup were the nose and cheek (50 pts; 49 %; p < 0.001; odds ratio [OR] 2.19; 95 % confidence interval [CI] 1.35–3.57), followed by the auricle (32 pts; 31 %), scalp (16 pts; 16 %), ocular region (3 pts; 3 %), and lips (1 pt; 1 %). Patients in the farmer group were significantly younger than non-farmers (62 vs. 73 years; p < 0.001; OR 0.90, 95 % CI 0.88–0.93). Farmers were significantly more likely to present disease recurrence (27 vs. 12 % of cases; p < 0.001; OR 5.94; 95 % CI 2.86–12.33). Conclusion The results highlight the increased incidence and risk of recurrence of BCC in farmers. It is therefore necessary to consider enhancing educational programmes and other preventative measures in this occupational group and to evaluate the effectiveness of such programmes.
    Full-text · Article · Oct 2015 · International Archives of Occupational and Environmental Health
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    • "Entomologists are exposed to more generic field, laboratory and office exposures such as extreme temperature, traffic accidents , solar radiation, musculoskeletal and psychosocial problems, and hazards associated with other animals, such as snakes (International Labor Organization, 2012). These may lead to a range of adverse health outcomes, from direct associations, such as skin cancer from prolonged sun exposure in field work (Bauer et al., 2011; Schmitt et al., 2011), to less tangible postural and overuse problems with intensive microscopy. Despite the high theoretical risk of adverse work-related health outcomes for entomologists, no systematic review has been conducted to provide high level evidence of such a risk. "
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    ABSTRACT: Adverse work-related health outcomes are a significant problem worldwide. Entomologists, including arthropod breeders, are a unique occupational group exposed to potentially harmful arthropods, pesticides, and other more generic hazards. These exposures may place them at risk of a range of adverse work-related health outcomes. To determine what adverse work-related health outcomes entomologists have experienced, the incidence/prevalence of these outcomes, and what occupational management strategies have been employed by entomologists, and their effectiveness. A systematic search of eight databases was undertaken to identify studies informing the review objectives. Data pertaining to country, year, design, work-exposure, adverse work-related health outcomes, incidence/prevalence of these outcomes, and occupational management strategies were extracted, and reported descriptively. Results showed entomologists experienced work-related allergies, venom reactions, infections, infestations and delusional parasitosis. These related to exposure to insects, arachnids, chilopods and entognathans, and non-arthropod exposures, e.g. arthropod feed. Few studies reported the incidence/prevalence of such conditions, or work-related management strategies utilised by entomologists. There were no studies that specifically investigated the effectiveness of potential management strategies for entomologists as a population. Indeed, critical appraisal analysis indicated poor research quality in this area, which is a significant research gap. Entomologists are a diverse, unique occupational group, at risk of a range of adverse work-related health outcomes. This study represents the first systematic review of their work-related health risks. Future studies investigating the prevalence of adverse work-related health outcomes for entomologists, and the effectiveness of management strategies are warranted to decrease the disease burden of this otherwise understudied group. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Jul 2015 · Environmental Research
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