Artikel
Occupational sun exposure and basal cell carcinoma – a systematic review with meta-analysis
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Autoren
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Ulrich Bolm-Audorff
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Henriette Rönsch
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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David Reißig
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Stefanie Deckert
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus der TU Dresden, Dresden, Germany
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Karla Romero Starke
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Andreas Seidler
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| Veröffentlicht: | 6. September 2024 |
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Gliederung
Text
Introduction: Basal cell carcinoma (BCC) is the most common cancer in Germany and causes high costs in the healthcare sector. The most important risk factor is ultraviolet radiation (UVR). Outdoor workers are exposed to high occupational doses of UVR. Previous systematic reviews partially, but not consistently, show an association between occupational UV exposure and BCC risk.
Method: The aim of this systematic review is to evaluate and summarize the findings on the association between occupational solar UV exposure and BCC risk. The study protocol was registered a priori in PROSPERO (CRD42020210543). Searches of the Medline and Embase databases, hand searching, citation tracking, data extraction, and risk of bias assessment were performed independently by at least two review authors. Cohort and case-control studies with a response rate >10% were included. We conducted meta-analyses for the association of outdoor work in general or specific outdoor occupations and BCC risk. In meta-analyses, the highest and second highest exposure categories, respectively, were compared with the lowest exposure category. In further meta-analyses, a dose-response relationship between BCC risk and lifetime occupational UV exposure in both hours and years was investigated using random-effects meta-regression models. All analyses were performed with Stata 17.0.
Results: The titles and abstracts of 10,558 database entries were reviewed; 127 articles were reviewed in full text, of which 31 studies met the selection criteria. All included studies had a high overall risk of bias. A meta-analysis comparing outdoor work versus no outdoor work found a significantly increased relative risk of 2.28 (95% confidence interval: 1.67-3.11; 6 studies). The included studies had a high risk of bias regarding recruitment. A meta-analysis of the dose-response relationship included 15 studies that provided separate risk estimates for several exposure groups. No increased risks were observed for the highest or second highest compared to the lowest exposure category. Of these studies, 7 had a high risk of bias with regard to the comparison groups because the lowest exposure categories also included people with occupational sun exposure. A meta-analysis found no statistically significant association between the cumulative duration of occupational sun exposure in hours or years and the BCC risk.
Conclusions: Given the current state of knowledge, there is insufficient evidence of a connection between cumulative occupational UV radiation and the development of basal cell carcinoma.
Ulrich Bolm-Audorff and Henriette Rönsch participated equally.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
