Abstract
BackgroundStudies suggest that ambient sunlight plays an important role in the pathogenesis of non-melanoma skin cancers (NMSC). However, there is ongoing controversy regarding the relevance of occupational exposure to natural and artificial ultraviolet radiation (UV) radiation.ObjectivesWe investigated potential associations between natural and artificial UV radiation exposure at work with NMSC in a case-control study conducted in Hungary, Romania, and Slovakia.MethodsOccupational exposures were classified by expert assessment for 527 controls and 618 NMSC cases (515 basal cell carcinoma, BCC). Covariate information was collected via interview and multiple logistic regression models were used to assess associations between UV exposure and NMSC.ResultsLifetime prevalence of occupational exposure in the participants was 13% for natural UV radiation and 7% for artificial UV radiation. Significant negative associations between occupational exposure to natural UV radiation and NMSC were detected for all who had ever been exposed (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.27–0.80); similar results were detected using a semi-quantitative metric of cumulative exposure. The effects were modified by skin complexion, with significantly decreased risks of BCC among participants with light skin complexion. No associations were observed in relation to occupational artificial UV radiation exposure.ConclusionsThe protective effect of occupational exposure to natural UV radiation was unexpected, but limited to light-skinned people, suggesting adequate sun-protection behaviors. Further investigations focusing on variations in the individual genetic susceptibility and potential interactions with environmental and other relevant factors are planned.
Highlights
Non-melanoma skin cancers (NMSC) comprise more than onethird of all cancers and are increasing worldwide, causing a significant economic burden at the individual and community levels [1,2]
Epidemiological findings show that non-melanoma skin cancers (NMSC) occurrence increases with increasing sunlight exposure, and overall estimates from meta-analyses suggest that NMSC is associated with sunlight exposure at the workplace, there is discordance among the results reported by individual occupational studies, for Basal Cell Carcinoma (BCC) [11]
There is ongoing controversy regarding the relevance of occupational exposure to artificial ultraviolet radiation (UV) radiation as a possible skin carcinogen [12]
Summary
Non-melanoma skin cancers (NMSC) comprise more than onethird of all cancers and are increasing worldwide, causing a significant economic burden at the individual and community levels [1,2]. The most common NMSCs are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC), occurring at a ratio of about 4:1 and accounting for about 90% of all skin cancers diagnosed globally [3,4]. Other environmental and occupational exposures, for instance to arsenic, polycyclic aromatic hydrocarbons, and ionizing radiation have been linked to NMSC [13,14,15,16] Lifestyle factors such as indoor/outdoor tanning-related behaviors, and host characteristics including medical history and familial susceptibility are associated with an enhanced risk of NMSC [17,18]. There is ongoing controversy regarding the relevance of occupational exposure to natural and artificial ultraviolet radiation (UV) radiation
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