J Schmitt1,2, E Haufe1,2, F Trautmann1, H-J Schulze3, P Elsner4, H Drexler5, A Bauer6, S Letzel7, S M John8,9, M Fartasch10, T Brüning10, A Seidler2, S Dugas-Breit3, M Gina4, W Weistenhöfer5, K Bachmann11, I Bruhn6, B M Lang12, S Bonness9,13, J P Allam14, W Grobe14, T Stange1, S Westerhausen15, P Knuschke16, M Wittlich15, T L Diepgen11. 1. Center of Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, University Hospital, Technical University Dresden, Germany. 2. Institute and Outpatient Clinics of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, Technical University Dresden, Germany. 3. Department of Dermatology, Dermatological Radiotherapy and Dermatohistopathology, Special Clinics Hornheide, Münster, Germany. 4. Department of Dermatology, University Hospital Jena, Jena, Germany. 5. Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-University Erlangen-Nuernberg, Nuernberg, Germany. 6. Department of Dermatology - University Allergy Center, Medical Faculty Carl Gustav Carus, Technical University Dresden, Germany. 7. Institute of Occupational, Social and Environmental Medicine, Johannes-Gutenberg University Mainz, Mainz, Germany. 8. Department of Dermatology, Environmental Health and Health Theory, University of Osnabrueck, Osnabrueck, Germany. 9. Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany. 10. Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV), Institute of Ruhr-University Bochum (IPA), Bochum, Germany. 11. Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany. 12. Department of Dermatology, University Medical Center, Johannes-Gutenberg University Mainz, Germany. 13. Employer's Liability Insurance Association Clinics Hamburg, Hamburg, Germany. 14. Department of Dermatology and Allergy, University Bonn, Bonn, Germany. 15. Department of Radiation, Institute of Occupational Health and Safety of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany. 16. Department of Dermatology - Experimental Photobiology, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
Abstract
BACKGROUND: Squamous cell carcinoma (SCC) is one of the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting ultraviolet (UV) exposure during leisure time. However, the relative impact of occupational and nonoccupational UV exposure for SCC occurrence is unclear. OBJECTIVES: To investigate the association between occupational and nonoccupational UV exposure for SCC in a multicentre population-based case-control study hypothesizing that high occupational UV exposure increases the risk of SCC. METHODS: Consecutive patients with incident SCC (n = 632) were recruited from a German national dermatology network. Population-based controls (n = 996) without history of skin cancer were recruited from corresponding residents' registration offices and propensity score matched to cases. Lifetime UV exposure, sociodemographic and clinical characteristics were assessed by trained physicians. Occupational and nonoccupational UV exposure doses were estimated by masked investigators using established reference values. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were assessed using conditional logistic regression adjusting for relevant confounders. RESULTS: Total solar UV exposure was significantly associated with increased SCC. The OR for high (> 90th percentile) vs. low (< 40th percentile) and high vs, moderate (40-59th percentile) occupational UV exposure was 1·95 (95% CI 1·19-3·18) and 2·44 (95% CI 1·47-4·06) for SCC. Adjusting for occupational UV exposure, nonoccupational UV exposure was not significantly related to SCC incidence. Dose-response relationships were observed for occupational but not for nonoccupational solar UV exposure. CONCLUSIONS: Solar occupational UV exposure is a major determinant of incident SCC. Our findings indicate that prevention strategies should be further expanded to the occupational setting.
BACKGROUND:Squamous cell carcinoma (SCC) is one of the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting ultraviolet (UV) exposure during leisure time. However, the relative impact of occupational and nonoccupational UV exposure for SCC occurrence is unclear. OBJECTIVES: To investigate the association between occupational and nonoccupational UV exposure for SCC in a multicentre population-based case-control study hypothesizing that high occupational UV exposure increases the risk of SCC. METHODS: Consecutive patients with incident SCC (n = 632) were recruited from a German national dermatology network. Population-based controls (n = 996) without history of skin cancer were recruited from corresponding residents' registration offices and propensity score matched to cases. Lifetime UV exposure, sociodemographic and clinical characteristics were assessed by trained physicians. Occupational and nonoccupational UV exposure doses were estimated by masked investigators using established reference values. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were assessed using conditional logistic regression adjusting for relevant confounders. RESULTS: Total solar UV exposure was significantly associated with increased SCC. The OR for high (> 90th percentile) vs. low (< 40th percentile) and high vs, moderate (40-59th percentile) occupational UV exposure was 1·95 (95% CI 1·19-3·18) and 2·44 (95% CI 1·47-4·06) for SCC. Adjusting for occupational UV exposure, nonoccupational UV exposure was not significantly related to SCC incidence. Dose-response relationships were observed for occupational but not for nonoccupational solar UV exposure. CONCLUSIONS: Solar occupational UV exposure is a major determinant of incident SCC. Our findings indicate that prevention strategies should be further expanded to the occupational setting.
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