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Occupational UV-Exposure is a Major Risk Factor for Basal Cell Carcinoma

Results of the Population-Based Case-Control Study FB-181

Schmitt, Jochen MD, MPH; Haufe, Eva PhD; Trautmann, Freya MSc; Schulze, Hans-Joachim MD; Elsner, Peter MD; Drexler, Hans MD; Bauer, Andrea MD, MPH; Letzel, Stephan MD; John, Swen Malte MD; Fartasch, Manigé MD; Brüning, Thomas MD; Seidler, Andreas MD, MPH; Dugas-Breit, Susanne MD; Gina, Michal MD; Weistenhöfer, Wobbeke MD; Bachmann, Klaus MD; Bruhn, Ilka MD; Lang, Berenice Mareen MD; Bonness, Sonja MD; Allam, Jean Pierre MD; Grobe, William MD; Stange, Thoralf BSc; Westerhausen, Stephan BSc; Knuschke, Peter MSc; Wittlich, Marc PhD; Diepgen, Thomas Ludwig MD for the FB 181 Study Group

Journal of Occupational and Environmental Medicine: January 2018 - Volume 60 - Issue 1 - p 36–43
doi: 10.1097/JOM.0000000000001217
ORIGINAL ARTICLES
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Objective: The aim of this study was to investigate the role of occupational and nonoccupational ultraviolet (UV)-exposure concerning the development of basal cell carcinoma (BCC).

Methods: We undertook a population-based multicenter case–control study. Patients with first incident BCC (n = 836) were propensity score matched by age and sex to controls without skin cancer (n = 836). Sociodemographic characteristics, clinical characteristics, and lifetime UV-exposure were assessed by trained investigators. The differential estimation of occupational and nonoccupational UV-exposure dosages was based on validated instruments and established reference values. Associations were assessed using multivariable-adjusted conditional logistic regression models.

Results: Individuals with high levels of occupational UV-exposure were at significantly increased BCC-risk compared with individuals with low [odds ratio (OR) 1.84; 95% confidence interval (95% CI) 1.19 to 2.83 and moderate (OR 1.97; 95% CI 1.20 to 3.22) occupational UV-exposure. Nonoccupational UV-exposure was not independently associated with BCC.

Conclusion: Skin cancer prevention strategies should be expanded to the occupational setting.

Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany (Dr Schmitt, Dr Haufe, Trautmann, Stange); Institute and Outpatient Clinics of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, TU Dresden, Germany (Drs Haufe, Andreas Seidler); Department of Dermatology, Dermatological Radiotherapy and Dermatohistopathology, Special Clinics Hornheide, Münster, Germany (Drs Schulze, Dugas-Breit); Department of Dermatology, University Hospital Jena, Jena, Germany (Drs Elsner, Gina); Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany (Drs Drexler, Weistenhöfer); Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Germany (Drs Bauer, Bruhn); Institute of Occupational, Social and Environmental Medicine, University Medical Center, Johannes-Gutenberg University, Mainz, Germany (Dr Letzel); Department of Dermatology, Environmental Health and Health Theory, University of Osnabrück and Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany (Dr John); Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV), Institute of Ruhr-University Bochum (IPA), Bochum, Germany (Drs Fartasch, Brüning); Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany (Drs Bachmann, Diepgen); Department of Dermatology, University Medical Center, Johannes-Gutenberg University, Mainz, Germany (Dr Lang); Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Employer's Liability Insurance Association Clinics Hamburg, Hamburg, Germany (Dr Bonness); Department of Dermatology and Allergy, University Bonn, Bonn, Germany (Drs Allam, Grobe); Department of Radiation, Institute of Occupational Health and Safety of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany (Westerhausen, Dr Wittlich); and Department of Dermatology, Experimental Photobiology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany (Knuschke).

Address correspondence to: Prof. Dr. med. Prof. h.c. Jochen Schmitt, MD, MPH, Zentrum für Evidenzbasierte Gesundheitsversorgung, Fetscherstr. 74, 01307 Dresden, Germany (Jochen.Schmitt@uniklinikum-dresden.de).

Jochen Schmitt and Eva Haufe, Equally contributing authors.

The FB 181 Study Group includes all authors and the following persons (alphabetically ordered): Thomas Bieber, MD (Department of Dermatology and Allergy, University Bonn, Bonn, Germany); Richard Brans, MD (Department of Dermatology, Environmental Health and Health Theory, University of Osnabrück and Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany); Beate Brecht (Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany); Stephan Grabbe, MD (Department of Dermatology, University Medical Center, Johannes-Gutenberg University, Mainz, Germany); Denise Küster (Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany), MPH; Linda Ruppert, MPH (Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany); Victoria Stephan (Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Germany); Anja Thielitz, MD (Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Employer's Liability Insurance Association Clinics Hamburg, Hamburg, Germany); Elisabeth Zimmermann (Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany).

Sources of funding: The study was funded by a research grant from the German Institutions for Social Accident Insurance (DGUV).

The study was funded by the German Social Accident Insurance (DGUV, study ID FB-181). The funder had no active role in the design, conduct, analysis and interpretation of the study, or the writing of the study report.

The study did not receive other funding or pharmaceutical industry support.

The authors declare no potential conflicts of interest.

Copyright © 2018 by the American College of Occupational and Environmental Medicine