Is ultraviolet exposure acquired at work the most important risk factor for cutaneous squamous cell carcinoma? Results of the population-based case-control study FB-181

Abstract

BACKGROUND Squamous cell carcinoma (SCC) is among the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting UV-exposure during leisure time. However, the relative impact of occupational and non-occupational UV-exposure for SCC occurrence is unclear. OBJECTIVES To investigate the association between occupational and non-occupational UV-exposure with SCC in a multicenter population-based case-control study hypothesizing that high occupational UV-exposure increases the risk for 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 non-occupational UV-exposure dosages were estimated by blinded investigators using established reference values. Odds ratios (OR) and corresponding 95%-confidence intervals (95%-CI) were assessed using conditional logistic regression adjusting for relevant confounders. RESULTS Total solar UV-exposure was significantly associated with an increased SCC. The OR (95%-CI) for high (>90(th) percentile) vs. low (<40(th) percentile) and moderate (40(th) to 60(th) percentile) occupational UV-exposure was 1.95 (1.19-3.18) and 2.44 (1.47-4.06) for SCC. Adjusting for occupational UV-exposure non-occupational UV-exposure was not significantly related to SCC incidence. Dose-response relationships were observed for occupational but not for non-occupational 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. This article is protected by copyright. All rights reserved.