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de Boer FL, van der Molen HF, Wang JH, Raun E, Pereda J, Hwu EET, Jakasa I, Dubrac S, Rustemeyer T, Kezic S. Skin Barrier- and Immune Response-Related Biomarkers of Solar UVR Exposure Comparing Indoor and Outdoor Workers. JID INNOVATIONS 2024; 4:100280. [PMID: 38756236 PMCID: PMC11097112 DOI: 10.1016/j.xjidi.2024.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 05/18/2024] Open
Abstract
Outdoor workers have increased risk of developing keratinocyte cancer due to accumulated skin damage resulting from chronic and excessive exposure to UVR. This study aims to identify potential noninvasive biomarkers to assess chronic UVR exposure. We analyzed stratum corneum biomarkers collected from 2 skin locations and 2 occupational groups with contrasting solar UVR exposure: the forehead and retroauricular skin among outdoor workers and indoor workers. Using a linear mixed model adjusting for age and skin phototype, we compared biomarkers between both skin sites in indoor and outdoor workers. We measured markers of the immune response and skin barrier, including cytokines, GFs, 15-hydroxyeicosatetraenoic acid, cis- and trans-urocanic acid, and corneocyte topography, indicated by circular nano objects. Differences between the 2 skin sites were found for cis-urocanic acid, total urocanic acid, IL-1α, IL-1RA, IL-1RA/IL-1α, IL-18, 15-hydroxyeicosatetraenoic acid, CCL4, and circular nano objects. The levels of cis-urocanic acid and CCL4 also differed between indoor and outdoor workers. These findings underscore changes in both immune response and skin barrier induced by UVR. They indicate the potential utility of stratum corneum biomarkers in detecting both chronic UVR exposure in occupational setting and aiding in the development of preventive measures.
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Affiliation(s)
- Florentine L. de Boer
- Amsterdam Public Health Research Institute, Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk F. van der Molen
- Amsterdam Public Health Research Institute, Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jen-Hung Wang
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ellen Raun
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jorge Pereda
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Edwin En-Te Hwu
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ivone Jakasa
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Sandrine Dubrac
- Epidermal Biology Laboratory, Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Noord-Holland, The Netherlands
| | - Sanja Kezic
- Amsterdam Public Health Research Institute, Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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2
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Slot N, Tenkate T, Forsman-Phillips L, Arrandale VH, Kalia S, Holness DL, Peters CE. Barriers and Facilitators in the Creation of a Surveillance System for Solar Radiation-Induced Skin Cancers. New Solut 2023; 33:7-24. [PMID: 37083551 DOI: 10.1177/10482911231165975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Outdoor workers are exposed to many hazards, including solar ultraviolet radiation (UVR). Identifying, reporting, analyzing and tracking the exposures or health outcomes of outdoor workers have not generally been formally considered. This article aims to summarize the best practices/strategies for creating an occupational sun exposure or skin cancer surveillance system for outdoor workers and to understand the key barriers and facilitators to the development of such a system. For the design of a successful occupational safety and health (OSH) surveillance system five occupational surveillance strategies are summarized: exposure registry, disease registry, disease screening/medical surveillance, sentinel event surveillance, and disease surveillance via data linkage. Ten key considerations are identified, including identifying a clear goal, a defined target population and stakeholder involvement, five critical barriers are highlighted including underreporting and funding, and five vital facilitators are recognized including communication/collaboration and a simple reporting process.
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Affiliation(s)
- Nicole Slot
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - Thomas Tenkate
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | - Victoria H Arrandale
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sunil Kalia
- Dermatology and Skin Science, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Photomedicine Institute and Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Departments of Cancer Control, BC Cancer and Division of Dermatology, BC Children's Hospital, Provincial Health Services Authority, Vancouver, BC, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine and MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | - Cheryl E Peters
- CAREX Canada, University of British Columbia, Vancouver, British Columbia, Canada
- University of Calgary Cumming School of Medicine, Department of Community Health Sciences and Preventive Oncology, Calgary, Alberta, Canada
- BC Centre for Disease Control & BC Cancer, Vancouver, British Columbia
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3
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Dubrall D, Sachs B, Kraywinkel K, Schulz M, Schmid M, Fischer-Barth W, Bate J. Analyses of Basal and Squamous Cell Carcinoma Reported as an Adverse Drug Reaction and Comparison with Cases from the Cancer Registry from Germany. Drugs R D 2023; 23:21-33. [PMID: 36401718 PMCID: PMC9985531 DOI: 10.1007/s40268-022-00407-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In Germany, incidence rates of basal cell (BCC) and squamous cell carcinoma (SCC) rose significantly from 1998 to 2010. Ultraviolet (UV) light exposure, immunosuppressants and drugs with photosensitising potential are known to increase the risk to develop BCC and SCC. The aim of our study was to analyse the adverse drug reaction (ADR) reports from Germany referring to BCC and SCC and to compare them to BCC and SCC occurring in the general population. METHODS We analysed all validated spontaneous ADR reports referring to BCC (n = 191) and SCC (n = 75) from Germany contained in the European ADR database EudraVigilance prior to 6 March 2019. These reports were compared to 1,267,210 BCC and 476,903 SCC cases from the German Centre for Cancer Registry Data recorded from 2006 to 2018. RESULTS The number of BCC and SCC reports as well as the BCC and SCC incidences in the registry increased in the analysed time period. Patients with drug-associated BCC (60 years) and SCC (64 years) were younger than patients with BCC (72 years) and SCC (76 years) in the registry. In 57.1 and 60.0% of BCC and SCC reports immunosuppressants were reported as suspected. The reported suspected drug was assumed to possess a photosensitising potential in 41.9 and 44.0% of BCC and SCC reports. CONCLUSIONS In Germany, drug-associated BCC and SCC occurred at a younger age than in the general population. The results underline the necessity for skin cancer screening of patients treated with immunosuppressants or with drugs with photosensitising potential.
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Affiliation(s)
- Diana Dubrall
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany. .,Federal Institute for Drugs and Medical Devices, Bonn, Germany.
| | - Bernhardt Sachs
- Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Department for Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
| | | | - Maike Schulz
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | | | - Jens Bate
- Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Institute for Transfusion Medicine, Cologne Municipial Hospitals, Cologne, Germany
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4
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Ahmels M, Mariz FC, Braspenning-Wesch I, Stephan S, Huber B, Schmidt G, Cao R, Müller M, Kirnbauer R, Rösl F, Hasche D. Next generation L2-based HPV vaccines cross-protect against cutaneous papillomavirus infection and tumor development. Front Immunol 2022; 13:1010790. [PMID: 36263027 PMCID: PMC9574214 DOI: 10.3389/fimmu.2022.1010790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022] Open
Abstract
Licensed L1-VLP-based immunizations against high-risk mucosal human papillomavirus (HPV) types have been a great success in reducing anogenital cancers, although they are limited in their cross-protection against HPV types not covered by the vaccine. Further, their utility in protection against cutaneous HPV types, of which some contribute to non-melanoma skin cancer (NMSC) development, is rather low. Next generation vaccines achieve broadly cross-protective immunity against highly conserved sequences of L2. In this exploratory study, we tested two novel HPV vaccine candidates, HPV16 RG1-VLP and CUT-PANHPVAX, in the preclinical natural infection model Mastomys coucha. After immunization with either vaccines, a mock control or MnPV L1-VLPs, the animals were experimentally infected and monitored. Besides vaccine-specific seroconversion against HPV L2 peptides, the animals also developed cross-reactive antibodies against the cutaneous Mastomys natalensis papillomavirus (MnPV) L2, which were cross-neutralizing MnPV pseudovirions in vitro. Further, both L2-based vaccines also conferred in vivo protection as the viral loads in plucked hair after experimental infection were lower compared to mock-vaccinated control animals. Importantly, the formation of neutralizing antibodies, whether directed against L1-VLPs or L2, was able to prevent skin tumor formation and even microscopical signs of MnPV infection in the skin. For the first time, our study shows the proof-of-principle of next generation L2-based vaccines even across different PV genera in an infection animal model with its genuine PV. It provides fundamental insights into the humoral immunity elicited by L2-based vaccines against PV-induced skin tumors, with important implications to the design of next generation HPV vaccines.
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Affiliation(s)
- Melinda Ahmels
- Division of Viral Transformation Mechanisms, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Filipe C. Mariz
- Research Group Tumorvirus-specific Vaccination Strategies, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ilona Braspenning-Wesch
- Division of Viral Transformation Mechanisms, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sonja Stephan
- Division of Viral Transformation Mechanisms, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bettina Huber
- Laboratory of Viral Oncology, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Schmidt
- Core Facility Unit Light Microscopy, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rui Cao
- Division of Viral Transformation Mechanisms, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Müller
- Research Group Tumorvirus-specific Vaccination Strategies, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Reinhard Kirnbauer
- Laboratory of Viral Oncology, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Frank Rösl
- Division of Viral Transformation Mechanisms, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Hasche
- Division of Viral Transformation Mechanisms, Research Program “Infection, Inflammation and Cancer”, German Cancer Research Center (DKFZ), Heidelberg, Germany
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5
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Scola L, Bongiorno MR, Forte GI, Aiello A, Accardi G, Scrimali C, Spina R, Lio D, Candore G. TGF-β/VEGF-A Genetic Variants Interplay in Genetic Susceptibility to Non-Melanocytic Skin Cancer. Genes (Basel) 2022; 13:genes13071235. [PMID: 35886018 PMCID: PMC9317818 DOI: 10.3390/genes13071235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Differential genetically determined expression of transforming growth factor-β (TGF-β pathway and of vascular endothelial growth factor-A (VEGF-A) might modulate the molecular “milieu” involved in the etio-pathogenesis of non-melanoma skin cancer (NMSC). We have evaluated the frequency of some functionally relevant SNPs of TGF-β and VEGF-A genes in 70 NMSC patients and 161 healthy controls, typed for TGF-β1 rs1800471, TGF-β2 rs900, TGF-βR1 rs334348 and rs334349, TGF-βR2 rs4522809 and VEGF-A rs3025039 SNPs. TGF-βR2 rs1800629G allele and related genotypes were found to be associated with a possible protective role against NMSC, whereas VEGF-A rs3025039T was associated with an increased risk. To evaluate the effect of genotype combinations on NMSC susceptibility, we determined the frequencies of 31 pseudo-haplotypes due to non-random linkage among alleles of loci not lying on the same chromosome. Two pseudo-haplotypes that imply a minor allele of TGF-βR2 or minor allele of VEGF-A SNPs combined with major alleles of the other SNPs were, respectively, associated with a protective effect, and susceptibility to NMSC. In addition, a pseudo-haplotype involving minor alleles of TGF-β2 rs900, TGF-βR1 rs334348 and rs4522809 SNPs might be a susceptibility marker for NMSC. In conclusion, our data suggest that a complex interplay among the genetic polymorphisms of TGF-β, TGF-β receptors and VEGF-A genes might influence the net effect of genetic background of the patients on NMSC development. This might be relevant in the risk evaluation, diagnosis and treatment of NMSC.
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Affiliation(s)
- Letizia Scola
- Clinical Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90135 Palermo, Italy;
| | - Maria Rita Bongiorno
- Section of Dermatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy;
| | - Giusi Irma Forte
- Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy;
| | - Anna Aiello
- General Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90135 Palermo, Italy; (A.A.); (G.A.); (G.C.)
| | - Giulia Accardi
- General Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90135 Palermo, Italy; (A.A.); (G.A.); (G.C.)
| | - Chiara Scrimali
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.S.); (R.S.)
| | - Rossella Spina
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (C.S.); (R.S.)
| | - Domenico Lio
- Interdepartmental Research Center “Migrate”, University of Palermo, 90135 Palermo, Italy
- Correspondence:
| | - Giuseppina Candore
- General Pathology, Department of Bio-Medicine, Neuroscience, and Advanced Diagnostics, University of Palermo, 90135 Palermo, Italy; (A.A.); (G.A.); (G.C.)
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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Stimulating Sunscreen Use Among Outdoor Construction Workers: A Pilot Study. Front Public Health 2022; 10:857553. [PMID: 35433569 PMCID: PMC9010717 DOI: 10.3389/fpubh.2022.857553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Outdoor workers (OW) receive a higher dose of ultraviolet radiation (UVR) compared to indoor workers (IW) which increases the risk of non-melanoma skin cancer (NMSC). Regular sunscreen use reduces the NMSC risk, however, adequate sun-safety behavior among OW is poor. The main objective was to conduct method- and intervention-related elements of a future intervention trial among OW, based on providing sunscreen and assessing sunscreen use on group- and individual level. Methods This pilot study was conducted at a construction site in the Netherlands from May-August 2021. Nine dispensers with sunscreen (SPF 50+) were installed at the worksite. OW (n = 67) were invited to complete two (cross-sectional) questionnaires on sun-safety behavior, before and after providing sunscreen. Stratum corneum (SC) samples for the assessment of UV-biomarkers were collected from the forehead and behind the ear from 15 OW and 15 IW. The feasibility of the following elements was investigated: recruitment, (loss to) follow-up, outcome measures, data collection, and acceptability of the intervention. Results The first questionnaire was completed by 27 OW, the second by 17 OW. More than 75 percent of the OW were aware of the risks of sun exposure, and 63% (n = 17) found sunscreen use during worktime important. The proportion of OW never applying sunscreen in the past month was 44.4% (n = 12) before, and 35.3% (n = 6) after providing sunscreen. A majority of OW (59.3%, n = 16) found sunscreen provision encouraging for sunscreen use, the dispensers easy to use (64.7%, n = 17) and placed in practical spots (58.8%, n = 18). Collecting SC-samples was fast and easy, and several UV-biomarkers showed higher levels for sun-exposed compared to less exposed body parts. There was no significant difference in UV-biomarker levels between OW and IW. Conclusions This pilot study revealed low sunscreen use among OW despite providing sunscreen, overall satisfaction with the sunscreen, and the sufficient awareness of the risks of UVR-exposure. Collecting SC-samples at the workplace is feasible and several UV-biomarkers showed to be promising in assessing UVR-exposure. The low participation rate and high loss to follow-up poses a challenge for future intervention studies.
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Affiliation(s)
- Anne J. Keurentjes
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Anne J. Keurentjes
| | - Sanja Kezic
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
| | - Carel T. J. Hulshof
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Henk F. van der Molen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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7
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1H-NMR-based metabolomics of skin squamous cell carcinoma and peri-tumoral region tissues. J Pharm Biomed Anal 2022; 212:114643. [DOI: 10.1016/j.jpba.2022.114643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/21/2022]
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8
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Boothby-Shoemaker WT, Mohammad TF, Ozog DM, Lim HW. Photoprotection by clothing: A review. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:478-488. [PMID: 35073443 DOI: 10.1111/phpp.12776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/19/2021] [Accepted: 01/13/2022] [Indexed: 12/18/2022]
Abstract
Clothing is recognized by leading health agencies as a primary method to protect against the harmful effects of photodamage caused by ultraviolet (UV) radiation and visible light. The photoprotective capacity of clothing is commonly measured as the ultraviolet protective factor (UPF). While the technology driving photoprotective clothing has been well-established, there continues to be efforts to discover new materials to improve the UPF of clothing. Here, we show increased Google searches for photoprotective clothing over the last decade, suggesting a high level of public interest in photoprotective clothing. In addition, we investigate the frequency of UPF-graded photoprotective clothing sold by large retail stores featured in Fortune 1000. We review factors that alter the UPF of clothing and describe emerging textile technologies used to increase clothing's photoprotective capacity. Finally, we compare how photoprotective clothing is regulated among different countries, the importance of photoprotective clothing in occupational health, and research in visible light and clothing photoprotection.
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Affiliation(s)
- Wyatt T Boothby-Shoemaker
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA.,Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Tasneem F Mohammad
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA
| | - David M Ozog
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA
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9
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National and subnational burden of disease attributable to occupational exposure to solar ultraviolet radiation (SUVR) in Iran, 2005-2019. Int J Hyg Environ Health 2021; 240:113897. [PMID: 34861595 DOI: 10.1016/j.ijheh.2021.113897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/22/2022]
Abstract
Overexposure to solar ultraviolet radiation (SUVR) can cause skin and eye adverse effects for outdoor workers. In this study, the burden of disease induced by occupational exposure to SUVR and its spatiotemporal trend at national and sub-national levels in Iran, 2005-2019 were assessed. The attributable burden of disease was assessed using the following five datasets: (1) distribution of occupational exposure to SUVR, (2) total incidences and deaths of health outcomes of SUVR exposure, (3) population attributable fractions of the health outcomes of SUVR exposure, (4) age-gender distribution of outdoor workers, and (5) disability-adjusted life year (DALY) calculation constants. During 2005-2019, the attributable DALYs increased from 2442 to 2907 and the attributable DALY rate (per 100,000 workers) slightly decreased from 11.94 to 11.91. The share of YLL in the attributable burden of disease was in the range of 43%-46%. Out of nine causes, about 90% of the attributable burden of disease in 2019 was related to cataracts (29.9%), malignant skin melanoma (27.4%), squamous-cell carcinoma (18.6%), and sunburn (17.2%). During the study period, the attributable DALY rate in women increased by 60.95% (from 5.04 to 8.11) and in men decreased by 2.06% (from 13.03 to 12.76). The total attributable DALYs and DALY rate rose by age during 2005-2019. The contributions of population growth, risk-deleted DALY rates, exposure risk, and population age structure in temporal changes of the attributable burden of disease were 19.27%, 9.13%, -1.35%, and -14.8%, respectively. The three highest attributable DALY rates in 2019 were observed in South Khorasan (21.28), Chahar Mahal and Bakhtiari (17.42), and Kordestan (17.26), respectively. The preventive interventions against SUVR overexposure, regular screenings, and early treatments with an emphasis on occupations with continuous sun exposure and provinces with increasing attributable DALY rates should be considered in the occupational health action plan in the country.
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10
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Boyas JF, Woodiwiss JL, Nahar VK. Examining intentions to engage in sun protective behaviors among Latino day laborers: An application of the theory of planned behavior. Health Promot Perspect 2021; 11:351-359. [PMID: 34660231 PMCID: PMC8501480 DOI: 10.34172/hpp.2021.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background: The past two decades has revealed an unprecedented increasing incidence of skin cancer within the Latinx population. Although Latino day laborers (LDLs) are at heightened risk for developing skin cancer because of the outdoor work in which they engage, there is limited research examining their intentions to engage in sun protective behaviors (SPBs). Therefore, this study sought to assess the explanatory power of the theory of planned behavior (TPB) to identify attitudinal, subjective norms, and perceived behavioral control factors associated with intentions to engage in SPB among LDLs. Methods: This cross-sectional retrospective study consists of a non-random convenience,community-based, sample of 137 LDLs residing in Mississippi and Illinois. Data were collected using a self-report survey centered on health practices and sun-protective behaviors. Results: Findings revealed that five significant factors shaped intentions to engage in SPBs, including barriers to engaging in SPBs (β =.30, P<0.001), benefits of engaging in SPBs (β =.27,P<0.001), education (β=0.20, P<0.01), and acculturation (β=0.18, P≤0.05). The independent variables tested in the model accounted for 42% of the change in intentions to engage in SPBs. Conclusion: This study demonstrates TPB’s usefulness for predicting future intentions to engage in SPBs among LDLs. Moreover, the strongest factor associated with predicting intentions to engage in SPBs among LDLs was perceived behavioral control. Thus, since SPBs are malleable, emphasis is placed on implementing interventions for this population that promote intentions and address perceived behavioral control.
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Affiliation(s)
- Javier F Boyas
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
| | - Jana L Woodiwiss
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
| | - Vinayak K Nahar
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS 39216, USA
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11
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Keurentjes AJ, Jakasa I, van Dijk A, van Putten E, Brans R, John SM, Rustemeyer T, van der Molen HF, Kezic S. Stratum corneum biomarkers after in vivo repeated exposure to sub-erythemal dosages of ultraviolet radiation in unprotected and sunscreen (SPF 50+) protected skin. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 38:60-68. [PMID: 34278599 DOI: 10.1111/phpp.12717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/16/2021] [Accepted: 07/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a need for non-invasive biomarkers to assess in vivo efficacy of protective measures aiming at reducing ultraviolet radiation (UVR) exposure. Stratum corneum (SC) biomarkers showed to be promising markers for internal UVR dose and immune response. PURPOSE To establish a dose-response relationship for SC biomarkers and explore their suitability for in vivo assessment of the blocking effect of two sunscreens with a high sun protection factor (SPF) (50+). METHODS Twelve volunteers were exposed to a broad-spectrum UVB (280-320 nm), five times a week, during one week. Unprotected back skin was irradiated with 0.24, 0.48, 0.72 and 1.44 standard erythema dose (SED) and sunscreen-protected skin with 3.6 SED. SC samples for determination of the relative amount of cis-urocanic acid (cUCA) and thirteen immunological makers including cytokines and matrix metalloproteinases (MMP) were collected after each irradiation. RESULTS cUCA sharply increased after the first irradiation in a dose-dependent fashion. However, it levelled-off after subsequent exposures and reached a plateau for the highest UV-dose after the third irradiation. None of the immunological markers showed dose-dependency. However, MMP-9, IL-1β and CCL27 increased gradually from baseline during repetitive exposures to the highest UV-dose. Assessed from cUCA, both sunscreens blocked >98% of the applied UV-dose. CONCLUSIONS cUCA is a sensitive, non-invasive marker of the internal UVR dose enabling in vivo assessment of the blocking effect of high SPF sunscreens in the UVB-region. Immunological SC markers show low sensitivity in detecting immune response at sub-erythemal UVR dosages, suggesting they might be suitable only at higher and/or repetitive UVR exposure.
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Affiliation(s)
- Anne Josephine Keurentjes
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Ivone Jakasa
- Department of Chemistry and Biochemistry, Laboratory for Analytical Chemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Arjan van Dijk
- Center for Environmental Safety and Security, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Edith van Putten
- Center for Environmental Safety and Security, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Sanja Kezic
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Determinants of Sailors' Protective Behaviors in Fishing Spots against the Risks of Sunlight and Skin Cancer: A Qualitative Study in Iran. J Skin Cancer 2021; 2021:9954946. [PMID: 34327024 PMCID: PMC8310437 DOI: 10.1155/2021/9954946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The growing rate of nonmelanoma skin cancer (NMSC) and melanoma has been a great challenge for global health system. The present research aims to determine sailors' protective behaviors against the risks of sunlight and skin cancer in Iran. Materials and Methods The present research was qualitative in type, and its data were collected from August to December 2019. To this aim, 23 participants were recruited with whom semistructured interviews were held. The data collection continued until data saturation, and the interviews were coded in MAXQDA 10. Conventional content analysis was used to analyze the qualitative data. Results Analysis of sailors' perceptions and experiences revealed 7 categories: protective behaviors, hard personal and familial conditions, social interactions, poor social support, feeling of satisfaction, self-care, and fear. Conclusion Sailors are prone to skin cancer due to their specific work conditions. Perceptions and determinants of skin cancer and protective behaviors against sunlight were identified among sailors. Promotion of protective behaviors and beliefs that impeded preventive behaviors are among issues that require special attention.
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The role of drugs and selected dietary factors in cutaneous squamous cell carcinogenesis. Postepy Dermatol Alergol 2021; 38:198-204. [PMID: 34408589 PMCID: PMC8362749 DOI: 10.5114/ada.2021.106196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/20/2020] [Indexed: 01/31/2023] Open
Abstract
Cutaneous squamous cell carcinoma represents the second most common non-melanoma skin cancer and its incidence increases worldwide. This review provides an overview of selected exogenous risk factors for cutaneous squamous cell carcinoma, which include drugs (azathioprine, calcineurin inhibitors, hydrochlorothiazide, angiotensin-converting-enzyme inhibitors) and few dietary factors (fat meet, whole milk products, arsenic) to better understand squamous skin cancer etiopathogenesis. Ingredients such as leafy vegetables, nuts, fish, caffeine, niacin are preventive factors for cutaneous squamous cell cancer. The heart transplant recipients have an increased risk of squamous cell carcinoma development than kidney or liver transplant ones and switching photosensitizing azathioprine to mycophenolate mofetil can reduce the incidence of cutaneous squamous cell carcinoma. The great attention should be paid to early change of cardiac photosensitizing antihypertensive drugs to non-photosensitizing ones among patients with a history of prior skin cancers and among organ transplant recipients. Based on current knowledge that ultra-violet radiation is the main risk factor for squamous cell carcinoma development, promotion of the skin self-examination, photoprotection, tanning bed avoidance and early skin cancer diagnosis is important for this tumour prevention.
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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Protection Against Solar Ultraviolet Radiation in Outdoor Construction Workers: Study Protocol for a Non-randomized Controlled Intervention Study. Front Public Health 2021; 9:602933. [PMID: 33748058 PMCID: PMC7969508 DOI: 10.3389/fpubh.2021.602933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/10/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Non-melanoma skin cancer (NMSC) incidence is increasing, and occupational solar exposure contributes greatly to the overall lifetime ultraviolet radiation (UVR) dose. This is reflected in an excess risk of NMSC showing up to three-fold increase in outdoor workers. Risk of NMSC can be reduced if appropriate measures to reduce UVR-exposure are taken. Regular use of sunscreens showed reduced risk of NMSC. However, sun-safety behavior in outdoor workers is poor. The objective of this study is to investigate the effectiveness of an intervention aiming at increasing sunscreen use by construction workers. Methods: This non-randomized controlled intervention study is comprised of two intervention and two control groups recruited at four different construction sites in the Netherlands. The study population comprises ~200 construction workers, aged 18 years or older, followed during 12 weeks. The intervention consists of providing dispensers with sunscreens (SPF 50+) at construction sites and regular feedback on the application achieved by continuous electronic monitoring. All groups will receive basic information on UV-exposure and skin protection. Stratum corneum (SC) samples will be collected for measurement of biomarkers to assess internal UV-dose. External UV-dose will be assessed by personal UV-sensors worn by the workers during work-shifts in both groups. To detect presence of actinic keratosis (AK) or NMSC, a skin check of body parts exposed to the sun will be performed at the end of the study. The effect of the intervention will be assessed from data on self-reported sunscreen use by means of questionnaires collected on baseline and after 12 weeks of intervention (primary outcome). Levels of SC biomarkers of internal UV-dose, external UV-dose, number of sunburn episodes, and prevalence of NMSC including AK will be assessed as secondary outcomes. The electronically monitored sunscreen consumption will be assessed as process outcome. Discussion: This study is intended to provide evidence of the effectiveness of a technology-driven intervention to increase sunscreen use in outdoor construction workers. Furthermore, it will increase insight in the UV-protective behavior, external and internal UV-exposure, and the prevalence of NMSC, including AK, in construction workers. Trial Registration: The Netherlands Trial Register (NTR): NL8462 Registered on March 19, 2020.
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Affiliation(s)
- Anne J Keurentjes
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sanja Kezic
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Carel T J Hulshof
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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15
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Paasch U, Grunewald S. Update Dermatologische Lasertherapie II – Weiterentwicklung der photodynamischen Therapie durch Laser‐assistierte transkutane Applikation von Topika. J Dtsch Dermatol Ges 2020; 18:1370-1378. [PMID: 33373145 DOI: 10.1111/ddg.14339_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Abstract
Die technische Fortentwicklung der jüngeren Vergangenheit bietet dem Dermatologen Zugriff auf neue Laser, Strahlquellen und Behandlungskonzepte. Seit langem eingeführte Wellenlängen zur Ablation sind nunmehr fraktioniert applizierend verfügbar und stehen nunmehr für eine wirksamere und effizientere Behandlung von zahlreichen Hautveränderungen zur Verfügung. Das gezielte Einbringung von Topika (laser assisted drug delivery; LADD) ist das wichtigste Beispiel. Die LADD erfordert eine spezifische Weiterbildung, um sicher und wirksam zur Therapie (prä-)maligner nichtmelanozytärer Neoplasien der Haut wie der Feldkanzerisierung in Form der Laser-assistierten photodynamischen Therapie angewandt werden zu können. Bisher verfügbare Daten weisen auf eine höhere Effektivität im Vergleich zu konventionell verwendeten Topika hin, wobei anhaltend über Weiterentwicklungen berichtet wird. Unter anderem wurde die Kombination mit Tageslicht oder alternativen tageslichtähnlichen Strahlquellen bekannt. Dieses Update basiert wie zitiert gekürzt und aktualisiert auf "Paasch, U. 2019. Laser-assistierte photodynamische Therapie. p. 226-239. In G. Kautz (ed.) Energie für die Haut. Springer Nature, Springer Nature.".
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Affiliation(s)
- Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig
| | - Sonja Grunewald
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig
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16
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Paasch U, Grunewald S. Update on dermatologic laser therapy II - advances in photodynamic therapy using laser-assisted drug delivery. J Dtsch Dermatol Ges 2020; 18:1370-1377. [PMID: 33331083 DOI: 10.1111/ddg.14339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
Technical advances in recent years have led to the development of new dermatologic laser systems, light sources, and treatment concepts. With the introduction of ablative fractional lasers (using common wavelengths) in the field of dermatology, it is now possible to more effectively and efficiently treat a variety of skin disorders. One important example of these advances is laser-assisted drug delivery (LADD). A type of LADD, laser-assisted photodynamic therapy has been successfully employed in the treatment of non-melanoma skin cancer including field cancerization. This treatment concept has been continually modified and today includes the use of daylight as well as artificial daylight systems. This update is based as cited, shortened and updated according to "Paasch,U. 2019. Laser-assistierte photodynamische Therapie. p. 226-239. In G.Kautz (ed.) Energie für die Haut. Springer Nature, Springer Nature".
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Affiliation(s)
- Uwe Paasch
- Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, and Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sonja Grunewald
- Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, and Medical Faculty, Leipzig University, Leipzig, Germany
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17
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John SM, Garbe C, French LE, Takala J, Yared W, Cardone A, Gehring R, Spahn A, Stratigos A. Improved protection of outdoor workers from solar ultraviolet radiation: position statement. J Eur Acad Dermatol Venereol 2020; 35:1278-1284. [PMID: 33222341 DOI: 10.1111/jdv.17011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
The vast majority of non-melanoma skin cancer (NMSC) is attributable to excessive exposure to ultraviolet radiation (UVR). Outdoor workers are exposed to an UVR dose at least 2 to 3 times higher than indoor workers and often to daily UVR doses 5 times above internationally recommended limits. The risk of UVR workplace exposure is vastly neglected, and the evident future challenges presented in this statement are contrasted with the current situation regarding legal recognition, patient care and compensation. While prevention is crucial to reduce cancer risks for outdoor workers, it is as much of relevance to better protect them through legally binding rules and regulations. Specific actions are outlined in five recommendations based on a Call to Action (table 1). The role of health professionals, including dermatologists, in this context is crucial.
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Affiliation(s)
- S M John
- EADV Task Force Occupational Skin Diseases and Dept. Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany
| | - C Garbe
- European Association of Dermato Oncology (EADO) and Department of Dermatology, Eber, hard Karls University, Tübingen, Germany
| | - L E French
- International League of Dermatological Societies (ILDS) and Department of Dermatology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - J Takala
- International Commission on Occupational Health (ICOH), University of Tampere, Tampere, Finland
| | - W Yared
- European Cancer Leagues (ECL), Brussels, Belgium
| | - A Cardone
- European Cancer Patient Coalition (ECPC), Brussels, Belgium
| | - R Gehring
- Safety and Health, European Federation Building and Woodworkers (EFBWW), Brussels, Belgium
| | - A Spahn
- Agriculture Section, European Federation of Food, Agriculture and Tourism Trade Unions (EFFAT), Brussels, Belgium
| | - A Stratigos
- European Academy of Dermatology and Venereology (EADV) and Dept. Dermatology, National and Kapodistrian University of Athens, Athens, Greece
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18
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Gallo R, Guarneri F, Corazza M, Schena D, Stingeni L, Foti C, Patruno C, Signori A, Parodi A. Role of occupational and recreational sun exposure as a risk factor for keratinocytic non-melanoma skin cancers: an Italian multicenter case-control study. Ital J Dermatol Venerol 2020; 156:692-702. [PMID: 33179876 DOI: 10.23736/s2784-8671.20.06699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sun exposure is the main external risk factor for keratinocytic non-melanoma skin cancer (NMSC). Outdoor workers are at increased risk, but the relationship of NMSC with occupational solar exposure is often confounded by concurrent recreational sun exposure. We compared the percentage of outdoor workers in NMSC patients versus controls without history of NMSC and assessed occupational and recreational sun exposure in both groups, evaluating also other risk factors and use of protective measures. METHODS Adult NMSC patients and controls without history of NMSC or actinic keratoses, matched for sex and age range, were recruited in the Departments of Dermatology of seven Italian University Hospitals, with a 1:2 patient/control ratio whenever possible. Data were collected using specifically designed questionnaires. RESULTS Eight hundred thirty-four patients and 1563 controls were enrolled. History of outdoor work was significantly (P=0.033) more frequent in patients. Patients were more sun exposed from outdoor leisure activities (P=0.012) and sunbathed for longer periods (P=0.13) and between 12 pm and 3.30 pm (P=0.011). Cumulative sun exposure during hobbies was similar between patients and controls in outdoor workers, higher (P<0.05) in patients among indoor workers. Patients and controls with history of outdoor work were more sun exposed at work than during leisure activities (P<0.001). Use of sunscreens by outdoor workers was very low, particularly at work (19.9%). Patients used sunscreens more than controls (P=0.002). CONCLUSIONS Occupational and recreational sun exposure are relevant risk factors for outdoor and indoor workers respectively. Sunscreens are alarmingly underused, particularly at work, and are used mainly by patients.
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Affiliation(s)
- Rosella Gallo
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Cataldo Patruno
- Section of Dermatology, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, DISSAL, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
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Abstract
The relationship between solar ultraviolet radiation and the risk of breast cancer is conflicting. The purpose of our study was to quantitatively assess the relationship between solar ultraviolet radiation and breast cancer risk and to analyze related factors such as age and sunscreen use.Articles indexed in PubMed and Embase and published between January 2005 and March 2020 were searched for relevant keywords. The relative risk was calculated using random-effect or fixed-effect models in the meta-analysis and dose-response meta-analysis, which were conducted according to the Meta-Analyses of Observational Studies in Epidemiology reporting guidelines. Sensitivity analyses for heterogeneity and publication bias were evaluated.Six studies were eligible for inclusion in the meta-analysis, and three of these were included in the dose-response analysis. We found a correlation between exposure to solar ultraviolet radiation and breast cancer risk (relative risk: 0.70, 95% confidence interval: 0.65, 0.75). We also found a linear dose-response relationship between the exposure and breast cancer risk (relative risk: 0.86, 95% confidence interval: 0.81, 0.91) in women over 40. Not tanning and covering the limbs were associated with breast cancer risk, but sunscreen use was not.Exposure to solar ultraviolet radiation is negatively correlated with breast cancer risk, and the association is linear in women over 40. This is the first dose-response meta-analysis on the topic, and the influence of factors such as estrogen receptor status, occupational exposure, and ethnicity requires in-depth study.
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20
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Keurentjes AJ, Jakasa I, John SM, Ulrich C, Bekkenk MW, Rustemeyer T, Kezic S. Tape stripping the stratum corneum for biomarkers of ultraviolet radiation exposure at sub-erythemal dosages: a study in human volunteers. Biomarkers 2020; 25:490-497. [PMID: 32657162 DOI: 10.1080/1354750x.2020.1792551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Prevalence of skin cancer is rapidly increasing. There is a need for non-invasive biomarkers to assess efficacy of prevention strategies aiming at reduction of exposure to ultraviolet radiation (UVR). Recently, stratum corneum (SC) biomarkers were applied in various inflammatory skin diseases. Here, we explore their suitability as candidate biomarkers for UVR. MATERIAL AND METHODS Twelve volunteers were exposed to a UVB-dose of 0.72 SED, three times a week, during three weeks. As candidate biomarkers, cis-isomers of urocanic acid (cUCA) and 25 immunological mediators were measured in the SC. RESULTS Eight immunological markers significantly changed from baseline. Of them, IL-1RA/IL-1α and a placental growth factor (PIGF) showed gradual changes during UVR-exposure (p < 0.01 for linear trend). cUCA increased sharply already after the first exposure, however, reached a plateau in the second week. CONCLUSIONS SC represents a promising, non-invasive alternative to skin biopsy in detecting UVR-induced changes. cUCA is the marker of choice for assessment of single UVR-exposure; however, it is less suitable for cumulative UVR-dose. Immunological markers including IL-1RA/IL-1α and PIGF showed gradual changes, and therefore are convenient for monitoring chronic UVR-exposure. These candidate biomarkers might facilitate assessment of the efficacy of preventive measures in the workplace and general population.
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Affiliation(s)
- Anne J Keurentjes
- Coronel Institute of Occupational Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Ivone Jakasa
- Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, Laboratory for Analytical Chemistry, University of Zagreb, Zagreb, Croatia
| | - Swen M John
- Department of Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Lower-Saxonian Institute of Occupational Dermatology (NIB), University of Osnabrück, Osnabrueck, Germany
| | - Claas Ulrich
- Skin Cancer Centre/HTCC, Hautklinik der Charité, Berlin, Germany
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
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Loney T, Paulo MS, Modenese A, Gobba F, Tenkate T, Whiteman DC, Green AC, John SM. Global evidence on occupational sun exposure and keratinocyte cancers: a systematic review. Br J Dermatol 2020; 184:208-218. [PMID: 32320481 DOI: 10.1111/bjd.19152] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/29/2022]
Abstract
Individual studies have suggested that the association between occupational exposure to solar ultraviolet radiation (UVR) and the development of keratinocyte cancers (KCs) may only be valid in populations of European ancestry living in certain geographical regions. Comparative global data are scarce and so this review aimed to summarize current evidence on the association between occupational exposure to solar UVR and the development of KCs, with a specific focus on geographical location and skin colour. Ovid MEDLINE, PubMed, Embase and Web of Science were searched for potentially relevant records. Extracted data were summarized by study, country and region. We included one prospective cohort study and 18 case-control studies (n = 15 233) from 12 countries in regions where the majority of the population is white skinned (Americas, Europe and Oceania). Eighteen of the 19 studies reported effect estimates suggesting an increased risk of basal cell carcinoma (BCC) and/or squamous cell carcinoma (SCC) among outdoor workers. Only 11 studies found a significantly increased risk and many had imprecise estimates. There was a significantly increased risk of BCC and SCC in individual studies in North America, Latin America and the Caribbean, Western Europe and Southern Europe, but not across regions or countries. Overall, 95% of studies reported higher risks among outdoor workers, although the increases in risk were statistically significant in just over half of the studies. Well-designed and sufficiently powered occupational case-control and cohort studies with adequate adjustment for confounding factors and other risk factors are required to provide more accurate risk estimates for occupational KC.
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Affiliation(s)
- T Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - M S Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - A Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - F Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - T Tenkate
- School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - A C Green
- QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, QLD, Australia.,CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - S M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Lower-Saxonian Institute of Occupational Dermatology, Osnabrück, Germany
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Abstract
BACKGROUND Ultraviolet radiation (UV)-induced malignancies, especially skin cancer, have continued to increase for decades. The main cause is natural and artificial UV radiation. The affected persons and the health care system are heavily burdened. The situation threatens to worsen, as climate change could lead to an increase in UV radiation exposure of the population and, thus, the risk of UV-related cancer in Germany as well. The prevention of UV-related diseases is, therefore, a health and radiation protection objective that needs to be considered. OBJECTIVE Necessary and appropriate prevention measures for the precaution of UV-related cancer are presented. MATERIALS AND METHODS The currently recommended and applied primary behavioral and structural preventive measures and potential, prevention-related relief for the health care system are examined and summarized. RESULTS Numerous behavioral and structural preventive measures are already being applied. Sustainably designed, multicomponent and personalized behavioral preventive measures in combination with structural prevention modules are effective and have a high economic and health-related benefit. The use of modern media and multimedia measures is recommended. CONCLUSION Structural prevention measures in addition to behavioral measures enable a reduction of the cancer risk caused by UV radiation. The aim must be to establish these measures nationwide for the entire population.
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23
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Tizek L, Schielein MC, Berger U, Ege MJ, Schneider S, Zink A. Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers. J Eur Acad Dermatol Venereol 2020; 34:2526-2533. [PMID: 32365247 DOI: 10.1111/jdv.16560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees. OBJECTIVES We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk. METHODS In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC. RESULTS A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected. CONCLUSION Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.
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Affiliation(s)
- L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich, Munich, Germany
| | - M C Schielein
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich, Munich, Germany
| | - U Berger
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich, Munich, Germany
| | - M J Ege
- Dr. von Hauner Children's Hospital, Member of the German Center of Lung Research (DZL), Ludwig-Maximilians University Munich, Munich, Germany
| | - S Schneider
- Medical Faculty Mannheim, Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Heidelberg University, Mannheim, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
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Kovačić J, Wittlich M, John SM, Macan J. Personal ultraviolet radiation dosimetry and its relationship with environmental data: A longitudinal pilot study in Croatian construction workers. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 207:111866. [DOI: 10.1016/j.jphotobiol.2020.111866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/20/2020] [Accepted: 03/24/2020] [Indexed: 12/22/2022]
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Nahar VK, Wilkerson AH, Martin B, Boyas JF, Ford MA, Bentley JP, Johnson P, Beason KR, Black WH, Brodell RT. Sun Protection Behaviors of State Park Workers in the Southeastern USA. Ann Work Expo Health 2020; 63:521-532. [PMID: 30916316 DOI: 10.1093/annweh/wxz019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/06/2019] [Accepted: 02/19/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Due to the nature of their work, state park workers receive substantial exposure to sunlight, putting them at an increased risk of developing skin cancer. Increased use of sun protection behaviors can reduce this risk. OBJECTIVES Using the health belief model (HBM) as a theoretical framework, the purpose of this study was to assess factors associated with sun protection behaviors among state-park workers. METHODS In this cross-sectional study, a convenience sample of participants were recruited from 23 state parks in the Southeastern USA to complete a self-administered questionnaire based on the constructs of the HBM. RESULTS The sample comprised 310 state park workers. The majority of participants were non-Hispanic White (61.6%), male (63.5%), and were aged 39.56 (±13.97) years on average. The average duration of sun exposure during the workday was reported as 3.51 h (±1.88). Nearly 12% of the participants reported that their workplace had a sun-safety policy and ~10% reported receiving sun-safety training at their workplace. The majority of participants reported that they did not sufficiently use sun protection methods. Factors associated with sun protection behaviors included the HBM constructs of perceived benefits outweighing perceived barriers (standardized coefficient = 0.210, P = 0.001), self-efficacy (standardized coefficient = 0.333, P < 0.001), and cues to action (standardized coefficient = 0.179, P = 0.004). CONCLUSION Future research should explore the barriers to adopting and enforcing sun-safety policies in the workplace. HBM appears to be efficacious in explaining sun protection behaviors among state park workers. HBM constructs should be considered in future interventions aimed at increasing sun protection behaviors in this population.
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Affiliation(s)
- Vinayak K Nahar
- Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, DeBusk College of Osteopathic Medicine, and School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN, USA.,Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amanda H Wilkerson
- Department of Health and Exercise Science, College of Arts and Sciences, University of Oklahoma, Norman, OK, USA
| | - Brian Martin
- DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Javier F Boyas
- School of Social Work, University of Georgia, Athens, GA, USA
| | - Mary A Ford
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, University, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Paul Johnson
- Department of Management, School of Business Administration, University of Mississippi, University, MS, USA
| | - Kim R Beason
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, University, MS, USA
| | - William H Black
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Robert T Brodell
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Skin Cancer Prevalence in Outdoor Workers of Ski Resorts. J Skin Cancer 2020; 2020:8128717. [PMID: 32231797 PMCID: PMC7097757 DOI: 10.1155/2020/8128717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Snow reflectivity and altitude increase the exposure of ski resort workers to solar ultraviolet radiation. The aim was to assess the presence of skin cancer in ski resorts workers and compare it with other groups of outdoor workers reviewing published studies. Methods An observational cross-sectional prospective study was conducted in the three largest ski resorts in Spain: Baqueira Beret, Lleida; Formigal, Huesca and Sierra Nevada, Granada. All outdoor workers including ski instructors were invited to participate in the study. The participants completed a validated questionnaire about sun exposure and underwent a skin examination. Results 219 workers were included in the study (80% male; mean age 43.8 (SD 11.31) years). Actinic keratosis (AK) but no other skin cancers were detected in 32 participants (14.62%). Those with AK worked in the Southernmost ski resort, were more likely to have light colour hair, and were older and with higher photoaging grade than those without them. Conclusion Compared to other studies, outdoor workers on ski resorts show a higher prevalence of AK than general population but a lower prevalence than other groups of outdoor workers.
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Vimercati L, De Maria L, Caputi A, Cannone ESS, Mansi F, Cavone D, Romita P, Argenziano G, Di Stefani A, Parodi A, Peris K, Scalvenzi M, Girolomoni G, Foti C. Non-Melanoma Skin Cancer in Outdoor Workers: A Study on Actinic Keratosis in Italian Navy Personnel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072321. [PMID: 32235587 PMCID: PMC7177289 DOI: 10.3390/ijerph17072321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 12/12/2022]
Abstract
Occupational exposure to ultraviolet radiation is one of the main risk factors for non-melanoma skin cancer (NMSC) development. The most common variants of NMSC are basal cell carcinomas, squamous cell carcinomas, and actinic keratosis (AK). The latter is nowadays considered by most authors as an early squamous cell carcinoma rather than a precancerous lesion. Outdoor workers have a higher risk of developing NMSC because they spend most of the working day outside. The aim of this descriptive study was to assess the prevalence of skin lesions, especially AK, in a professional category of individuals exposed to ultraviolet (UV) radiation: the Italian Navy. From January to June 2016, a questionnaire and a total skin examination of 921 military personnel were administered by medical specialists (dermatologists) in seven different Italian Navy centres. AK was detected in 217 of 921 (23.5%) workers. Older age, outdoor occupation, longer working life, and fair skin seem to promote the development of AK. Of the 217 workers with AK, 187 (86.2%) had lesions in chronically sun-exposed skin areas. Italian Navy personnel have a high AK prevalence. Further studies are needed to investigate occupational hazards and their health effects among outdoor workers to promote protective behaviour and raise awareness of skin cancer.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, 70124 Bari, Italy; (L.D.M.); (A.C.); (E.S.S.C.); (F.M.); (D.C.)
- Correspondence: ; Tel.: 0039-080-547-8256
| | - Luigi De Maria
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, 70124 Bari, Italy; (L.D.M.); (A.C.); (E.S.S.C.); (F.M.); (D.C.)
| | - Antonio Caputi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, 70124 Bari, Italy; (L.D.M.); (A.C.); (E.S.S.C.); (F.M.); (D.C.)
| | - Enza Sabrina Silvana Cannone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, 70124 Bari, Italy; (L.D.M.); (A.C.); (E.S.S.C.); (F.M.); (D.C.)
| | - Francesca Mansi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, 70124 Bari, Italy; (L.D.M.); (A.C.); (E.S.S.C.); (F.M.); (D.C.)
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, 70124 Bari, Italy; (L.D.M.); (A.C.); (E.S.S.C.); (F.M.); (D.C.)
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy; (P.R.); (C.F.)
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mentals and Physical Health and Preventive medicine, University of Campania Luigi Vanvitelli Naples, 80138 Naples, Italy
| | - Alessandro Di Stefani
- Institute of Dermatology, Università Cattolica, 00168 Rome, Italy; (A.D.S.); (K.P.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Aurora Parodi
- Section of Dermatology, Di.S.Sal. Department of Health Science, University of Genoa, San Martino Polyclinic Hospital, 16132 Genoa, Italy;
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, 00168 Rome, Italy; (A.D.S.); (K.P.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy;
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, 37134 Verona, Italy;
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy; (P.R.); (C.F.)
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Ludewig M, Rocholl M, John SM, Wilke A. Secondary prevention of UV-induced skin cancer: development and pilot testing of an educational patient counseling approach for individual sun protection as standard procedure of patient care. Int Arch Occup Environ Health 2020; 93:765-777. [PMID: 32162123 PMCID: PMC7320965 DOI: 10.1007/s00420-020-01532-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/23/2020] [Indexed: 01/07/2023]
Abstract
Objective To outline the development and pilot testing of a patient counseling approach for individual sun protection for patients in outdoor professions diagnosed with squamous cell carcinoma or multiple actinic keratosis due to solar UV radiation. This is a secondary prevention measure as part of the standard procedure of patient care by the respective statutory accident insurance. Methods Results of guideline-based qualitative interviews with seven outdoor workers and a search of literature formed the basis for the counseling approach, which was compiled in a manual. Interdisciplinary experts (dermatologists and educators) reviewed and consented the final manual. The pilot testing was conducted in consecutive steps (N1 = 36 patients and N1 = 2 counselors; N4 = 12 patients and N4 = 6 counselors). The first two stages of the revised guideline ‘Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI 2)’ serve as background and structure for presenting the results. Results The ‘counseling approach for individual sun protection (ILB: Individuelle Lichtschutz-Beratung)’ consists of seven general and eight add-on modules. These can be combined and tailored according to the patient’s individual needs. Interactive, educational components (e.g. haptic experiments) are crucial elements of the counseling approach. Conclusions The special requirements of outdoor workers are hardly taken into consideration in Germany, even though the interest for an improved sun protection behavior of some occupational groups is high. The advantage of the presented approach is that the heterogeneous needs of patients can be specifically addressed with its various modules.
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Affiliation(s)
- Michaela Ludewig
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany. .,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany.
| | - Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
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Moldovan HR, Wittlich M, John SM, Brans R, Tiplica GS, Salavastru C, Voidazan ST, Duca RC, Fugulyan E, Horvath G, Alexa A, Butacu AI. Exposure to solar UV radiation in outdoor construction workers using personal dosimetry. ENVIRONMENTAL RESEARCH 2020; 181:108967. [PMID: 31806287 DOI: 10.1016/j.envres.2019.108967] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/06/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
Occupational exposure to solar UV radiation (SUVR), a Group 1 carcinogen according to the IARC classification is at high exposure levels in outdoor construction workers, usually above the suggested occupational limits. Furthermore, there are no regulations related to this exposure in the EU, except for the artificial UVR. Also, the use of the ICNIRP exposure guideline in an outdoor setting poses problems of adequate dose assessment. In this context, the main purpose of the study was to perform direct measurements of the SUVR dose in outdoor workers from the construction sector, using individual SUVR dosimeters (GENESIS-UV system), for a period of 7 months, from April to October, in a prospective, observational study in two groups of 10 outdoor workers in Romania, located at two different geographic sites. In term of cumulative standard erythema dose (SED), our study population of outdoor construction workers received high levels of solar UV radiation, ranging from 165 SED to 453 SED during 7 months of occupational activity, from April to October. Our results, ranging from 1.28 SED (standard erythema dose) per day to 6.4 SED per day pose an alarm signal to the national and European health authorities to take preventive action for outdoor workers, as the ICNIRP suggested limit value of 1.33 SED for mean daily erythemal UV exposure is vastly exceeded. We suggest that personal dosimetry for SUVR, from simple devices to complex systems as GENESIS-UV should be regularly and mandatory used in outdoor workers, similarly to the usage of personal dosimetry in occupational exposure to ionizing radiations, which could be included in European and national legislation to reduce both, the level of exposure and the detrimental effects on outdoor workers' health.
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Affiliation(s)
- Horatiu Remus Moldovan
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, Targu-Mures, Romania.
| | - Marc Wittlich
- Institute for Occupational Safety and Health of the German Social Accident Insurance, St. Augustin, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany; Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Lower-Saxonian Institute of Occupational Dermatology, Osnabrück, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - George Sorin Tiplica
- 'Carol Davila' University of Medicine and Pharmacy, Department of Dermatology 2, "Colentina" Clinical Hospital, Bucharest, Romania
| | - Carmen Salavastru
- 'Carol Davila' University of Medicine and Pharmacy, Dermato-oncology Research Unit, Paediatric Dermatology Discipline, "Colentina" Clinical Hospital, Bucharest, Romania
| | - Septimiu Toader Voidazan
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, Targu-Mures, Romania.
| | - Radu Corneliu Duca
- Unit Environmental Hygiene and Human Biological Monitoring, National Health Laboratory (LNS), Dudelange, Luxembourg
| | - Ecaterina Fugulyan
- Occupational Medicine Clinic, Mures County Clinical Hospital, Targu-Mures, Romania
| | - Gyopar Horvath
- Occupational Medicine Clinic, Mures County Clinical Hospital, Targu-Mures, Romania
| | - Andrei Alexa
- Occupational Medicine Clinic, Mures County Clinical Hospital, Targu-Mures, Romania
| | - Alexandra Irina Butacu
- 'Carol Davila' University of Medicine and Pharmacy, Department of Dermatology 2, "Colentina" Clinical Hospital, Bucharest, Romania
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Ultraviolet Radiation Exposure: Some Observations and Considerations, Focusing on Some Italian Experiences, on Cancer Risk, and Primary Prevention. ENVIRONMENTS 2020. [DOI: 10.3390/environments7020010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Solar ultraviolet radiation may cause acute and chronic health effects on the skin, eyes, and also on the immune system. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects. In the white population, the most common type of cancer worldwide is skin cancer, and the incidence of this cancer has increased during the last decades. The most important risk factor responsible for this trend seems to be Ultraviolet Radiation (UVR). IARC has classified UVR as being carcinogenic to humans. UV radiation exposure is ubiquitous; to study skin cancer risk, it is important to take into account the fact that UV exposure may occur both for occupational activities but also during vacation or recreational activities. Furthermore, exposure to artificial UVR such as those emitted by artificial devices, classified by IARC as carcinogenic to humans, is also to be considered. Due to the prominent role of UVR, primary prevention of skin cancer is very suitable, because when following specific rules this risk factor can be reduced. The incidence rate of skin cancer is higher in people with fair skin. Outdoor workers exposed to solar UVR are at risk of developing skin cancer, particularly non-melanoma skin cancers, and welders exposed to artificial UVR are at risk of developing ocular melanoma. A specific project on solar UVR risk in outdoor workers in Tuscany, Italy, has shown that outdoor workers had an unsatisfactory sun protection behaviour. The project demonstrates the complexity of studying UVR exposure and recommended the need for prevention programs. Risk increases with increasing ambient solar radiation and with unsafe behaviours in the sun or when using artificial UVR (e.g., sunbeds). Effective prevention strategies have to be adopted both for the outdoor workers and for the general population exposed to UVR. A standardized program of proven efficacy, such as that implemented in Australia, should also be implemented in other countries. All these strategies could contribute to the aim of decreasing the morbidity and mortality of cancers associated with this exposure. The aim of this paper is to provide an overview of UVR exposure risk, particularly occupational risk, and to give some elements to understand the complexity of the relation between UVR exposure and cancer risk, as well as to outline primary prevention measures, focusing also on Italian experiences that could be useful for providing additional elements of knowledge on this topic.
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Rocholl M, Ludewig M, John SM, Bitzer EM, Wilke A. Outdoor workers' perceptions of skin cancer risk and attitudes to sun-protective measures: A qualitative study. J Occup Health 2020; 62:e12083. [PMID: 31478315 PMCID: PMC6970388 DOI: 10.1002/1348-9585.12083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/11/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Since January 2015, squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural ultraviolet irradiation (UVR) is recognized as occupational disease in Germany. Interventions which improve the sun protection behavior of outdoor workers are urgently needed. When developing preventive interventions, the attitudes of target groups need to be taken into consideration. Therefore, outdoor workers' perceptions and attitudes were investigated. METHODS Seven guided, problem-centered qualitative interviews with healthy male outdoor workers were conducted. A qualitative content analysis was used to analyze the data. RESULTS We found an underestimation of the perceived skin cancer risk in the seven outdoor workers and heterogeneous attitudes toward the usage of sun-protective measures. Participants stated that the feasibility of technical sun-protective measures depends on the size of the working area. While using a headgear seemed common, none of the participants stated using additional neck protection. Wearing long-sleeved shirts and long trousers were considered problematic. The interviews revealed important requirements for sun-protective clothes, especially in terms of different materials. Although the usage of sunscreen was common, our interviewees seemed to apply it wrongly. CONCLUSION Risk perceptions of outdoor workers and their attitudes toward sun protection measures may influence the factual UV protection behavior in the workplace. Structures to facilitate the implementation of technical and organizational sun-protective measures seem to be necessary. Educational interventions and clear instructions which are tailored to the individual needs and attitudes of outdoor workers are required to improve the UV protection behavior and to avoid common mistakes.
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Affiliation(s)
- Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Michaela Ludewig
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Eva Maria Bitzer
- Public Health and Health Education, University of Education Freiburg, Freiburg im Breisgau, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
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Perceptions of Occupational Heat, Sun Exposure, and Health Risk Prevention: A Qualitative Study of Forestry Workers in South Africa. ATMOSPHERE 2019. [DOI: 10.3390/atmos11010037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Occupational exposure to heat and solar ultraviolet radiation (UVR) threatens the health and wellbeing of outdoor workers. These threats are likely to increase as a result of climate change. This study examined the perceptions of occupational heat and sun exposure and health risk prevention among forestry workers removing alien invasive vegetation in the Western Cape, South Africa. The linkages between workers’ perceptions of heat, solar UVR, and herbicide exposure and impacts under the current climate were investigated to better understand potential adaptation needs under a changing climate. Using focus group discussions and participatory risk mapping, heat stresses identified by workers were either environmental (e.g., lack of shade) or work-related (e.g., wearing required personal protective equipment). Several heat and solar UVR health impacts were reportedly experienced by workers; local indigenous knowledge and coping mechanisms, such as wearing ochre for sun protection, were used to prevent these impacts. Despite workers’ current efforts to protect their health, existing gaps and opportunities to improve working conditions were identified. Institutional structures for improved reporting of adverse events are imperative, together with awareness and education campaigns about the risks associated with working in hot and sunny environments.
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Mir JF, Estrada-Campmany M, Heredia A, Rodríguez-Caba C, Alcalde M, Espinosa N, Monnier J, Pérez-Anker J, Yélamos O, Puig S, Bosch N, Malvehy J. Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain. Pharm Pract (Granada) 2019; 17:1455. [PMID: 31592287 PMCID: PMC6763307 DOI: 10.18549/pharmpract.2019.3.1455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/28/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Skin cancer incidence is increasing alarmingly, despite current efforts
trying to improve its early detection. Community pharmacists have proven
success in implementing screening protocols for a number of diseases because
of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the
photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a
descriptive cross-sectional study to assess photoprotection habits and skin
cancer risk factors by using a validated questionnaire in 218 community
pharmacies in Barcelona from May 23rd to June 13th
2016. All participants received health education on photoprotection and skin
cancer prevention. Patients with ≥1 skin cancer risk factor were
referred to their physician, as they needed further screening of skin
cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2%
participants had received a total body skin examination for skin cancer
screening in the past by a physician and 57.1% reported using a SPF
50+ sunscreen. 53.9% participants presented ≥1 skin cancer
risk factor: 11.8% participants reported having skin cancer familial
history and 6.2% reported skin cancer personal history; pharmacists
found ≥10 melanocytic nevi in 43.8% participants and
chronically sun-damaged skin in 21.4%. Lesions suspicious for
melanoma were reported in 10.9% of the participants and urgent
dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their
users. This intervention can be considered in multidisciplinary strategies
of skin cancer screening.
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Affiliation(s)
- Joan F Mir
- Consultant Pharmacist in Research and Projects Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Maria Estrada-Campmany
- Consultant Pharmacist in Research and Projects Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Anna Heredia
- Professional Relations Manager. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Cristina Rodríguez-Caba
- Head of Department of Continuous Professional Development. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Marta Alcalde
- Community Pharmacist. Dermopharmacy and Medical Devices Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Natalia Espinosa
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Jilliana Monnier
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Javiera Pérez-Anker
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Oriol Yélamos
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Susana Puig
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona; & Biomedical Research Networking Centers Consortium, Institute of Health Carlos III (CIBER-ISCIII). Barcelona (Spain).
| | - Núria Bosch
- Community Pharmacist. Dermopharmacy and Medical Devices Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Josep Malvehy
- Dermatologist. Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).Centro de Investigación Biomédica en Red (CIBER), Instituto Carlos III, Barcelona (Spain).
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Labrèche F, Kim J, Song C, Pahwa M, Ge CB, Arrandale VH, McLeod CB, Peters CE, Lavoué J, Davies HW, Nicol AM, Demers PA. The current burden of cancer attributable to occupational exposures in Canada. Prev Med 2019; 122:128-139. [PMID: 31078166 DOI: 10.1016/j.ypmed.2019.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Exposure to occupational carcinogens is often overlooked as a contributor to the burden of cancer. To estimate the proportion of cancer cases attributable to occupational exposure in Canada in 2011, exposure prevalence and levels of 44 carcinogens were informed by data from the Canadian carcinogen exposure surveillance project (CAREX Canada). These were used with Canadian Census (between 1961 and 2011) and Labour Force Survey (annual surveys between 1976 and 2013) data to estimate the number of workers ever exposed to occupational carcinogens. Risk estimates of the association between each carcinogen and cancer site were selected mainly from published literature reviews. Population attributable risks were estimated using Levin's equation and applied to the 2011 cancer statistics from the Canadian Cancer Registry. It is estimated that 15.5 million Canadians alive in 2011 were exposed, during at least one year between 1961 and 2001, to at least one carcinogen in the workplace. Overall, we estimated that in 2011, between 3.9% (95% CI: 3.1%-8.1%) and 4.2% (95% CI: 3.3%-8.7%) of all incident cases of cancer were due to occupational exposure, corresponding to lower and upper numbers of 7700-21,800 cases. Five of the cancer sites - mesothelioma, non-melanoma skin cancer, lung, female breast, and urinary bladder - account for a total of 7600 to 21,200 cancers attributable to occupational exposures such as solar radiation, asbestos, diesel engine exhaust, crystalline silica, and night shift work. Our study highlights cancer sites and occupational exposures that need recognition and efforts by all stakeholders to avoid preventable cancers in the future.
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Affiliation(s)
- France Labrèche
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montréal, Québec, Canada; School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Joanne Kim
- Occupational Cancer Research Centre (OCRC), Cancer Care Ontario, Toronto, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Chaojie Song
- Occupational Cancer Research Centre (OCRC), Cancer Care Ontario, Toronto, Ontario, Canada
| | - Manisha Pahwa
- Occupational Cancer Research Centre (OCRC), Cancer Care Ontario, Toronto, Ontario, Canada
| | - Calvin B Ge
- CAREX Canada, Simon Fraser University, Burnaby, British Columbia, Canada; Institute for Risk Assessment Sciences, Universiteit Utrecht, Utrecht, the Netherlands
| | - Victoria H Arrandale
- Occupational Cancer Research Centre (OCRC), Cancer Care Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Institute for Work & Health, Toronto, Ontario, Canada
| | - Cheryl E Peters
- CAREX Canada, Simon Fraser University, Burnaby, British Columbia, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jérôme Lavoué
- School of Public Health, Université de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Hugh W Davies
- CAREX Canada, Simon Fraser University, Burnaby, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Anne-Marie Nicol
- CAREX Canada, Simon Fraser University, Burnaby, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre (OCRC), Cancer Care Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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35
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Ziehfreund S, Schuster B, Zink A. Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019. J Eur Acad Dermatol Venereol 2019; 33:1477-1495. [PMID: 30801774 DOI: 10.1111/jdv.15525] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
Worldwide 2-3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun-related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer-related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between 1 January 2012 and 31 December 2018. We identified 51 relevant cross-sectional studies and 22 interventional studies. Sun-related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun protection programmes using new technologies seem to have great potential to increase sun-related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by healthcare institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.
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Affiliation(s)
- S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - B Schuster
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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Zink A, Schielein M, Wildner M, Rehfuess EA. 'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer. Br J Dermatol 2019; 180:1412-1419. [PMID: 30861096 DOI: 10.1111/bjd.17872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks. OBJECTIVES To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs. METHODS Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest. CONCLUSIONS Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - M Wildner
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.,Bavarian Health and Food Safety Authority, Munich, Germany
| | - E A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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Zink A. Trends in the treatment and prevention of keratinocyte carcinoma (non-melanoma skin cancer). Curr Opin Pharmacol 2019; 46:19-23. [PMID: 30660857 DOI: 10.1016/j.coph.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
Keratinocyte carcinoma (KC), previously also known as non-melanoma skin cancer, is the most common malignancy worldwide. It comprises basal cell carcinoma, squamous cell carcinoma (SCC), and actinic keratoses as carcinoma in situ or precursors of SCC. With solar ultraviolet radiation being the main risk factor, several countries have accepted KC as an occupational disease of outdoor professions. The prevalence in these high-risk groups is substantial, but awareness and preventive behavior remains inadequate. Parallel to the development of improved treatments, such as daylight photodynamic therapy and PD1 inhibitors for progressive KC, target-oriented prevention strategies are requisite if the global burden of KC is to be lowered. Health-related communication, internet search analysis, and telemedicine could be the key to addressing this issue.
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Affiliation(s)
- Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany; Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany.
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Cetintepe SP, McElroy B, Drummond A. Sun-related risks and risk reduction practices in Irish outdoor workers. Occup Med (Lond) 2018; 68:635-637. [DOI: 10.1093/occmed/kqy142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S P Cetintepe
- Division of Occupational Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
- Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - B McElroy
- Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - A Drummond
- Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Alfonso JH, Sandvik A, John SM. Occupational skin cancer: sweeping the path to prevention. Occup Med (Lond) 2018; 67:328-330. [PMID: 28838221 DOI: 10.1093/occmed/kqw180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jose Hernán Alfonso
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway, National Secretary for Norway International Commission on Occupational Health
| | - Anniken Sandvik
- Department of Environmental and Occupational Medicine, Oslo University Hospital, Oslo, Norway
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
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Larese Filon F, Buric M, Fluehler C. UV exposure, preventive habits, risk perception, and occupation in NMSC patients: A case-control study in Trieste (NE Italy). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:24-30. [PMID: 30058127 DOI: 10.1111/phpp.12417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND UV exposure is strongly associated with the incidence of non melanoma skin cancers (NMSCs), both basal and squamous cell carcinomas. The aim of our study was to analyze risk perception, UV exposure, preventive habits, and occupation in 126 subjects affected by NMSC and 187 controls. METHODS Consecutive cases with incident NMSC were recruited in Dermatologic Unit at University of Trieste; controls were recruited in Unit of Occupational Medicine. All had a medical examination to define Fitzpatrick skin type and skin lesions, and filled a standardized questionnaire on sun exposure habits, sun protection, occupational exposures, and sunburns in adulthood and childhood. RESULTS In multivariate regression analysis, NMSC resulted significantly associated with age (OR: 1.03; 95% CI 1.01-1.05), with a positive feeling for tan (OR: 1.10; 95% CI 1.01-1.20), and sunbath numbers per year (OR: 1.02; 95% CI: 1.001-1.03). A protective effect was demonstrated for Fitzpatrick phototypes III-IV compared to I and II (OR: 0.31; 95% CI: 0.18-0.55), sunscreen use (OR: 0.35; 95% CI: 0.22-0.58), and risk perception (OR: 0.98; 95% CI: 0.97-0.99). In univariate analysis, we demonstrated an increased risk for fishermen, sailors, and lifeguards (OR: 4.3; 95% CI: 1.1-16.4); foundry and metallurgy workers (OR: 5.58; 95% CI: 1.14-27.3); and mechanics, fixers, and welders (OR: 8.2; 95% CI: 1.76-37.9). CONCLUSIONS Our study demonstrated that protective behavior must be implemented in people living in Trieste. Workers must avoid direct UV exposure and must use protective equipment. More efforts are needed to increase knowledge on this risk and to raise awareness among at-risk people.
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Affiliation(s)
- Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Masa Buric
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Catharina Fluehler
- Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy
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41
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Zink A, Thomé F, Schielein M, Spinner CD, Biedermann T, Tizek L. Primary and secondary prevention of skin cancer in mountain guides: attitude and motivation for or against participation. J Eur Acad Dermatol Venereol 2018; 32:2153-2161. [PMID: 29846981 DOI: 10.1111/jdv.15095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Outdoor professionals such as mountain guides are at a substantial risk of developing non-melanoma skin cancer (NMSC) due to solar ultraviolet radiation (UVR) exposure. Despite major recent primary prevention efforts, studies on secondary skin cancer prevention efforts are limited and corresponding data on outdoor workers scarce. OBJECTIVE To assess the sun protective behaviour and individual motivations for or against skin cancer screening examinations in the German mountain guide population to aid in the development of effective awareness and prevention strategies. METHODS A cross-sectional study among all registered mountain guides in Germany was conducted using a 35-item online questionnaire on primary and secondary prevention of NMSC as well as perceived barriers for prevention. RESULTS A total of 145 mountain guides participated in the study in January 2017. Of these, 86.2% reported using sunscreen often or always, 62.1% with a sun protection factor (SPF) of 30-50% and 60.7% had undergone dermatological examination by a medical professional. The most common reasons for using secondary prevention efforts were hope of an early diagnosis (77.3%), fear of skin cancer (73.9%) and the intention to be aware of one's own health (70.5%). The main reasons for not doing so were absence of conspicuous skin conditions (63.2%) and feeling healthy (59.6%). CONCLUSION Awareness of prevention strategies recommended by the scientific community is low among affected occupationally high-risk mountain guide populations. Understanding the specific needs of this high-risk group is essential for the development of sustainable awareness and prevention strategies.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
| | - F Thomé
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
| | - C D Spinner
- Department of Medicine II, Technical University of Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany
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42
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Zink A, Tizek L, Schielein M, Böhner A, Biedermann T, Wildner M. Different outdoor professions have different risks - a cross-sectional study comparing non-melanoma skin cancer risk among farmers, gardeners and mountain guides. J Eur Acad Dermatol Venereol 2018; 32:1695-1701. [PMID: 29806193 DOI: 10.1111/jdv.15052] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND One of the main risk factors for non-melanoma skin cancer (NMSC), the most common cancer worldwide, is solar ultraviolet radiation (UVR). This has led to the recognition of NMSC as occupational disease for outdoor workers in several countries. However, outdoor professions are a very heterogeneous group with diverse daily activities and associated UVR exposure. OBJECTIVE To compare the prevalence of NMSC and associated risk behaviour in different outdoor professions. METHODS Cross-sectional study among outdoor workers (farmers, gardeners, mountain guides) and indoor workers (office employees) as control group using a paper-based questionnaire on UVR exposure and protective behaviour followed by a skin examination by a dermatologist. RESULTS A total of 563 participants (46.9% women, 46.9 ± 13.8 years) consisting of 348 outdoor workers (38.8% farmer, 35.3% gardener, 25.9% mountain guides) and 215 indoor workers were included in the study between March and September 2017. NMSC incl. actinic keratosis was diagnosed in 33.3% of mountain guides, 27.4% of farmers, 19.5% of gardeners and in 5.6% of indoor workers. Significant differences were seen between the outdoor professions with mountain guides at highest risk compared to farmers (OR = 2.6, 95% CI = 1.2-5.7). Substantial differences between the professions were also seen in skin cancer screening attendance rates (indoor worker 61.4%, mountain guides 57.8%, farmers 31.9%, gardeners 27.6%), daily UVR exposure during work and protective behaviour such as sunscreen use during work. CONCLUSION Different outdoor professions have significant different risks for NMSC and show different risk behaviour. Tailoring prevention efforts to different professions based on their individual needs could be the key to lower the global burden of (occupational) NMSC.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Böhner
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Wildner
- Bavarian Health and Food Safety Authority, Munich, Germany.,Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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43
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Seidl S, Schuster B, Rüth M, Biedermann T, Zink A. What Do Germans Want to Know About Skin Cancer? A Nationwide Google Search Analysis From 2013 to 2017. J Med Internet Res 2018; 20:e10327. [PMID: 29698213 PMCID: PMC5956155 DOI: 10.2196/10327] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 12/31/2022] Open
Abstract
Background Experts worldwide agree that skin cancer is a global health issue, but only a few studies have reported on world populations’ interest in skin cancer. Internet search data can reflect the interest of a population in different topics and thereby identify what the population wants to know. Objective Our aim was to assess the interest of the German population in nonmelanoma skin cancer and melanoma. Methods Google AdWords Keyword Planner was used to identify search terms related to nonmelanoma skin cancer and melanoma in Germany from November 2013 to October 2017. The identified search terms were assessed descriptively using SPSS version 24.0. In addition, the search terms were qualitatively categorized. Results A total of 646 skin cancer-related search terms were identified with 19,849,230 Google searches in the period under review. The search terms with the highest search volume were “skin cancer” (n=2,388,500, 12.03%), “white skin cancer” (n=2,056,900, 10.36%), “basalioma” (n=907,000, 4.57%), and “melanoma” (n=717,800, 3.62%). The most searched localizations of nonmelanoma skin cancer were “nose” (n=93,370, 38.99%) and “face” (n=53,270, 22.24%), and the most searched of melanoma were “nails” (n=46,270, 70.61%) and “eye” (n=10,480, 15.99%). The skin cancer‒related category with the highest search volume was “forms of skin cancer” (n=10,162,540, 23.28%) followed by “skin alterations” (n=4,962,020, 11.36%). Conclusions Our study provides insight into terms and fields of interest related to skin cancer relevant to the German population. Furthermore, temporal trends and courses are shown. This information could aid in the development and implementation of effective and sustainable awareness campaigns by developing information sources targeted to the population’s broad interest or by implementing new Internet campaigns.
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Affiliation(s)
- Stefanie Seidl
- Klinikum rechts der Isar, Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Barbara Schuster
- Klinikum rechts der Isar, Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Melvin Rüth
- Klinikum rechts der Isar, Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Klinikum rechts der Isar, Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Klinikum rechts der Isar, Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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Hasche D, Vinzón SE, Rösl F. Cutaneous Papillomaviruses and Non-melanoma Skin Cancer: Causal Agents or Innocent Bystanders? Front Microbiol 2018; 9:874. [PMID: 29770129 PMCID: PMC5942179 DOI: 10.3389/fmicb.2018.00874] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
There is still controversy in the scientific field about whether certain types of cutaneous human papillomaviruses (HPVs) are causally involved in the development of non-melanoma skin cancer (NMSC). Deciphering the etiological role of cutaneous HPVs requires - besides tissue culture systems - appropriate preclinical models to match the obtained results with clinical data from affected patients. Clear scientific evidence about the etiology and underlying mechanisms involved in NMSC development is fundamental to provide reasonable arguments for public health institutions to classify at least certain cutaneous HPVs as group 1 carcinogens. This in turn would have implications on fundraising institutions and health care decision makers to force - similarly as for anogenital cancer - the implementation of a broad vaccination program against "high-risk" cutaneous HPVs to prevent NMSC as the most frequent cancer worldwide. Precise knowledge of the multi-step progression from normal cells to cancer is a prerequisite to understand the functional and clinical impact of cofactors that affect the individual outcome and the personalized treatment of a disease. This overview summarizes not only recent arguments that favor the acceptance of a viral etiology in NMSC development but also reflects aspects of causality in medicine, the use of empirically meaningful model systems and strategies for prevention.
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Affiliation(s)
- Daniel Hasche
- Division of Viral Transformation Mechanisms, Research Program "Infection, Inflammation and Cancer", German Cancer Research Center, Heidelberg, Germany
| | - Sabrina E Vinzón
- Laboratory of Molecular and Cellular Therapy, Fundación Instituto Leloir, IIBBA-CONICET, Buenos Aires, Argentina
| | - Frank Rösl
- Division of Viral Transformation Mechanisms, Research Program "Infection, Inflammation and Cancer", German Cancer Research Center, Heidelberg, Germany
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Grandahl K, Eriksen P, Ibler KS, Bonde JP, Mortensen OS. Measurements of Solar Ultraviolet Radiation Exposure at Work and at Leisure in Danish Workers. Photochem Photobiol 2018; 94:807-814. [PMID: 29603236 DOI: 10.1111/php.12920] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Abstract
Exposure to solar ultraviolet radiation is the main cause of skin cancer and may well present an occupational health and safety problem. In Denmark, skin cancer is a common disease in the general population, but detailed data on solar ultraviolet radiation exposure among outdoor workers are lacking. The aim of this study was to provide objective measurements of solar ultraviolet radiation exposure on working days and at leisure and compare levels of exposure between groups of mainly outdoor, equal-parts-outdoor-and-indoor and indoor workers. To this end, UV-B dosimeters with an aluminum gallium nitride (AlGaN) photodiode detector were used to measure the solar ultraviolet radiation exposure of 457 workers in the Danish summer season. Presented as semi-annual standard erythemal dose (SED) on working days, respectively, at leisure, the results are for mainly outdoor workers 214.2 SED and 64.8 SED, equal-parts-outdoor-and-indoor workers 131.4 SED and 64.8 SED, indoor workers 55.8 SED and 57.6 SED. The daily SED by month is significantly different (α = 0.05) between mainly outdoor, equal-parts-outdoor-and-indoor and indoor workers and across professional groups; some of which are exposed at very high levels that is roofers 361.8 SED. These findings substantiate that exposure to solar ultraviolet radiation is indeed an occupational health and safety problem in Denmark.
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Affiliation(s)
- Kasper Grandahl
- The Department of Occupational Medicine, Copenhagen University Holbaek, Holbaek, Denmark
| | - Paul Eriksen
- The Danish Meteorological Institute, Copenhagen, Denmark
| | | | - Jens Peter Bonde
- The Department of Occupational Medicine, Copenhagen University Bispebjerg, Copenhagen NV, Denmark
| | - Ole Steen Mortensen
- The Department of Occupational Medicine, Copenhagen University Holbaek, Holbaek, Denmark.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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46
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von Schuckmann LA. Is occupational sun exposure important for squamous cell carcinoma risk? Br J Dermatol 2018; 178:325-326. [PMID: 29441555 DOI: 10.1111/bjd.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Schmitt J, Haufe E, Trautmann F, Schulze HJ, Elsner P, Drexler H, Bauer A, Letzel S, John S, Fartasch M, Brüning T, Seidler A, Dugas-Breit S, Gina M, Weistenhöfer W, Bachmann K, Bruhn I, Lang B, Bonness S, Allam J, Grobe W, Stange T, Westerhausen S, Knuschke P, Wittlich M, Diepgen T. 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. Br J Dermatol 2018; 178:462-472. [DOI: 10.1111/bjd.15906] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 12/24/2022]
Affiliation(s)
- J. Schmitt
- Center of Evidence-based Healthcare; Medical Faculty Carl Gustav Carus; University Hospital; Technical University Dresden; Germany
- Institute and Outpatient Clinics of Occupational and Social Medicine; Medical Faculty Carl Gustav Carus; Technical University Dresden; Germany
| | - E. Haufe
- Center of Evidence-based Healthcare; Medical Faculty Carl Gustav Carus; University Hospital; Technical University Dresden; Germany
- Institute and Outpatient Clinics of Occupational and Social Medicine; Medical Faculty Carl Gustav Carus; Technical University Dresden; Germany
| | - F. Trautmann
- Center of Evidence-based Healthcare; Medical Faculty Carl Gustav Carus; University Hospital; Technical University Dresden; Germany
| | - H.-J. Schulze
- Department of Dermatology; Dermatological Radiotherapy and Dermatohistopathology; Special Clinics Hornheide; Münster Germany
| | - P. Elsner
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - H. Drexler
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine; Friedrich-Alexander-University Erlangen-Nuernberg; Nuernberg Germany
| | - A. Bauer
- Department of Dermatology - University Allergy Center; Medical Faculty Carl Gustav Carus; Technical University Dresden; Germany
| | - S. Letzel
- Institute of Occupational, Social and Environmental Medicine; Johannes-Gutenberg University Mainz; Mainz Germany
| | - S.M. John
- Department of Dermatology; Environmental Health and Health Theory; University of Osnabrueck; Osnabrueck Germany
- Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); University of Osnabrück; Osnabrück Germany
| | - M. Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV); Institute of Ruhr-University Bochum (IPA); Bochum Germany
| | - T. Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV); Institute of Ruhr-University Bochum (IPA); Bochum Germany
| | - A. Seidler
- Institute and Outpatient Clinics of Occupational and Social Medicine; Medical Faculty Carl Gustav Carus; Technical University Dresden; Germany
| | - S. Dugas-Breit
- Department of Dermatology; Dermatological Radiotherapy and Dermatohistopathology; Special Clinics Hornheide; Münster Germany
| | - M. Gina
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - W. Weistenhöfer
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine; Friedrich-Alexander-University Erlangen-Nuernberg; Nuernberg Germany
| | - K. Bachmann
- Department of Clinical Social Medicine; Occupational and Environmental Dermatology; University of Heidelberg; Heidelberg Germany
| | - I. Bruhn
- Department of Dermatology - University Allergy Center; Medical Faculty Carl Gustav Carus; Technical University Dresden; Germany
| | - B.M. Lang
- Department of Dermatology; University Medical Center; Johannes-Gutenberg University Mainz; Germany
| | - S. Bonness
- Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); University of Osnabrück; Osnabrück Germany
- Employer's Liability Insurance Association Clinics Hamburg; Hamburg Germany
| | - J.P. Allam
- Department of Dermatology and Allergy; University Bonn; Bonn Germany
| | - W. Grobe
- Department of Dermatology and Allergy; University Bonn; Bonn Germany
| | - T. Stange
- Center of Evidence-based Healthcare; Medical Faculty Carl Gustav Carus; University Hospital; Technical University Dresden; Germany
| | - S. Westerhausen
- Department of Radiation; Institute of Occupational Health and Safety of the German Social Accident Insurance (DGUV); Sankt Augustin Germany
| | - P. Knuschke
- Department of Dermatology - Experimental Photobiology; University Hospital and Medical Faculty Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - M. Wittlich
- Department of Radiation; Institute of Occupational Health and Safety of the German Social Accident Insurance (DGUV); Sankt Augustin Germany
| | - T.L. Diepgen
- Department of Clinical Social Medicine; Occupational and Environmental Dermatology; University of Heidelberg; Heidelberg Germany
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Damps T, Laskowska AK, Kowalkowski T, Prokopowicz M, Puszko AK, Sosnowski P, Czuwara J, Konop M, Różycki K, Borkowska JK, Misicka A, Rudnicka L. The effect of wool hydrolysates on squamous cell carcinoma cells in vitro. Possible implications for cancer treatment. PLoS One 2017; 12:e0184034. [PMID: 28859143 PMCID: PMC5578621 DOI: 10.1371/journal.pone.0184034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
Squamous cell carcinoma of the skin is the second most common cutaneous malignancy. Despite various available treatment methods and advances in noninvasive diagnostic techniques, the incidence of metastatic cutaneous squamous cell carcinoma is rising. Deficiency in effective preventive or treatment methods of transformed keratinocytes leads to necessity of searching for new anticancer agents. The present study aims to evaluate the possibility of using wool hydrolysates as such agents. Commercially available compounds such as 5-fluorouracil, ingenol mebutate, diclofenac sodium salt were also used in this study. The process of wool degradation was based on chemical pre-activation and enzymatic digestion of wool. The effect of mentioned compounds on cell viability of squamous carcinoma cell line and healthy keratinocytes was evaluated. The obtained data show a significantly stronger effect of selected wool hydrolysates compared to commercial compounds (p<0.05) on viability of cells. The wool hydrolysates decreased squamous cell carcinoma cells viability by up to 67% comparing to untreated cells. These results indicate bioactive properties of wool hydrolysates, which affect the viability of squamous carcinoma cells and decrease their number. We hypothesize that these agents may be used topically for treatment of transformed keratinocytes in actinic keratosis and invasive squamous skin cancer in humans.
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Affiliation(s)
- Tatsiana Damps
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- * E-mail:
| | - Anna Katarzyna Laskowska
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Kowalkowski
- Chair of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Toruń, Poland
- Interdisciplinary Centre of Modern Technology, Nicolaus Copernicus University, Toruń, Poland
| | - Monika Prokopowicz
- Laboratory of Chemical Synthesis, CePT, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | - Piotr Sosnowski
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Konop
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Różycki
- Laboratory of Chemical Synthesis, CePT, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Joanna Karolina Borkowska
- Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Aleksandra Misicka
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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