Part 2 of research project "Malignant skin tumors induced by UV radiation": Case-Control-Study evaluating the association of occupational exposition to UV radiation and A) squamous-cell carcinoma and B) basal-cell carcinoma

Status:

completed 05/2016

Aims:

Solar ultraviolet radiation is an important risk factor for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Dose-response relationships between cumulative UV exposure and risk for both entities as well as the role of occupational UV exposure in the development of BCC have not yet been conclusively investigated. This is where the research project FB-0181 comes in as second part of "Malignant skin tumors induced by UV-irradiation - Development and evaluation of differentiation criteria between occupational and non-occupational causes relevant for the occupational health insurance" (FB-0170).

The primary objective of the research project FB 181 was the risk assessment of SCC and BCC of the skin with respect to natural UV exposure. Furthermore, instruments for the quantification of light damage ("Lichtschaden") of the skin as well as instruments for assessment of the individual occupational and non-occupational UV exposure, which have been developed within the research project FB-0170, were validated and reviewed for practicability.

Activities/Methods:

A methodologically demanding, population-based and multicenter case-control study with two case groups (incident spontaneous squamous cell carcinoma; incident spontaneous basal cell carcinoma) and a control group was conducted to investigate the role of solar radiation in the development of SCC and BCC with particular focus on occupational and non-occupational UV exposure. A propensity score matching was conducted to ensure balanced proportions of age and sex within case and control groups. Potential risk factors such as positive family anamnesis, skin type, immunosuppression, age and sex were taken into account in the analyses on the association of UV exposure and skin cancer risk.

In total, 626 persons with SCC/actinic keratosis grade III or Bowen’s disease, 739 persons with BCC and 996 controls were recruited and examined.

Results:

Persons with high lifetime UV exposure levels (≥ 90. percentile) were at significantly higher risk of SCC in comparison to persons with medium lifetime UV exposure levels (40.-60. percentile). For BCC this association was not significant. Farmers, outdoor construction workers as well as outdoor locksmiths, installers and pipe constructors yielded an especially high risk for both entities of non-melanoma skin cancer. Modifications by skin type were not analyzed and remain for further research. Furthermore it became apparent that solarium use was positively associated with an increased risk of non-melanoma skin cancer.

The instruments for quantification of solar damage ("Lichtschaden") and the individual occupational and non-occupational UV exposure developed within the research project FB-0170 proved to be valid, reliable and practicable within the field study being applied by investigators/physicians not being involved in the instrument development. However, special training of medical personal is required to ensure a correct usage.

Conclusion:
The data collected within the project distinguish themselves by their high level of representativeness regarding selected parameters and by their high quality achieved by monitoring, electronic data collection as well as thorough plausibility checks. Results of the FB 181 research project provide substantial new knowledge for discussions regarding the role of occupational and non-occupational natural UV exposure in the development of non-melanoma skin cancer. However, the researchers are taking care of overinterpret the very complex results of the research project. The epidemiological specificities with their possible pitfalls should also be noted. Meanwhile, the results were published in two leading journals (squamous cell carcinoma in British Journal of Dermatology, basal cell carcinoma in Journal of Occupational and Environmental Medicine). On the issue of occupationally caused squamous cell carcinoma the findings introduced BK 5103 essentially were confirmed. On the issue of basal cell carcinoma new indications for occupational causes were referred. Because of the incidence of basall cell carcinoma in different clinical and histological subtypes further analyses of relevant subgroups are conducted. This helps to assess occupational causes.

Publications:

Diepgen, T.: UV-Strahlung und Hautkrebs (PDF, 390 kB, non-accessible) . Forschungsprojekt "Durch UV-Strahlung induzierte bösartige Hauttumore" – berufliche und außerberufliche Exposition gegenüber UV-Strahlung und Hautkrebs. IPA-Journal 3/2017: S. 12-15 (2017)

Krohn. S.: DGUV-Forschung: Alles klar rund um die Sonne? - Erkenntnisse aus dem DGUV Forschungsprojekt FB 181 und deren Auswirkungen auf die Praxis. DGUV Forum 12/2017: S. 17-18 (2017)

Schmitt, J., Haufe, E., Trautmann, F., Allam, J. P., Bachmann, K., Bauer, A., Bieber, T., Bonness, S., Brans, R., Brecht, B, Brüning, T., Bruhn, I., Drexler, H., Dugas-Breit, S., Elsner, P., Fartasch, M., Gina, M., Grabbe, S., Grobe, W., John, S.M., Knuschke, P., Küster, D., Lang, B., Letzel, S., Ruppert, L., Schulze, H.J., Seidler. A., Stange, T., Stephan, V., Thielitz, A., Weistenhöfer, W., Westerhausen, S., Wittlich, M., Zimmermann, E., Diepgen, T. L.: Forschungsprojekt "Durch UV-Strahlung induzierte bösartige Hauttumore" - Berufliche und außerberufliche Exposition gegenüber UV-Strahlung und Hautkrebs. Dermatologie in Beruf und Umwelt, Jahrgang 65, Nr. 1/2017, S. 13-14. (2017)

Schmitt, J., Haufe, E., Trautmann, F, Schulze, H.-J., Elsner, P., Drexler, H, Bauer, A., Letzel, S., John, S.M., Fartasch, M., Brüning, T., Seidler, A., Dugas-Breit, S., Gina, M., Weistenhöfer, W., Bachmann, K., Bruhn, I., Lang, B.M., Bonness, S., Allam, J.P., Grobe, W., Stange, T., Westerhausen, S., Knuschke, P., Wittlich, M., T.L. Diepgen, for the FB-181 Study Group: Is UV-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 Feb, 178(2), S. 462-472 (2018)

Schmitt, J., Haufe, E., Trautmann, F., Schulze, H.-J., Elsner, P., Drexler, H., Bauer, A., Letzel, S., John, S.M., Fartasch, M., Brüning, T., Seidler, A., Dugas-Breit, S., Gina, M., Weistenhöfer, W., Bachmann, K., Bruhn, I., Lang, B.M., Bonness, S., Allam, J.P., Grobe, W., Stange, T., Westerhausen, S., Knuschke, P., Wittlich, M., Diepgen, T.L. on behalf of the FB 181 Study Group: Occupational UV-exposure is a major risk factor for basal cell carcinoma: Results of the population-based case-control study FB-181. J Occup Environ Med, 2018 Jan;, 60(1), S. 36-43 (2018)

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