Global evidence on occupational sun exposure and keratinocyte cancers: a systematic review.
Level 3 - non-randomized controlled study
Systematic review of observational studies (1 prospective cohort, 18 case-control).
PubMed 32320481 · doi:10.1111/bjd.19152
What was done
Researchers performed a systematic review across Ovid MEDLINE, PubMed, Embase, and Web of Science to evaluate the relationship between occupational solar ultraviolet radiation exposure and keratinocyte cancers (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]), examining geographical location and skin colour. The review identified 1 prospective cohort study and 18 case-control studies comprising 15,233 participants across 12 countries in the Americas, Europe, and Oceania.
What was found
Eighteen of the 19 studies (95%) reported effect estimates suggesting an increased risk of BCC and/or SCC among outdoor workers. However, only 11 studies demonstrated a statistically significant increase in risk, and many studies provided imprecise estimates. Statistically significant risks for BCC and SCC appeared in individual studies in North America, Latin America and the Caribbean, Western Europe, and Southern Europe, but consistent associations were not shown across entire regions or countries. The abstract reported no pooled numerical effect estimates.
Why it matters
This review synthesizes global observational literature demonstrating that outdoor workers consistently exhibit elevated risks for keratinocyte cancers across diverse geographic regions.
Limits
The included literature is predominantly retrospective (18 of 19 are case-control studies) and prone to recall and selection bias. Many studies were limited by small sample sizes, imprecise estimates, and inadequate control for confounding factors. Data were also restricted entirely to regions with predominantly white-skinned populations, leaving non-European ancestry groups uncharacterized.
Cited by
- supports Observational cohort studies show that increased sun exposure increases the risk of developing basal cell and squamous cell carcinomas.