Occupational exposure to arsenic and risk of nonmelanoma skin cancer in a multinational European study

Abstract

Occupational studies show a high risk of lung cancer related to arsenic exposure by inhalation; however, only a few studies, and with conflicting results, previously examined a potential link between arsenic exposure at work and skin cancer. The aim of this study is to assess airborne arsenic exposures at the workplace and to quantify associations with nonmelanoma skin cancer (NMSC). The study sample consists of 618 incident cases of NMSC and 527 hospital-based controls aged 30-79 years from Hungary, Romania and Slovakia. Exposures were evaluated by local experts using occupational histories. Information on host factors and other exposures was collected and used to adjust the associations of interest using multivariable logistic regression. The lifetime prevalence of exposure to work-related arsenic is 23.9% for cases and 15.5% for controls. No significant association between arsenic exposure in the workplace and NMSC was detected, although an increased adjusted odd ratio was observed for participants with higher cumulative lifetime workplace exposure to arsenic in dust and fumes compared to referents [odds ratios (OR) 5 1.94, 95% confidence interval (CI) 5 0.76-4.95]. There is evidence for modification of the workplace arsenic-NMSC association by work-related sunlight exposure in women, with a markedly increased adjusted OR in the presence of workplace sunlight exposure (OR 5 10.22, 95% CI 5 2.48-42.07). Workplace coexposure to arsenic and sunlight may thus pose an increased risk of NMSC.Nonmelanoma skin cancer (NMSC) is the most common type of cancer worldwide and its incidence is rising. Although exact statistics are not known as these tumors are not generally reported to cancer registries, the trend is confirmed by a report published by the International Agency for Research on Cancer in 2008. 1 The two main histological types of NMSC linked to arsenic exposure are squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs), occurring not only on sun-exposed areas of the body but also develop on sun-unexposed skin. 2,3 If NMSC is not diagnosed and treated in early stages, high morbidity and substantial disfigurement due to local invasion is of great concern for public health and is an important source of healthcare expenditure. 4 NMSC has also been associated with other environmental and occupational risk factors, including ultraviolet (UV)

Skin cancer in rural workers: nursing knowledge and intervention

“…This study's results corroborate the findings of other studies addressing the potential of skin cancer being triggered in population groups under similar occupational and clinical conditions, such as: average age because skin cancer is more frequent among male individuals (1) aged above 50 years of age (2,19) , a profile similar to that found in other countries such as the United States (2) ; continuous and cumulative exposure (working time) to UV radiation and contact with pesticides (3,(7)(8)(9)12) , which are the working conditions experienced by men and women associated with the development of recurrence of the disease (11,19) ; the study setting is located in the extreme south of Rio Grande do Sul, which is one of the Brazilian states located in the south with the highest incidence of non-melanoma skin cancer among men (1) . Note that only one worker, out of the seven workers with a previous diagnosis of the disease, was able to report the type of skin cancer he was diagnosed with; melanoma.…”

“…The pathological exams indicated melanocytes nevi and actinic keratosis. Plausible evidence is presented by studies (7,(10)(11)(12) addressing specific conditions of exposure to UV radiation and pesticides as being risks associated with the development of skin cancer. Such evidence is demonstrated in one study conducted with rural workers in farmers' markets in the United States, which suggests that most farming workers who took part in the study were concerned with skin cancer risks and were aware of the importance of using protective measures.…”

“…Other evidence associates skin cancer with occupational exposure to chemical compounds. Arsenic is shown as a compound that may be related to the development of skin cancer, especially when associated with UV radiation (11) , as is the case of farm workers. These workers are in contact with both physical and chemical risks because arsenic is a compound used in pesticides (12) .…”

Occupational skin cancer: Systematic review

“…The references analyzed noted that occupational skin cancer arises in individuals at more advanced ages, that is, from the sixth decade of life onward. [6][7][8][9] The only discrepancy noted among the articles was that Lee et al 10 conducted a case control study and noted that the average age of individuals with cutaneous malignant melanoma was 48.9 years, which did not differ much from the age of the control group. Even though this is an earlier age than that observed in other articles, this does not contradict the literature, as according to Korand et al 11 cutaneous melanoma has a higher incidence in the age range of 40 to 60 years of age.…”

“…Another article that presented a contradiction was the study of Surdu et al, 23 which showed an inverse relationship between non-melanoma skin cancer, primarily basal cell carcinoma (BCC), and sun exposure in the workplace. However, this article presented limitations that may have favored this contradiction, as the evaluation of sun exposure may have been misclassified, or participants may have had low levels of sun exposure, as well as having been protected against UV exposure, leading to these professionals not developing skin cancer.…”