Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Int Arch Occup Environ Health. 2017 Nov;90(8):873-881. doi: 10.1007/s00420-017-1248-5. Epub 2017 Aug 1.
Arc welding produces the full spectrum of ultraviolet radiation and may be a contributory cause of skin cancer; however, there has been little research into this occupational hazard. The aim of this study is to explore if metal arc welding increases the risk of malignant melanoma and/or basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on skin areas which may possibly be exposed (neck, head, and upper extremities).
A Danish national company-based historic cohort of 4333 male metal arc welders was followed from 1987 through 2012 to identify the risk of skin cancer. An external reference group was established including all Danish skilled and unskilled male workers with similar age distribution. Occupational histories were gathered by questionnaires in 1986 and information about skin cancer diagnoses [BCC, SCC, cutaneous malignant melanoma (CMM), and precancerous conditions, actinic keratosis (AK)] were gathered from the Danish Cancer Registry supplemented by the data from the Danish Pathology Register. Hazard ratios (HRs) were calculated in the follow-up period from 1987 until 2012 using Cox regression analysis and adjusted for baseline data regarding age and social group.
The adjusted HR and 95% confidence interval (CI) for skin cancer (all types) were 0.99 (CI 0.94-1.04) for welders. The adjusted HR for AK and BCC located only at neck was 2.49 (CI 1.03-5.99) for welders exposed >20 years (n = 5) and 2.46 (CI 1.02-5.94), respectively, for welders exposed >30 years (n = 5). No statistically significant difference was observed for SCC. The risk of CMM at the neck was also significantly elevated after 30 years of welding, but this is based upon only one exposed case.
This study indicates that long-term exposure to metal arc welding may be related to increased risk of BCC and AK located exclusively at the neck. The study provides no support for the hypothesis that welding exposure increases the risk for skin cancer at other locations.
电弧焊接会产生全光谱紫外线辐射，可能是皮肤癌的致病因素之一；然而，针对这一职业危害的研究甚少。本研究旨在探究金属电弧焊接是否会增加颈部、头部和上肢等可能暴露部位的恶性黑色素瘤和/或基底细胞癌（BCC）和鳞状细胞癌（SCC）的患病风险。
对丹麦一家公司的 4333 名男性金属电弧焊工进行了一项基于队列的历史性研究，自 1987 年开始追踪至 2012 年，以确定其皮肤癌的患病风险。建立了一个外部参照组，包括所有丹麦熟练和非熟练男性工人，他们的年龄分布相似。1986 年通过问卷收集职业史信息，从丹麦癌症登记处收集皮肤癌诊断信息（BCC、SCC、皮肤恶性黑色素瘤（CMM）和癌前病变，光化性角化病（AK）），并通过丹麦病理登记处的数据进行补充。在 1987 年至 2012 年的随访期间，使用 Cox 回归分析计算危险比（HR），并根据年龄和社会群体的基线数据进行调整。
调整后的 HR 和 95%置信区间（CI）显示，所有类型的皮肤癌（0.99，CI 0.94-1.04）在焊工中的发病率与参照组相似。暴露>20 年（n=5）的焊工中，仅在颈部的 AK 和 BCC 的调整后 HR 为 2.49（CI 1.03-5.99），暴露>30 年（n=5）的焊工分别为 2.46（CI 1.02-5.94）。未观察到 SCC 的统计学差异。颈部 CMM 的患病风险在焊接 30 年后也显著升高，但这仅基于一个暴露病例。
本研究表明，长期接触金属电弧焊接可能与颈部特发性 BCC 和 AK 风险增加有关。该研究并未支持焊接暴露会增加其他部位皮肤癌风险的假说。
