Review date
November 2023
Article publication date
October 2023
Summary
This study presents the World Health Organization/International Labour Organization joint estimates of occupational exposures to ultraviolet radiation (UVR) globally and attributable non-melanoma skin cancer (NMSC) deaths and overall disease burden (i.e., disability-adjusted life year or DALYs) for the years 2000, 2010 and 2019. Occupational exposure to UVR was estimated using occupation as a proxy for outdoor work, involving 763 cross-sectional surveys from 96 countries/areas. Attributable NMSC burden was estimated by applying the population attributable fraction (PAFs) to WHO’s estimates of the total NMSC burden. The study reported that 1.6 billion workers (28.4 % of the working-age population) were occupationally exposed to UVR across the world in 2019. Globally, the PAFs were 29.0 % [95% uncertainty range 24.7–35.0)] for NMSC deaths, and 30.4 % (UR 29.0–31.7) for DALYs. Attributable NMSC burdens were 18,960 deaths (UR 18,180–19,740) and 0.5 million DALYs (UR 0.4–0.5). During 2000–2019, attributable deaths and DALYs almost doubled; and men and old age populations carried larger burden. The study also reports that Australia has one of the highest rates of NMSC burden and rate of death associated with occupational UVR exposure. The study concluded that UVR exposure is responsible for a considerable and growing attributable burden of NMSC; therefore, occupational outdoor UVR exposure is a significant hazard.
Link to
Published in
Environment International - Volume 181
ARPANSA commentary
The (International Agency for Research on Cancer, IARC) classifies solar UVR as a Group 1 carcinogen (IARC, 1992). The global burden of occupational UVR exposure estimated by this study shows that occupational UVR exposure is the third largest attributable burden of cancer globally. Therefore, the estimations of NMSC deaths and DALYs associated with occupational UVR exposure are significant. A key limitation of this study is that UVR exposure estimations were done based on exposure assigned via occupation as a proxy that experts judged as always working outdoors rather than data gathered employing personal exposure measurements. This might have introduced some exposure misclassification bias, which results in under- or overestimation of the exposure and subsequent estimation of the burden/risk of disease. Notably, a recent WHO systematic review and meta-analysis (WHO, 2021) reported limited evidence for an association between occupational UVR exposure and skin cancer.
In Australia, skin cancer accounts for the largest number of cancers diagnosed each year (Australian Institute of Health and Welfare, 2016). A study reports that 22% of workers are occupationally exposed to UVR (Carey et al., 2014) along with other known carcinogens. Therefore, the findings of this study highlight the need of adequate sun protection for outdoor workers internationally, including Australia. This is supported by both IARC and Australian national (e.g., Cancer Council Australia Sun safety | Cancer Council) recommendations for current sun protection. ARPANSA recommends that all people including workers should limit their UVR exposures, and a combination of sun protection measures (e.g., clothing and sunglasses, shade and sunscreen) should be used, wherever applicable. For more information see the ARPANSA factsheet, Sun exposure and health.
