Risk of Skin Cancer in Workers Exposed to Diesel Exhaust: A Systematic Review and Meta-Analysis of Cohort Studies
Keywords:
Diesel exhaust, Skin cancer, Meta-analysis, Occupational exposure, Occupational healthAbstract
Background: Our objective was to study the association between occupational exposure to diesel exhaust (DE) and skin cancer. Methods: A systematic review following STROBE guidelines and PECOS criteria was conducted to identify cohort studies describing the association between occupational DE exposure and the risk of skin cancer. We extracted 12 independent risk estimates for melanoma skin cancer (MSC), 8 for non-melanoma skin cancer (NMSC), and 3 for skin cancer not otherwise specified (SC-NOS). Random effects meta-analyses were performed, site-specific and stratified by geographic region and quality score. 95% confidence intervals (CI) were reported. Between-study heterogeneity and potential publication bias were investigated. Results: There was no overall evidence of an increased risk of MSC [RR=0.90, 95% CI: 0.73-1.11; I2=92.86%, 95% CI: 82.83-97.03%], NMSC [RR=1.04, 95% CI: 0.88-1.23; I2=60.79%, 95% CI: 0-87.34%] or SC-NOS [RR=0.72, 95% CI: 0.54-0.97; I2=26.60%, 95% CI: 0-94.87%] in workers exposed to DE. No difference between low-quality and high-quality studies was found. A stratified analysis by geographical region did not reveal any significant differences. There was no evidence of publication bias. Conclusions: No evidence of an association between skin cancer and occupational DE exposure was found. Residual confounding and other sources of bias cannot be ruled out.
References
Pronk A, Coble J, Stewart PA. Occupational exposure to diesel engine exhaust: a literature review. J Expo Sci Environ Epidemiol. 2009;19(5):443-457. Doi: 10.1038/jes.2009.21
IARC: diesel engine exhaust carcinogenic. Cent Eur J Public Health. 2012 Jun;20(2):120, 138.
Soll-Johanning H, Bach E, Olsen JH, Tüchsen F. Cancer incidence in urban bus drivers and tramway employees: a retrospective cohort study. Occup Environ Med. 1998;55(9):594-598. Doi: 10.1136/oem.55.9.594
Vasama-Neuvonen K, Pukkala E, Paakkulainen H, et al. Ovarian cancer and occupational exposures in Finland. Am J Ind Med. 1999 Jul;36(1):83-9. Doi: 10.1002/(sici)1097-0274(199907)36:1<83::aid-ajim12>3.0.co;2-q
Guo J, Kauppinen T, Kyyrönen P, et al. Risk of esophageal, ovarian, testicular, kidney and bladder cancers and leukemia among finnish workers exposed to diesel or gasoline engine exhaust. Int J Cancer. 2004;111(2):286-92. Doi: 10.1002/ijc.20263
Andersen A, Barlow L, Engeland A, et al. Work-related cancer in the Nordic countries. Scand J Work Environ Health. 1999;25 Suppl 2:1-116.
Gawkrodger DJ. Occupational skin cancers. Occup Med (Lond). 2004;54(7):458-463. Doi: 10.1093/occmed/kqh098
Sena JS, Girão RJ, Carvalho SM, et al. Occupational skin cancer: Systematic review. Rev Assoc Med Bras (1992). 2016;62(3):280-286. Doi: 10.1590/1806-9282.62.03.280
Diepgen TL. Occupational skin diseases. J Dtsch Dermatol Ges. 2012;10(5):297-315. Doi: 10.1111/j.1610-0387.2012.07890.x
Karagas MR, Weinstock MA, Nelson HH. Keratinocyte Carcinomas (Basal and Squamous Cell Carcinomas of the Skin) In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. New York (US): Oxford University Press; 2006. p. 1230-50.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting sys-tematic reviews. BMJ. 2021;372:n71. Published 2021 Mar 29. Doi: 10.1136/bmj.n71
Morgan RL, Whaley P, Thayer KA, Schünemann HJ. Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int. 2018;121(Pt 1):1027-1031. Doi: 10.1016/j.envint.2018.07.015
Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exem-plars for reporting systematic reviews. BMJ. 2021;372:n160. Doi: 10.1136/bmj.n160
Sidik K, Jonkman JN. A simple confidence interval for meta-analysis. Stat Med. 2002;21(21):3153-9. Doi: 10.1002/sim.1262
Thorlund K, Imberger G, Johnston BC, et al. Evolution of heterogeneity (I2) estimates and their 95% confidence intervals in large meta-analyses. PLoS One. 2012;7(7):e39471. Doi: 10.1371/journal.pone.0039471
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58. Doi: 10.1002/sim.1186
Cochran, WG. The comparison of percentages in matched samples. Biometrika. 1950;37(3-4):256-66.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-34. Doi: 10.1136/bmj.315.7109.629
Galbraith RF. A note on graphical presentation of estimated odds ratios from several clinical trials. Stat Med. 1988 Aug;7(8):889-94. Doi: 10.1002/sim.4780070807
StataCorp. 2021. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.
Howe GR, Fraser D, Lindsay J, Presnal B, Yu SZ. Cancer mortality (1965-77) in relation to diesel fume and coal exposure in a cohort of retired railway workers. J Natl Cancer Inst. 1983;70(6):1015-9
Wong O, Morgan RW, Kheifets L, et al. Mortality among members of a heavy construction equipment operators union with potential exposure to diesel exhaust emissions. Br J Ind Med. 1985 Jul;42(7):435-48. Doi: 10.1136/oem.42.7.435
Boffetta P, Stellman SD, Garfinkel L. Diesel exhaust exposure and mortality among males in the American Can-cer Society prospective study. Am J Ind Med. 1988;14(4):403-15. Doi: 10.1002/ajim.4700140405
Gustavsson P, Plato N, Lidström EB, Hogstedt C. Lung cancer and exposure to diesel exhaust among bus garage workers. Scand J Work Environ Health. 1990;16(5):348-54. Doi: 10.5271/sjweh.1780
Van Den Eeden SK, Friedman GD. Exposure to engine exhaust and risk of subsequent cancer. J Occup Med. 1993;35(3):307-11.
Nokso-Koivisto P, Pukkala E. Past exposure to asbestos and combustion products and incidence of cancer among Finnish locomotive drivers. Occup Environ Med. 1994;51(5):330-4. Doi: 10.1136/oem.51.5.330
Boffetta P, Dosemeci M, Gridley G, et al. Occupational exposure to diesel engine emissions and risk of cancer in Swedish men and women. Cancer Causes Control. 2001;12(4):365-74. Doi: 10.1023/a:1011262105972
Järvholm B, Silverman D. Lung cancer in heavy equipment operators and truck drivers with diesel exhaust ex-posure in the construction industry. Occup Environ Med. 2003;60(7):516-20. Doi: 10.1136/oem.60.7.516
Pukkala E, Martinsen JI, Lynge E, et al. Occupation and cancer – follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009;48(5):646-790. Doi: 10.1080/02841860902913546
Birdsey J, Alterman T, Li J, et al. Mortality among members of a truck driver trade association. AAOHN J. 2010;58(11):473-80. Doi: 10.3928/08910162-20101018-01
Risher JF, Rhodes SW. Toxicological Profile for Fuel Oils. Atlanta (GA): Agency for Toxic Substances and Disease Registry (US); 1995 Jun.
Li FK, Yip PS, Chan KW, et al. Acute renal failure after immersion in seawater polluted by diesel oil. Am J Kidney Dis. 1999;34(6):E26. Doi: 10.1016/s0272-6386(99)70031-4
Barrientos A, Ortuño MT, Morales JM, et al. Acute renal failure after use of diesel fuel as shampoo. Arch Intern Med. 1977;137(9):1217.
Weistenhöfer W, Lutz R, Hiller J, Schmitz-Spanke S, Drexler H. Syncarcinogenesis of natural UV radiation and polycyclic aromatic hydrocarbons in the development of squamous cell carcinomas of the skin? J Dtsch Dermatol Ges. 2022;20(9):1179-1186. Doi: 10.1111/ddg.14818
National Toxicology Program. 15th Report on Carcinogens [Internet]. Research Triangle Park (NC): National Toxicology Program; 2021 Dec 21. Diesel Exhaust Particulates: CAS No.: none assigned. Available from: https://www.ncbi.nlm.nih.gov/books/NBK590901/
Stenehjem JS, Robsahm TE, Bråtveit M et al. Aromatic hydrocarbons and risk of skin cancer by anatomical site in 25 000 male offshore petroleum workers. Am J Ind Med. 2017;60(8):679-688. Doi: 10.1002/ajim.22741
Kurtul S, Güngördü N. Occupational skin carcinogens. Eur Res J. 2023. Doi: 10.18621/eurj.1193815
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Diesel and Gasoline Engine Exhausts and Some Nitroarenes. Lyon (FR): International Agency for Research on Cancer; 2014. (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 105.) 4. MECHANISTIC AND OTHER RELEVANT DATA. Available from: https://www.ncbi.nlm.nih.gov/books/NBK294271/
Solar and ultraviolet radiation. IARC Monogr Eval Carcinog Risks Hum. 1992;55:1-316.
Armenian HK. Incubation periods of cancer: old and new. J Chronic Dis. 1987;40 Suppl 2:9S-15S. Doi: 10.1016/s0021-9681(87)80004-8
Armstrong BK. How sun exposure causes skin cancer: An epidemiological perspective In: Hill D, Elwood JM, English D. Prevention of Skin Cancer. Dordrecht, The Netherlands: Kluwer Academic Publishers; 2004. p. 89-116. Doi: 10.1007/978-94-017-0511-0_6
Leiter U, Garbe C. Epidemiology of melanoma and nonmelanoma skin cancer--the role of sunlight. Adv Exp Med Biol. 2008;624:89-103. Doi: 10.1007/978-0-387-77574-6_8
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-88. Doi: 10.1016/0197-2456(86)90046-2
Veroniki AA, Jackson D, Viechtbauer W, et al. Methods to estimate the between-study variance and its uncer-tainty in meta-analysis. Res Synth Methods. 2016;7(1):55-79. Doi: 10.1002/jrsm.1164
Downloads
Additional Files
Published
Issue
Section
License
Copyright (c) 2024 Marika D'Agostini, Giulia Collatuzzo, Federica Teglia, Paolo Boffetta
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a CC BY-NC-SA 4.0 Creative Commons Attribution-NonCommercial ShareAlike 4.0 International License.