Occupational exposure and cancer: an umbrella review

Abstract Objective: to provide an overview of the associations between occupational exposure and risk of occurrence or death from cancer. Methods: this umbrella review used the Medline and Web of Science databases. Based on the search protocol, meta-analysis was included for several occupational circumstances and selected cancers that had some level of evidence associated with the occupation. Results: 37 meta-analysis were included, covering 18 cancer locations. By assessing the heterogeneity of studies, quality of evidence, and strength of association, results highly indicated associations between solvent exposure and multiple myeloma, asbestos and lung cancer, hydrocarbons and upper aerodigestive tract cancer, occupational stress and colorectal cancer. Conclusion: robust evidence shows an association between occupational exposures and types of cancer not initially foreseen in the guidelines for work-related cancer surveillance in Brazil. Gaps in relevant exposures require further research and more consistent meta-analysis, including: exposure to inorganic dust and lung cancer and mesothelioma; solvents and hematological tumors. Evidence of cancer in other anatomical regions was less robust, showing signs of uncertainty or bias.

摘要：研究目的：系统概述职业暴露与癌症发生或死亡风险之间的关联。研究方法：本伞状综述（umbrella review）依托MEDLINE数据库（Medline）与科学网（Web of Science）开展，依据预设检索方案，纳入了针对多种职业暴露场景及特定癌症类型的元分析（meta-analysis），此类研究均已获得与职业暴露相关的一定级别证据支持。研究结果：共纳入37项元分析，覆盖18个癌症发病部位。通过评估研究异质性、证据质量及关联强度，结果高度提示以下关联：溶剂暴露与多发性骨髓瘤、石棉与肺癌、碳氢化合物与上呼吸道消化道癌、职业应激与结直肠癌之间存在显著关联。研究结论：确凿证据表明，职业暴露与巴西职业性癌症监测指南中未预先提及的癌症类型存在关联。部分关键暴露场景的研究存在缺口，需开展进一步研究及更具一致性的元分析，具体包括无机粉尘暴露与肺癌、间皮瘤；溶剂暴露与血液系统肿瘤。其余解剖部位的癌症关联证据强度较弱，呈现出不确定性或偏倚迹象。