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与Web of Science数据库开展检索，根据既定检索方案，纳入了针对若干职业场景及特定癌症类型、且与对应职业存在一定等级证据关联的荟萃分析（meta-analysis）。
研究结果：本综述共纳入37项荟萃分析，覆盖18个癌症发病部位。通过对研究异质性、证据质量及关联强度进行评估，结果明确显示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症、职业应激与结直肠癌之间存在显著关联。
研究结论：现有强有力的证据表明，巴西职业相关癌症监测指南中未预先涵盖的部分癌症类型与职业暴露存在关联。当前部分相关暴露场景的研究尚存缺口，需开展进一步研究与更具一致性的荟萃分析，具体包括无机粉尘暴露与肺癌、间皮瘤的关联，以及溶剂暴露与血液系统肿瘤的关联。其余解剖部位的癌症关联证据则相对薄弱，存在不确定性或偏倚迹象。