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：系统梳理职业暴露与癌症发病或死亡风险之间的关联关系。
研究方法：本伞型综述（umbrella review）检索了Medline和Web of Science数据库。依据既定检索方案，本研究纳入了针对多种职业暴露场景及特定癌症类型的荟萃分析（meta-analysis），此类分析均具备与职业暴露相关的一定级别证据。
研究结果：本研究共纳入37项荟萃分析（meta-analysis），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，研究结果明确显示：溶剂暴露与多发性骨髓瘤、石棉与肺癌、烃类物质与上消化道呼吸道癌症、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，职业暴露与巴西职业相关癌症监测指南中最初未被预判的多种癌症类型存在关联。部分相关暴露场景仍存在研究空白，需开展进一步研究及更严谨的荟萃分析，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。针对其他解剖部位癌症的相关证据则较为薄弱，存在不确定性或偏倚迹象。