On 2015 Feb 21, William Grant commented:

Outdoor workers have better health outcomes due to UVB exposure

The paper by Bauer and colleagues recommended that outdoor workers reduce their UV radiation exposure in order to reduce their risk of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) [1]. Overlooked in this paper was any discussion of the health benefits of UV exposure through outdoor work.

Solar UVB exposure reduces risk of many types of cancer as shown in geographical ecological studies from Australia, China, France, Japan, Spain, and the United States [2]. Deaths due to internal cancers are much higher than those due to non-melanoma skin cancer [3]. Solar UVB exposure is the primary source of vitamin D for most people, and there are many health outcomes linked inversely to 25-hydroxyvitamin D concentrations [4].

Perhaps most relevant for Germany is a study of cancer incidence rates with respect to occupation in Nordic countries [5]. Using a data base of nearly three million cancer incidence cases for 54 occupation categories [6], an index of UVB exposure was developed, namely, lip cancer incidence rate less lung cancer incidence rate for males. Fourteen types of cancer were significantly inversely correlated with this index for males, but only three for females. Since females wear lipstick, an independent index could not be developed for them. Interestingly, this index was inversely correlated with incidence of non-melanoma skin cancer as well as melanoma for males.

Furthermore, a study in Denmark found "Mortality was reduced among patients with BCC (10-year MRR = 0.91 (95% CI: 0.89-0.92) and did not vary by age, comorbidity, or socioeconomic status. Mortality among patients with SCC was increased and varied by age, selected chronic diseases, but not socioeconomic status." [7]. Since smoking is a risk factor for SCC [8], the finding of an increased risk of death associated with SCC is not surprising since it is also an important risk factor for many types of cancer [2] as well as cardiovascular disease and other diseases.

Since skin pigmentation has adapted to where people have lived for many generations to both reduce the adverse effects of solar UVB as well as to produce sufficient vitamin D for optimal health [9,10], it is not clear that undue protection against solar UVB exposure is warranted. However, erythema is best avoided.

References 1. Bauer A, Beissert S, Knuschke P. [Prevention of occupational solar UV radiation-induced epithelial skin cancer.] Hautarzt. 2015 Feb 17. [Epub ahead of print] 2. Moukayed M, Grant WB. Molecular link between vitamin D and cancer prevention. Nutrients. 2013;5(10):3993-4023. 3. Grant WB. In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermatoendocrinol. 2009;1(4):207-14. 4. Pludowski P, Holick MF, Pilz S, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality- a review of recent evidence. Autoimmun Rev. 2013;12(10):976-89. 5. Grant WB. Role of solar UV irradiance and smoking in cancer as inferred from cancer incidence rates by occupation in Nordic countries. Dermatoendocrinol. 2012;4(2):203-11. 6. Pukkala E, Martinsen JI, Lynge E, et al. Occupation and cancer—follow-up of 15 million people in five Nordic countries. Acta Oncol 2009;48:646-790; 7. Jensen AØ, Lamberg AL, Jacobsen JB, et al. Non-melanoma skin cancer and ten-year all-cause mortality: a population-based cohort study. Acta Derm Venereol. 2010;90(4):362-7. 8. Leonardi-Bee J, Ellison T, Bath-Hextall F. Smoking and the risk of nonmelanoma skin cancer: systematic review and meta-analysis. Arch Dermatol. 2012;148(8):939-46. 9. Yuen AW, Jablonski NG. Vitamin D: in the evolution of human skin colour. Med Hypotheses. 2010;74(1):39-44. 10. Jablonski NG, Chaplin G. Colloquium paper: human skin pigmentation as an adaptation to UV radiation. Proc Natl Acad Sci U S A. 2010;107 Suppl 2:8962-8.

Disclosure I receive funding from Bio-Tech Pharmacal, Inc. (Fayetteville, AR), MediSun Technology (Highland Park, IL), and the Vitamin D Council (San Luis Obispo, CA).

On 2015 Feb 21, William Grant commented:

Outdoor workers have better health outcomes due to UVB exposure

The paper by Bauer and colleagues recommended that outdoor workers reduce their UV radiation exposure in order to reduce their risk of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) [1]. Overlooked in this paper was any discussion of the health benefits of UV exposure through outdoor work.

Solar UVB exposure reduces risk of many types of cancer as shown in geographical ecological studies from Australia, China, France, Japan, Spain, and the United States [2]. Deaths due to internal cancers are much higher than those due to non-melanoma skin cancer [3]. Solar UVB exposure is the primary source of vitamin D for most people, and there are many health outcomes linked inversely to 25-hydroxyvitamin D concentrations [4].

Perhaps most relevant for Germany is a study of cancer incidence rates with respect to occupation in Nordic countries [5]. Using a data base of nearly three million cancer incidence cases for 54 occupation categories [6], an index of UVB exposure was developed, namely, lip cancer incidence rate less lung cancer incidence rate for males. Fourteen types of cancer were significantly inversely correlated with this index for males, but only three for females. Since females wear lipstick, an independent index could not be developed for them. Interestingly, this index was inversely correlated with incidence of non-melanoma skin cancer as well as melanoma for males.

Furthermore, a study in Denmark found "Mortality was reduced among patients with BCC (10-year MRR = 0.91 (95% CI: 0.89-0.92) and did not vary by age, comorbidity, or socioeconomic status. Mortality among patients with SCC was increased and varied by age, selected chronic diseases, but not socioeconomic status." [7]. Since smoking is a risk factor for SCC [8], the finding of an increased risk of death associated with SCC is not surprising since it is also an important risk factor for many types of cancer [2] as well as cardiovascular disease and other diseases.

Since skin pigmentation has adapted to where people have lived for many generations to both reduce the adverse effects of solar UVB as well as to produce sufficient vitamin D for optimal health [9,10], it is not clear that undue protection against solar UVB exposure is warranted. However, erythema is best avoided.

References 1. Bauer A, Beissert S, Knuschke P. [Prevention of occupational solar UV radiation-induced epithelial skin cancer.] Hautarzt. 2015 Feb 17. [Epub ahead of print] 2. Moukayed M, Grant WB. Molecular link between vitamin D and cancer prevention. Nutrients. 2013;5(10):3993-4023. 3. Grant WB. In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermatoendocrinol. 2009;1(4):207-14. 4. Pludowski P, Holick MF, Pilz S, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality- a review of recent evidence. Autoimmun Rev. 2013;12(10):976-89. 5. Grant WB. Role of solar UV irradiance and smoking in cancer as inferred from cancer incidence rates by occupation in Nordic countries. Dermatoendocrinol. 2012;4(2):203-11. 6. Pukkala E, Martinsen JI, Lynge E, et al. Occupation and cancer—follow-up of 15 million people in five Nordic countries. Acta Oncol 2009;48:646-790; 7. Jensen AØ, Lamberg AL, Jacobsen JB, et al. Non-melanoma skin cancer and ten-year all-cause mortality: a population-based cohort study. Acta Derm Venereol. 2010;90(4):362-7. 8. Leonardi-Bee J, Ellison T, Bath-Hextall F. Smoking and the risk of nonmelanoma skin cancer: systematic review and meta-analysis. Arch Dermatol. 2012;148(8):939-46. 9. Yuen AW, Jablonski NG. Vitamin D: in the evolution of human skin colour. Med Hypotheses. 2010;74(1):39-44. 10. Jablonski NG, Chaplin G. Colloquium paper: human skin pigmentation as an adaptation to UV radiation. Proc Natl Acad Sci U S A. 2010;107 Suppl 2:8962-8.

Disclosure I receive funding from Bio-Tech Pharmacal, Inc. (Fayetteville, AR), MediSun Technology (Highland Park, IL), and the Vitamin D Council (San Luis Obispo, CA).