[UV radiation in Germany: influences of ozone depletion and climate change and measures to protect the population]

Ocular surface squamous cell neoplasia: risk factors for aggressive growth behaviour and the role of Ki-67

OBJECTIVE

Analyzing characteristics of ocular surface squamous cell neoplasia (OSSN) at first diagnosis and potential risk factors for aggressive growth behaviour.

DESIGN

Retrospective.

METHODS

Including patients with first diagnosis of OSSN at a tertiary center from 2013 until 2022. Cases were analyzed regarding demographics, clinical findings, and histopathological findings, including Ki-67 expression.

RESULTS

A total of 153 patients with first diagnosis of histopathological confirmed OSSN were included. Mean age was 72 years (36-98), with a slight male predominance (66%; n = 101). Most patients had invasive squamous cell carcinoma (SCC; 45.8%, 70), followed by carcinoma in situ (CIS; 37.9%, 58) and epithelial dysplasia (ED; 16.3%, 25). Duration of symptoms varied significantly: ED 6 months (0-36), CIS 1.5 (0-48), SCC 3 (0-36) (p = 0.048). 44.3% (51/115) of cases were previously misdiagnosed, and, therefore, inadequately treated. Orbital involvement was observed in 8.5% (13), intraocular in 1.3% (2), metastasis in 2.7% (4) at initial diagnosis. Ki-67 labeling index (LI) varied significantly across subtypes: ED 35% (2-87%), CIS 45% (11-85%), SCC 50% (18-93%) (p = 0.007) and was higher with involvement of the caruncle, lower fornix, lower eyelid margin, or tarsus (p = 0.023). Patients with globe or orbit invasion had significantly longer median symptom duration (6 months (0-48) vs 2 (0-48); p = 0.01). Patients with metastasis exhibited significantly higher Ki-67 LI (p = 0.027).

CONCLUSIONS

Our study found extended time intervals from first symptoms to first correct diagnosis correlate with higher risk for advanced SCC. Further, elevated Ki-67 LI correlated with more invasive tumor entities, such as SCC and CIS, and indicate an increased risk of metastasis.

The National Cancer Aid monitoring (NCAM-online) of ultraviolet radiation risk and protection behavior: a population-based observational trend study with four annual online survey waves

BACKGROUND

Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artificial UV radiation. Since the incidence of skin cancer is increasing worldwide, it is necessary to monitor UV-related risk behaviors such as intentional indoor and outdoor tanning, as well as sun protection behavior in the general population and specific subgroups and settings. This is the aim of the National Cancer Aid Monitoring online (NCAM-online), a continuation and further development of the NCAM.

METHODS

The NCAM-online is a longitudinal trend study consisting of four annual survey waves. Each year, 4,000 individuals aged 16-65 years living in Germany will be surveyed using online questionnaires. Each year, intentional indoor and outdoor tanning will be assessed. In addition, varying specific topics regarding skin cancer prevention, such as the utilization of skin cancer screening, will be addressed in the questionnaires.

DISCUSSION

The findings of the NCAM-online will provide an important basis for the German Cancer Aid and Working Group on Dermatologic Prevention (Arbeitsgemeinschaft Dermatologische Prävention, ADP) to develop targeted prevention campaigns and projects aimed at preventing skin cancer. The explorative nature of the NCAM-online allows for the identification of new potential starting points for prevention and education. In addition, the longitudinal design allows for a description of the trend in the prevalence of intentional tanning. For tanning bed use, representative trend data from 2012 are available for Germany, to which NCAM-online will add annual data until 2027.

Epidemiology of Keratinocyte Skin Cancer with a Focus on Cutaneous Squamous Cell Carcinoma

Keratinocyte skin cancer, consisting of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is by far the most common cancer in white-skinned populations, with rapid increases over the last 50 years. While the age-standardized incidence rates increase worldwide, the age-standardized mortality rates are variable. The incidence rates of keratinocyte skin cancer are much higher compared to those of melanoma, and are largely attributed to the raising exposure to ultraviolet (UV) radiation, the most important causal risk factor for skin cancer. Whereas the development of BCC is mainly due to intense UV exposure during childhood and adolescence, the development of SCC is related to chronic, cumulative UV exposure over decades. Although mortality rates are relatively low, SCC is an increasing problem for healthcare services, significantly causing morbidity, especially in older age groups. This review reports on the epidemiology of keratinocyte skin cancer, with a focus on SCC, in Australia, the United States, and the north of Europe, with an outlook on further challenges health systems will be confronted with in the next 20 years.

[Use of sunglasses in everyday life, at work, and during outdoor sports: current results from nationwide surveys]

BACKGROUND

Ultraviolet (UV) radiation can increase the risk of eye damage. Therefore, wearing sunglasses is recommended to protect the eyes from UV rays.

OBJECTIVE

To report the latest data on the use of sunglasses in everyday life in adults, children, at work, and during outdoor sports.

MATERIAL AND METHODS

We used data from waves 2020 and 2021 from the representative National Cancer Aid Monitoring (NCAM). The use of sunglasses in everyday life was assessed in 4000 participants aged 16-65 years. Data on use during outdoor work were obtained from 486 outdoor workers and the use of sunglasses during outdoor sports from 2081 participants. Additionally, 554 adults living in a household with at least 1 child aged 1-10 years reported the use of sunglasses by children. Descriptive results and associations with demographic characteristics are reported.

RESULTS

Overall, 50.6% of the general population, 31.0% of outdoor workers, 44.3% of those who reported being engaged in outdoor sports and 12.5% of children wore sunglasses always or often while being outside for more than 10 min in summer. The infrequent use of sunglasses was associated with a younger age, male sex, and lower school education.

CONCLUSION

Because of the relatively low use of sunglasses further education in various settings (e.g., at the workplace, kindergartens, and schools) seems necessary. The general public should also be made aware of the risks of UV radiation for the eyes, especially against the background of climate change.

Physical Activity, Climate Change and Health-A Conceptual Model for Planning Public Health Action at the Organizational Level

Climate change is linked to health risks for both professional and amateur athletes. Sports organisations will need to react to these developments. The starting point for this concept paper is a summary of the sport-specific health risks currently under discussion: increasing heatwaves, growing numbers of extreme weather events, rising UV, ozone and allergen levels and the spread of infectious diseases. Based on the current state of research, a conceptual model is developed to reduce these climate-related health risks in sports at organisational level. Given the wide variety of predicted direct and indirect health risks linked to climate change, the “sports, clubs and climate change model” (SC³ model) presented here follows a stepwise risk-specific approach using technical, organisational and person-related measures. The SC³ model also includes cross-cutting measures that have an overarching effect comprising training, warning systems, coordination and evaluation measures. The SC³ model makes it possible to develop prevention plans, both at national level for central associations and at the regional level of local organisations and clubs. It can be applied to typical settings (e.g., training or competition at elite or amateur levels) and target groups (e.g., athletes, spectators, referees and club officials).

[Current and future effects of climate change on ophthalmology]

BACKGROUND AND OBJECTIVES

Climate change is also an increasingly important issue in the healthcare system. Due to its anatomical and physiological nature, the eye is directly exposed to environmental influences and changes in a special way.

METHODS

The current literature is used to illustrate the effects of climate-induced changes and the respective influences on the eye. A PubMed search (cut-off date 3 October 2021) using the search terms "climate change" or "planetary health" or "global health" and in each case "ophthalmology" or "eye" or "ocular" was used to determine the development of the number of publications between 2011 and 2021.

RESULTS

Measurable effects of climate change are already evident in a wide variety of ophthalmological fields. The significance of this topic, for instance, is reflected in a relatively constant increase in the number of publications and an almost tenfold increase in the number of publications per year from 2011 to 2021.

CONCLUSION

The impact of climate change on eye diseases and on the field of ophthalmology is multifaceted and could be expected to intensify in the coming years. Therefore, the interrelationships need to be further investigated in future studies, preferably on a large scale.

Sport and climate change—how will climate change affect sport?

Climate change will have complex consequences for the environment, society, economy and people’s health. The issue of climate change has received comparatively little attention to date in the fields of sports science. Thus, sport-related health risks caused by climate change are discussed and summarized in a conceptual model presented here for the first time. Climate change is associated with the following increases of health-related risks for athletes in particular: Direct consequences caused by extreme temperature and other extreme weather events (e.g. increasing risks due to heatwaves, thunderstorms, floods, lightning, ultraviolet radiation) and indirect consequences as a result of climate-induced changes to our ecosystem (e.g. due to increased air pollution by ozone, higher exposures to allergens, increasing risks of infection by viruses and bacteria and the associated vectors and reservoir organisms). Each aspect is supplemented with advice on the prevention of health hazards. Not only individual athletes but also sports organizations and local clubs will have to respond to the changes in our climate, so that they can appropriately protect both athletes and spectators and ensure a plannable continuation of the sport in the future.

Quality of Information for Skin Cancer Prevention: A Quantitative Evaluation of Internet Offerings

(1) Background: Different sources of information are used by the population regarding skin cancer prevention. The pertinent quality of information that can be retrieved via an internet search engine needs assessment; (2) Methods: Four topical searches in common language were entered into Google™. The first 200 "hits" were stored for further use. Eligible websites were evaluated using content-based criteria based on the current German medical guideline "Skin cancer prevention" and employing generic (DISCERN, HONcode) quality criteria. (3) Results: Overlap between the four search results was between 0 and 7 of 200. The completeness of relevant content was scored with a median of 10 points (first quartile (Q1):6; Q3:14) and thus, it was much lower than the theoretical maximum of 43 points. Global quality, with a maximum of 10 points, was 3 in median (Q1:2; Q3:4). Quality and completeness, respectively, were somewhat higher in the higher ranks of search results. The generic quality was moderate. (4) Conclusions: A direct comparison with other sources of information (print, audio-visual, presentation, or personal counselling) is not possible, but important deficits concerning the quality and scope of relevant information on the internet are demonstrated.

[Behavioral and structural prevention of skin cancer : Implementation and effectiveness]

BACKGROUND

Ultraviolet radiation (UV)-induced malignancies, especially skin cancer, have continued to increase for decades. The main cause is natural and artificial UV radiation. The affected persons and the health care system are heavily burdened. The situation threatens to worsen, as climate change could lead to an increase in UV radiation exposure of the population and, thus, the risk of UV-related cancer in Germany as well. The prevention of UV-related diseases is, therefore, a health and radiation protection objective that needs to be considered.

OBJECTIVE

Necessary and appropriate prevention measures for the precaution of UV-related cancer are presented.

MATERIALS AND METHODS

The currently recommended and applied primary behavioral and structural preventive measures and potential, prevention-related relief for the health care system are examined and summarized.

RESULTS

Numerous behavioral and structural preventive measures are already being applied. Sustainably designed, multicomponent and personalized behavioral preventive measures in combination with structural prevention modules are effective and have a high economic and health-related benefit. The use of modern media and multimedia measures is recommended.

CONCLUSION

Structural prevention measures in addition to behavioral measures enable a reduction of the cancer risk caused by UV radiation. The aim must be to establish these measures nationwide for the entire population.