# Occupational hazards and bladder cancer—An umbrella review of the risk in workers exposed over the past 30 years

## TL;DR

This umbrella review identifies occupations and chemicals linked to bladder cancer risk based on recent studies over the past 30 years.

## Contribution

The study provides updated evidence-based associations between occupational exposures and bladder cancer risk using recent data.

## Key findings

- High evidence links firefighters, hairdressers, and painters to bladder cancer risk.
- Exposure to ortho-toluidine is confirmed as a bladder cancer risk.
- Welders and those exposed to hexavalent chromium need further study for confirmation.

## Abstract

Occupational exposure accounts for the second preventable risk factor for bladder cancer (BC), after smoking.

This study aimed to extract evidence-based data from the systematic reviews that included studies primarily from the past 30 years, based on a clearly defined method of exposure assessment.

A literature search in PubMed, Web of Science, ScienceDirect, and Embase was conducted using variations of the keywords “BC,” “occupational exposure,” and/or “occupation.” The inclusion criteria for the umbrella review were the following: systematic reviews and meta-analyses focused on occupational exposure, with a clear definition of the exposure assessment, a risk estimate for BC, and a majority of data from 1993 to 2023. We did not include other forms of reviews or systematic reviews focused on the general population and environmental exposure. Data were synthesized based either on occupations or on occupational hazards. After the overlap checking, the remaining reviews were assessed for quality using AMSTAR 2 criteria and afterwards classified for high, moderate, or low evidence using the GRADE scale.

We found relevant associations with a high level of evidence for firefighters, hairdressers, painters, workers in the petroleum industry, and dry cleaners exposed to tetrachloroethylene. Concerning hazards, exposure to ortho-toluidine was also confirmed to be a risk by recent studies. Welders, veterans, and those exposed to hexavalent chromium at higher risk need more well-designed studies to be confirmed.

Despite longstanding recognition of certain risks, occupational exposure remains insufficiently investigated. Recent data support the inclusion of occupations and hazards in the individual risk assessment for BC.