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Occupational Solar UV Exposure and Skin Cancer: A Quantitative Framework for Individual Causal Attribution in
Eytan Ellenberg1, Arieh Ingber1,2, Akshaya S Bhagavathula3
1Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem, Israel.
Background:
Occupational solar ultraviolet radiation (UVR) exposure is a major risk factor for keratinocyte carcinomas in outdoor workers. Individual causal attribution for medico-legal purposes requires partitioning risk contributions between occupational exposure and individual susceptibility factors-a question distinct from population-level burden estimation. This study is primarily a quantitative/methodological application of FAIR to occupational UV-related skin cancer.
Methods:
This methodological framework study applies the FAIR approach (Filtering evidence, Association quantification, Individual partitioning, Reasoned interpretation) to occupational solar UVR and skin cancer. Meta-analyses (1995-2025) were reviewed and adjusted for phototype, sex, and immune status. Individual attribution was estimated using game-theory-based decomposition (Shapley values) and stochastic Monte Carlo simulation to propagate uncertainty. Preventive scenarios incorporated sector-specific compliance and long-term economic modeling.
Results:
Mean occupational causal shares were 35% for squamous cell carcinoma (SCC), 25% for basal cell carcinoma (BCC), 10% for melanoma, and 50% for actinic keratosis. The probability of exceeding the 20% medico-legal attribution threshold reached 85% for SCC and 75% for BCC. Prevention reduced expected cases by 10-15% and healthcare costs by 8-12%.
Conclusions:
The FAIR framework provides a transparent, reproducible approach for integrating epidemiological evidence with individual attribution. These quantitative thresholds support the clinical and medico-legal recognition of work-related skin cancers.