BK 2402

BK 2402 is the acronym for "occupational disease according to BK 2402 and refers to diseases caused by ionizing radiation. Dermatologically, BK No. 2402 includes epithelial skin tumors such as squamous cell carcinomas including bowel carcinoma and their early forms (carcinomata in situ), but not basal cell carcinomas. Actinic keratoses are to be regarded as carcinomata in situ. Bowen's disease is to be equated with actinic keratosis. Bowen's carcinoma is considered a squamous cell carcinoma under insurance law.

Occurrence and sources of danger:

• X-rays are high-energy electromagnetic waves generated in the anticathode by the deceleration of electrons. Objects hit by X-rays emit scattered radiation. X-rays can be a source of danger for people who are exposed directly or indirectly, e.g. in the field of medicine, in material testing, in the X-ray apparatus or X-ray tube industry.
• Radioactive substances are elements, i.e. radionuclides, which decay by themselves and spontaneously emit radiation, usually alpha, beta or gamma rays. beta or gamma rays. A distinction is made between natural and artificial radioactive substances. The latter are mainly produced in reactors as fission products or by neutron bombardment. Radioactive substances occur in solid or liquid form or as gases; they are used as open or enclosed preparations. In appropriate doses, radioactive substances can be a source of danger for persons who come into contact with these substances or the radiation emitted by them during production, processing, use or transportation, e.g. in medical diagnostics or therapy, in scientific examinations, in materials testing, in certain measuring procedures, in the industrial processing and use of radionuclides and in activities in uranium mining and in nuclear facilities.
• Other ionizing radiation refers to atomic particles such as electrons, protons, deuterons and other accelerated ions as well as neutrons, which ionize directly or indirectly. These can occur in nuclear reactor and particle accelerator operations.

All high-energy ionizing radiation triggers physico-chemical reactions when it hits matter, which can lead to disturbances in cell activity, cell death and thus to functional and morphological changes in living tissue. Ionizing radiation acting through the body surface, i.e. from the outside (external exposure), has in principle the same effect in the organism at an identical dose as radiation emitted by incorporated radioactive substances (via the respiratory and digestive tracts or skin and mucous membranes) (internal exposure).

The extent of the biological effect depends on physical components such as

• the amount of radiation absorbed (dose),
• type of radiation,
• temporal distribution of the dose (dose rate, single or repeated irradiation at shorter or longer intervals),
• spatial distribution of the dose (whole-body irradiation, local irradiation) and biological factors such as
• Age, gender, health and nutritional status, temperature of the exposed individual,
• radiation sensitivity of the affected tissue.
• In the case of incorporation, the physical half-life and the metabolic behavior of the radioactive substance play a decisive role.

Disease patterns:

• Basal cell carcinoma and squamous cell carcinoma, laryngeal carcinoma, leukemia, lung cancer, cancers of the oral cavity and pharynx as well as the gastrointestinal tract, pleural mesothelioma (rare)

Examples of occupations and potential hazards (incomplete list):

• With regard to skin cancer, rather to be regarded as historical, especially for medical personnel in contact with X-rays
• Medical staff, dentists/doctors
• Workers in the nuclear power industry
• researchers, laboratory technicians, physicists
• Miners, mineral extractors, especially uranium miners (Wismut, former GDR)
• (Civil engineering) construction workers
• Metal, chemical and plastics workers
• Medicine, diagnostics and therapy (X-ray, nuclear medicine, radiotherapy), nuclear power, nuclear facilities, particle/electron accelerators, radioactive isotopes in research/industry, material testing by X-ray spectroscopy, material testing by ionizing radiation, surveying/positioning, sterilization facilities, mining (radon, uranium), construction industry

1. Bauer A (2016) Hautkrebs als Berufserkrankung [Skin cancer as occupational disease]. Dermatologist 67:884-890.