Marks R
University of Melbourne, Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Australia.
Australas J Dermatol. 1999 Feb;40(1):1-5. doi: 10.1046/j.1440-0960.1999.00307.x.
Incidence and mortality rates due to skin cancer are rising in most Western countries. Early detection of these tumours at a stage when they can be easily cured is the primary approach taken by many people wishing to deal with the problem. A primary prevention approach, that is, reduction in sunlight exposure, is being considered by an increasing number of organizations. The public health approach to primary prevention of skin cancer, including melanoma, requires an understanding of the role of sunlight in the production of these tumours. Despite a clear understanding of exactly how sunlight does this, there is enough epidemiological and laboratory evidence to suggest a broad approach to the problem. This includes reduction of sunlight exposure, particularly in childhood and adolescence. It also suggests the need to recommend avoidance of suntanning and particularly the excessive exposures that lead to sunburn. Widespread primary prevention public health programmes have been running in Australia for almost 20 years. The data measuring the effect of these programmes indicate a very large shift in knowledge attitudes and beliefs about sunlight exposure and suntans, and major shifts in behaviour. Suntans are no longer as popular as they were and people are reducing their sunlight exposure by a variety of methods encapsulated in Slip! Slop! Slap! Cohort analysis of the incidence rates for melanoma and non-melanoma skin cancer show that the incidence of these tumours is levelling out in young people and is dropping in some instances. These are the people who were able to be influenced by the public health programmes in recent decades. Finally, following initial dramatic changes in all the behavioural variables related to the programme, a period of consolidation with continuing effort and more specific targeting will be required in the coming decades to maintain the improvement.
在大多数西方国家，皮肤癌的发病率和死亡率都在上升。在肿瘤易于治愈的阶段尽早发现是许多希望解决这一问题的人采取的主要方法。越来越多的组织正在考虑采取一级预防措施，即减少阳光照射。包括黑色素瘤在内的皮肤癌一级预防的公共卫生方法需要了解阳光在这些肿瘤产生过程中的作用。尽管人们清楚地了解阳光是如何导致皮肤癌的，但有足够的流行病学和实验室证据表明可以采取广泛的方法来解决这个问题。这包括减少阳光照射，尤其是在儿童和青少年时期。这也表明需要建议避免晒黑，特别是避免过度暴露导致晒伤。澳大利亚已经开展广泛的一级预防公共卫生项目近20年了。衡量这些项目效果的数据表明，人们对阳光照射和晒黑的知识、态度和观念发生了很大转变，行为也发生了重大变化。晒黑不再像过去那样流行，人们通过“ Slip! Slop! Slap! ”（注：这是澳大利亚推广的防晒口号，分别代表穿上防晒服、涂抹防晒霜、戴上帽子）中包含的各种方法减少阳光照射。对黑色素瘤和非黑色素瘤皮肤癌发病率的队列分析表明，这些肿瘤的发病率在年轻人中趋于平稳，在某些情况下还在下降。这些人是近几十年来能够受到公共卫生项目影响的人群。最后，在与该项目相关的所有行为变量发生最初的巨大变化之后，未来几十年需要持续努力并进行更有针对性的巩固，以保持这种改善。
