Marks Robin
University of Melbourne, Department of Medicine, St Vincent's Hospital, Victoria, Australia.
Recent Results Cancer Res. 2002;160:113-21. doi: 10.1007/978-3-642-59410-6_15.
For many years Australia has had the highest incidence and mortality rates in the world for melanoma. The incidence rate has been increasing at around 5% per year and the mortality rate, at a rate slightly lower than that. Epidemiology studies have shown clearly that there is both a constitutional and an environmental contribution to melanoma risk, with sunlight being the major risk factor in the environment. The data also clearly show that the thickness of a melanoma at the time it is removed is one of the major determinants of the likelihood of metastasis and thus of the long-term prognosis. Both of these components have been incorporated into major public health programmes aimed at melanoma control in Australia over the last 25 years. Primary prevention programmes have been aimed at reducing the desire for a tan and subsequent overexposure to sunlight. Secondary prevention (early detection) programmes have encouraged people in the community to seek early attention if they notice a new or changing pigmented lesion. Although the age-adjusted incidence and mortality rates for Australia continue to rise, cohort analysis of both incidence and mortality rates reveals that the overall rise is not reflected in all age groups. In the younger cohorts--groups that it has been possible to influence by our public health campaigns in recent decades--both incidence and mortality rates are dropping.
多年来，澳大利亚的黑色素瘤发病率和死亡率一直位居世界之首。发病率以每年约5%的速度上升，死亡率的上升速度略低于此。流行病学研究清楚地表明，黑色素瘤风险既受体质因素影响，也受环境因素影响，阳光是环境中的主要风险因素。数据还清楚地表明，黑色素瘤切除时的厚度是转移可能性以及长期预后的主要决定因素之一。在过去25年里，澳大利亚针对黑色素瘤防控的主要公共卫生项目都纳入了这两个因素。一级预防项目旨在减少对晒黑的渴望以及随后过度暴露于阳光下的情况。二级预防（早期检测）项目鼓励社区民众如果发现新的或变化的色素沉着病变，要尽早寻求医疗关注。尽管澳大利亚经年龄调整后的发病率和死亡率持续上升，但对发病率和死亡率的队列分析显示，并非所有年龄组都呈现总体上升趋势。在较年轻的队列中——近几十年来我们的公共卫生运动有可能对其产生影响的群体——发病率和死亡率都在下降。
