Solomon Cam C, White Emily, Kristal Alan R, Vaughan Thomas
Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
Cancer Causes Control. 2004 Nov;15(9):893-902. doi: 10.1007/s10552-004-1142-9.
Because most risk factors for melanoma are immutable constitutional factors such as skin type, it is important to more fully understand the relationship between melanoma risk and sun exposure, one of the few modifiable risk factors for the disease. The goal of this case-control study was to quantify the risks of melanoma associated with UV exposure at different periods of life.
Cases were 386 patients between the ages of 35 and 74 who were diagnosed with primary cutaneous melanoma within the Seattle-Puget Sound area during 1997. Controls were 727 participants of the same age and geographic area, selected by random-digit dialing. A telephone interview included a complete residential history, lifetime sun exposure history (days in the summer sun for at least 4 h at each place of residence), and personal characteristics. UV exposure was calculated based on satellite data on potential erythemal exposure at each place of residence, years at each location and time spent in the sun at each location. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) reflecting the risk of melanoma associated with UV exposure, after adjustment for age, sex, income, tendency to burn and sunburns during ages 2-10.
Among women, lifetime UV exposure was associated with melanoma risk (adjusted OR = 1.99 for highest versus lowest quartile, 95% CI: 0.95-3.03, p for trend = 0.008). There were significant trends for UV exposure during ages 1-10, 11-20 and 31-40 (all p < 0.02). Among men, there were no significant associations at any time period, but lifetime UV exposure was associated with higher risk for men who had a tendency toward severe or painful sunburns (OR = 2.85 for highest versus lowest quartile, 95% CI: 0.84-9.64, p for trend = 0.04).
The differing results by sex are not easily interpretable, though it may be useful to target those with a higher sensitivity to the sun when formulating messages for prevention of melanoma by lowering exposure to UV.
由于黑色素瘤的大多数风险因素是诸如皮肤类型等不可改变的体质因素，因此更全面地了解黑色素瘤风险与日晒之间的关系非常重要，日晒是该疾病为数不多的可改变风险因素之一。这项病例对照研究的目的是量化在生命不同时期与紫外线暴露相关的黑色素瘤风险。
病例为1997年期间在西雅图 - 普吉特海湾地区被诊断为原发性皮肤黑色素瘤的386例年龄在35至74岁之间的患者。对照是通过随机数字拨号选择的727名相同年龄和地理区域的参与者。电话访谈包括完整的居住史、终生日晒史（在每个居住地点在夏季阳光下至少晒4小时的天数）和个人特征。根据每个居住地点的潜在红斑暴露卫星数据、在每个地点居住的年数以及在每个地点在阳光下花费的时间来计算紫外线暴露量。在对年龄、性别、收入、2至10岁期间晒伤和晒红倾向进行调整后，使用逻辑回归来估计反映与紫外线暴露相关的黑色素瘤风险的比值比（OR）和95%置信区间（CI）。
在女性中，终生紫外线暴露与黑色素瘤风险相关（最高四分位数与最低四分位数相比，调整后的OR = 1.99，95%CI：0.95 - 3.03，趋势p = 0.008）。在1至10岁、11至20岁和31至40岁期间紫外线暴露存在显著趋势（所有p < 0.02）。在男性中，在任何时间段均无显著关联，但终生紫外线暴露与有严重或疼痛性晒伤倾向的男性的较高风险相关（最高四分位数与最低四分位数相比，OR = 2.85，95%CI：0.84 - 9.64，趋势p = 0.04）。
尽管在制定通过降低紫外线暴露来预防黑色素瘤的信息时，针对对阳光敏感度较高的人群可能有用，但按性别得出的不同结果不易解释。
