Qureshi Abrar A, Laden Francine, Colditz Graham A, Hunter David J
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Arch Intern Med. 2008 Mar 10;168(5):501-7. doi: 10.1001/archinte.168.5.501.
Occurrences of melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) have been associated with varying geography. Our goal was to evaluate differences in risk of these skin cancers according to residence at varying UV indices at 3 time points.
Prospective 1984-2002 study of 84 836 female nurses who lived in different UV index regions of the United States at birth and at 15 or 30 years of age. The outcome measure was diagnosis of melanoma, SCC, or BCC.
During the 18-year study, 420 cases of melanoma, 863 cases of SCC, and 8215 cases of BCC occurred. At 30 years of age, age-adjusted risks for SCC were 1.47 (95% confidence interval [CI], 1.22-1.76) and 1.90 (95% CI, 1.51-2.36) for women residing in states with a UV index of 6 (medium) and 7 or more (high), respectively. Although elevated, the age-adjusted risk of BCC at 30 years of age associated with residence in these states was substantially less. Although the risk of melanoma was not elevated for women living in these states at 30 years of age, it was significantly elevated among women living in states with UV indices of 6 at birth and at 15 years of age. There was no material change in risk estimates with multivariate adjustment. For women who reported living in states with UV indices of 7 or more at all 3 time points, the multivariate risk of SCC was highest.
The risk of SCC is independently affected by residence in locations with medium and high UV indices; the gradient of risk is weaker for BCC; and the risk of melanoma does not change significantly across this gradient.
黑色素瘤、鳞状细胞癌（SCC）和基底细胞癌（BCC）的发病率与不同的地理位置有关。我们的目标是评估在三个时间点，根据居住地区紫外线指数的不同，这些皮肤癌的发病风险差异。
对1984年至2002年期间84836名女性护士进行前瞻性研究，这些护士出生时以及15岁或30岁时居住在美国不同紫外线指数区域。观察指标为黑色素瘤、SCC或BCC的诊断情况。
在18年的研究期间，共发生420例黑色素瘤、863例SCC和8215例BCC。30岁时，居住在紫外线指数为6（中等）和7或更高（高）的州的女性，SCC的年龄调整风险分别为1.47（95%置信区间[CI]，1.22 - 1.76）和1.90（95%CI，1.51 - 2.36）。虽然有所升高，但30岁时居住在这些州的女性BCC的年龄调整风险要低得多。虽然30岁时居住在这些州的女性黑色素瘤风险没有升高，但在出生时和15岁时居住在紫外线指数为6的州的女性中，黑色素瘤风险显著升高。多变量调整后风险估计无实质性变化。对于报告在所有三个时间点都居住在紫外线指数为7或更高的州的女性，SCC的多变量风险最高。
SCC的风险独立受居住在中等和高紫外线指数地区的影响；BCC的风险梯度较弱；黑色素瘤的风险在这个梯度上没有显著变化。
