儿童和青少年癌症成年幸存者队列中与紫外线辐射暴露相关的行为：儿童癌症幸存者研究报告
Behaviors associated with ultraviolet radiation exposure in a cohort of adult survivors of childhood and adolescent cancer: a report from the Childhood Cancer Survivor Study.
作者信息
Buchanan Natasha, Leisenring Wendy, Mitby Pauline A, Meadows Anna T, Robison Leslie L, Hudson Melissa M, Mertens Ann C
机构信息
Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta/Emory University, Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Atlanta, GA 30322, USA.
出版信息
Cancer. 2009 Sep 15;115(18 Suppl):4374-84. doi: 10.1002/cncr.24581.
BACKGROUND
Previous research from the Childhood Cancer Survivor Study (CCSS) has shown that risk of skin cancer is strongly associated with exposure to radiation therapy. The potential role of ultraviolet radiation exposure in survivors has not been described.
METHODS
The CCSS is a retrospective cohort study designed to investigate late effects among 5-year survivors of children and adolescents diagnosed with cancer between 1970-1986. Data regarding current sun protection behavior were collected on 9298 survivors and 2950 sibling controls. Median age at follow-up was 31 years (range, 17-54).
RESULTS
In this cohort, childhood cancer survivors and siblings showed similar patterns of sunscreen use (67% vs 66%). Survivors were significantly less likely to report having sunbathed in the previous year (none vs any in previous year: relative risk (RR)=0.92; 95% confidence interval (CI)=0.89-0.95) or use artificial tanning (none vs any in previous year: RR=0.76; 95% CI=0.70-0.83). Compared with survivors without radiation therapy, survivors with radiation exposure showed increased use of sunscreen (RR=1.06; 95% CI=1.03-1.10), and less sunbathing (none vs any in previous year: RR=0.89; 95% CI=0.86-0.92) or artificial tanning (none vs any in previous year: RR=0.62; 95% CI=0.56-0.69). In adjusted multivariable analysis, statistically significant factors for regular sunscreen use in the past summer (vs never/rarely) in the survivor population were being female, having lighter skin complexions, having previously been examined for skin cancer, and having skin that burned when in the sun unprotected.
CONCLUSIONS
Survivors of childhood cancer self-reported lower tanning practices than siblings. However, because of the potential increased risk of skin cancer from therapy-related exposures, future research should be directed at intervention studies to further reduce UV exposures.
背景
儿童癌症幸存者研究（CCSS）先前的研究表明，皮肤癌风险与放射治疗暴露密切相关。紫外线辐射暴露在幸存者中的潜在作用尚未得到描述。
方法
CCSS是一项回顾性队列研究，旨在调查1970年至1986年间被诊断患有癌症的儿童和青少年5年幸存者中的晚期效应。收集了9298名幸存者和2950名同胞对照者当前的防晒行为数据。随访时的中位年龄为31岁（范围17至54岁）。
结果
在该队列中，儿童癌症幸存者和同胞的防晒霜使用模式相似（67%对66%）。幸存者报告上一年进行日光浴的可能性显著较低（上一年无日光浴对有日光浴：相对风险（RR）=0.92；95%置信区间（CI）=0.89 - 0.95）或使用人工晒黑的可能性显著较低（上一年无人工晒黑对有人工晒黑：RR=0.76；95%CI=0.70 - 0.83）。与未接受放射治疗的幸存者相比，接受过放射治疗的幸存者防晒霜使用增加（RR=1.06；95%CI=1.03 - 1.10），日光浴减少（上一年无日光浴对有日光浴：RR=0.89；95%CI=0.86 - 0.92）或人工晒黑减少（上一年无人工晒黑对有人工晒黑：RR=0.62；95%CI=0.56 - 0.69）。在调整后的多变量分析中，幸存者群体中过去一个夏天经常使用防晒霜（与从不/很少使用相比）的统计学显著因素包括女性、肤色较浅、曾接受过皮肤癌检查以及皮肤在无防护阳光下会晒伤。
结论
儿童癌症幸存者自我报告的晒黑行为比同胞少。然而，由于治疗相关暴露导致皮肤癌风险可能增加，未来的研究应针对干预研究，以进一步减少紫外线暴露。
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