Silva Elizabet Saes da, Tavares Roberto, Paulitsch Felipe da Silva, Zhang Linjie
Physiotherapy and Dermatology Clinic, Postgraduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande-RS, Brazil.
Faculty of Medicine, Federal University of Rio Grande, Rio Grande-RS, Brazil.
Eur J Dermatol. 2018 Apr 1;28(2):186-201. doi: 10.1684/ejd.2018.3251.
The use of sunscreen is a key component of public health campaigns for skin cancer prevention, but epidemiological studies have raised doubts on its effectiveness in the general population. This systematic review and meta-analysis aimed to assess the association between risk of skin cancer and sunscreen use. We searched PubMed, BIREME and Google Scholar from inception to May 17, 2017, to identify observational studies and controlled trials. We used a random-effects model for conventional and cumulative meta-analyses. We included 29 studies (25 case-control, two cohort, one cross-sectional, and one controlled trial) involving 313,717 participants (10,670 cases). The overall meta-analysis did not show a significant association between skin cancer and sunscreen use (odds ratio (OR) = 1.08; 95% CI: 0.91-1.28, I = 89.4%). Neither melanoma (25 studies; 9,813 cases) nor non-melanoma skin cancer (five studies; 857 cases) were associated with sunscreen use, with a pooled OR (95% CI) of 1.10 (0.92-1.33) and 0.99 (0.62-1.57), respectively. The cumulative evidence before the 1980s showed a relatively strong positive association between melanoma and sunscreen use (cumulative OR: 2.35; 95% CI: 1.66-3.33). The strength of the association between risk of skin cancer and sunscreen use has constantly decreased since the early 1980s, and the association was no longer statistically significant from the early 1990s. While the current evidence suggests no increased risk of skin cancer related to sunscreen use, this systematic review does not confirm the expected protective benefits of sunscreen against skin cancer in the general population.
使用防晒霜是预防皮肤癌的公共卫生运动的关键组成部分，但流行病学研究对其在普通人群中的有效性提出了质疑。本系统评价和荟萃分析旨在评估皮肤癌风险与防晒霜使用之间的关联。我们检索了从数据库建立至2017年5月17日的PubMed、BIREME和谷歌学术，以识别观察性研究和对照试验。我们对传统和累积荟萃分析使用随机效应模型。我们纳入了29项研究（25项病例对照研究、2项队列研究、1项横断面研究和1项对照试验），涉及313,717名参与者（10,670例病例）。总体荟萃分析未显示皮肤癌与防晒霜使用之间存在显著关联（优势比（OR）=1.08；95%置信区间：0.91-1.28，I²=89.4%）。黑色素瘤（25项研究；9,813例病例）和非黑色素瘤皮肤癌（5项研究；857例病例）均与防晒霜使用无关，汇总OR（95%置信区间）分别为1.10（0.92-1.33）和0.99（0.62-1.57）。20世纪80年代以前的累积证据显示黑色素瘤与防晒霜使用之间存在相对较强的正相关（累积OR：2.35；95%置信区间：1.66-3.33）。自20世纪80年代初以来，皮肤癌风险与防晒霜使用之间关联的强度不断下降，从20世纪90年代初起该关联不再具有统计学意义。虽然目前的证据表明与使用防晒霜相关的皮肤癌风险没有增加，但本系统评价并未证实防晒霜对普通人群预防皮肤癌具有预期的保护作用。
