English D R, Armstrong B K
University Department of Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.
Br Med J (Clin Res Ed). 1988 May 7;296(6632):1285-8. doi: 10.1136/bmj.296.6632.1285.
To assess whether screening people at high risk of malignant melanoma would be effective in reducing the mortality from the disease data from 400 case-control pairs in a study of cutaneous malignant melanoma conducted in Western Australia during 1980-1 were used to predict the risk of melanoma in the remaining 111 pairs. All variables previously shown to be associated with a decrease or increase in the incidence of melanoma were considered for inclusion in a single conditional logistic regression model of the incidence of melanoma in the randomly chosen subset of 400 case-control pairs. Five of these variables--number of raised naevi on the arms, arrival in Australia before 10 years of age, history of non-melanocytic skin cancer, time spent outdoors in summer from the age of 10 to 24, and family history of melanoma--provided good discrimination between patients and controls in this sample and the 111 other case-control pairs. Among the 222 subjects in these other case-control pairs a group defined as being at high risk of melanoma by a risk score derived from these five variables contained 60 (54%) of the patients with melanoma but only 18 (16%) of the controls. These data suggest that in Western Australia more than half of all new patients with melanoma arise in an identifiable subpopulation constituting less than one fifth of the whole population. Identifying this subpopulation and screening it regularly for cutaneous malignant melanoma could be cost effective in reducing mortality from this disease.
为评估对恶性黑色素瘤高危人群进行筛查是否能有效降低该病的死亡率，在1980 - 1981年于西澳大利亚州开展的一项皮肤恶性黑色素瘤研究中，利用400对病例对照的数据来预测其余111对病例对照中黑色素瘤的发病风险。所有先前已表明与黑色素瘤发病率增减相关的变量，都被纳入到一个关于从随机选取的400对病例对照子集中黑色素瘤发病率的单条件逻辑回归模型中进行考量。其中五个变量——手臂上隆起痣的数量、10岁前抵达澳大利亚、非黑素细胞性皮肤癌病史、10至24岁夏季在户外的时间以及黑色素瘤家族史——在该样本以及另外111对病例对照中，能很好地区分患者和对照。在这另外111对病例对照的222名受试者中，根据这五个变量得出的风险评分定义为黑色素瘤高危组的人群中，有60名（54%）黑色素瘤患者，但只有18名（16%）对照。这些数据表明，在西澳大利亚州，超过一半的黑色素瘤新发病例出现在一个可识别的亚人群中，该亚人群占总人口不到五分之一。识别这个亚人群并定期对其进行皮肤恶性黑色素瘤筛查，在降低该病死亡率方面可能具有成本效益。
