Cahoon Elizabeth K, Mandal Soutrik, Pfeiffer Ruth M, Wheeler David C, Sargen Michael R, Alexander Bruce H, Kitahara Cari M, Linet Martha S, Mai Jim Z
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
J Natl Cancer Inst. 2024 Dec 1;116(12):1928-1933. doi: 10.1093/jnci/djae186.
Ultraviolet radiation (UVR) exposure is the primary risk factor for melanoma, although the relationship is complex. Compared with radiation from UVB wavelengths, UVA makes up a majority of the surface solar UVR, penetrates the skin more deeply, is the principal range emitted by tanning beds, and is less filtered by sunscreens and window glass. Few studies have examined the relationship between ambient UVA and UVB and melanoma risk.
Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated for the association between satellite-based ambient (based on residential history) UVA, UVB, and melanoma in non-Hispanic White participants using data from the United States Radiologic Technologists study, a large, nationwide prospective cohort. Associations of UVA and UVB quartile (Q) were examined in mutually adjusted and stratified models, additionally adjusted for demographic and sun sensitivity characteristics.
There were 837 incident melanoma cases among 62 785 participants. Incidence of melanoma was statistically significantly increased for the highest quartile of childhood UVA exposure after adjustment for UVB (IRR = 2.82; 95% CI = 1.46 to 5.44) but not for higher childhood UVB after adjustment for UVA. Childhood UVA was associated with increased melanoma risk within strata of UVB. Childhood UVB was not associated with melanoma after adjustment for UVA, but there was some evidence of lower risk with increased lifetime ambient UVB after UVA adjustment.
Melanoma risk was elevated among participants living in locations with high annual childhood and lifetime UVA after controlling for UVB. With confirmation, these findings support increased protection from solar UVA for melanoma prevention.
紫外线辐射（UVR）暴露是黑色素瘤的主要危险因素，尽管二者关系复杂。与UVB波长的辐射相比，UVA在地表太阳UVR中占大部分，能更深入地穿透皮肤，是晒黑床发出的主要波段，且较少被防晒霜和窗户玻璃过滤。很少有研究探讨环境UVA和UVB与黑色素瘤风险之间的关系。
利用美国放射技师研究（一项大型的全国性前瞻性队列研究）的数据，估计非西班牙裔白人参与者中基于卫星的环境（根据居住史）UVA、UVB与黑色素瘤之间关联的发病率比（IRR）和95%置信区间（CI）。在相互调整和分层模型中检验UVA和UVB四分位数（Q）的关联，并额外调整人口统计学和阳光敏感性特征。
62785名参与者中有837例黑色素瘤新发病例。在调整UVB后，儿童期UVA暴露最高四分位数的黑色素瘤发病率在统计学上显著增加（IRR = 2.82；95% CI = 1.46至5.44），但在调整UVA后，儿童期较高的UVB暴露则未出现这种情况。儿童期UVA在UVB各层内与黑色素瘤风险增加相关。调整UVA后，儿童期UVB与黑色素瘤无关，但有一些证据表明，调整UVA后，终生环境UVB增加会使风险降低。
在控制UVB后，居住在儿童期和终生UVA水平较高地区的参与者黑色素瘤风险升高。若得到证实，这些发现支持加强对太阳UVA的防护以预防黑色素瘤。
