White E, Kirkpatrick C S, Lee J A
Am J Epidemiol. 1994 May 1;139(9):857-68. doi: 10.1093/oxfordjournals.aje.a117092.
Constitutional factors and sun exposure were examined among 256 cases of melanoma and 273 controls in three counties of western Washington State. Cases were individuals diagnosed with melanoma at ages 25-65 years during 1984-1987 who were identified from a Seattle-Puget Sound cancer registry. Population controls were identified through random digit dialing and were randomly selected, stratified by age, sex, and county. Participants completed a telephone interview with questions on demographic, sun exposure, and constitutional factors. Risk factors for melanoma were examined through the use of logistic regression, controlling for age, sex, and educational level, and data on each exposure variable were tested for the significance of trends across levels of exposure. The constitutional factor most strongly associated with melanoma risk was sun sensitivity, measured as either reaction to chronic sun exposure (for no tan vs. deep tan, odds ratio (OR) = 9.0, 95% confidence interval (CI) 3.8-21.1; p < 0.001 for trend across four categories) or reaction to acute sun exposure (for severe burn vs. tan, OR = 5.7, 95% CI 2.6-12.6; p < 0.001 for trend across four categories). The number of raised nevi counted on both arms by subjects was also associated with increasing risk (for > or = 10 nevi vs. none, OR = 5.7, 95% CI 2.2-14.6; p for trend < 0.001). Sun exposure in adulthood and occupational sun exposure were not related to melanoma risk. The effect of sun exposure in childhood on melanoma risk was modified by tanning ability. Poor tanners showed no effect of sun exposure at ages 2-10 years or ages 11-20 years. In contrast, people who reported a deep or moderate tan in reaction to chronic sun exposure appeared to be protected from melanoma with increasing sun exposure at ages 2-10 years (for upper third vs. lower third, OR = 0.3, 95% CI 0.2-0.6; p for trend < 0.001), with identical results for exposure at ages 11-20 years. The finding that childhood sun exposure is protective only among those able to tan supports the hypothesis that developing a tan during childhood may reduce the risk of melanoma by offering protection from the effects of sunlight exposure.
在华盛顿州西部的三个县，对256例黑色素瘤患者和273名对照者进行了体质因素和阳光暴露情况的调查。病例为1984年至1987年期间年龄在25至65岁之间被诊断为黑色素瘤的个体，他们是从西雅图 - 普吉特海湾癌症登记处识别出来的。通过随机数字拨号确定人群对照，并按年龄、性别和县区进行随机选择。参与者完成了一项电话访谈，内容涉及人口统计学、阳光暴露和体质因素。通过逻辑回归分析黑色素瘤的危险因素，同时控制年龄、性别和教育水平，并对每个暴露变量的数据进行了不同暴露水平趋势的显著性检验。与黑色素瘤风险最密切相关的体质因素是对阳光的敏感性，这可以通过对慢性阳光暴露的反应来衡量（无晒黑与深晒黑相比，比值比（OR）= 9.0，95%置信区间（CI）3.8 - 21.1；四个类别趋势的p < 0.001），或者通过对急性阳光暴露的反应来衡量（严重晒伤与晒黑相比，OR = 5.7，95% CI 2.6 - 12.6；四个类别趋势的p < 0.001）。受试者双臂上凸起痣的数量也与风险增加相关（≥10颗痣与无痣相比，OR = 5.7，95% CI 2.2 - 14.6；趋势的p < 0.001）。成年期的阳光暴露和职业性阳光暴露与黑色素瘤风险无关。童年期阳光暴露对黑色素瘤风险的影响因晒黑能力而异。不易晒黑的人在2至10岁或11至20岁时阳光暴露没有影响。相比之下，那些因慢性阳光暴露而报告有深晒黑或中度晒黑的人，在2至10岁时随着阳光暴露增加似乎对黑色素瘤有保护作用（上三分位数与下三分位数相比，OR = 0.3，95% CI 0.2 - 0.6；趋势的p < 0.001），11至20岁时的暴露情况结果相同。童年期阳光暴露仅对那些能够晒黑的人有保护作用这一发现支持了这样的假设，即童年期晒黑可能通过提供免受阳光暴露影响的保护来降低黑色素瘤的风险。
