黑色素瘤的上升趋势。关于防晒霜有效性的一种假说。

Rising trends in melanoma. An hypothesis concerning sunscreen effectiveness.

作者信息

Garland C F, Garland F C, Gorham E D

机构信息

Department of Community and Family Medicine, University of California at San Diego, La Jolla 92138-0631.

出版信息

Ann Epidemiol. 1993 Jan;3(1):103-10. doi: 10.1016/1047-2797(93)90017-x.

Abstract

Incidence rates of melanoma have risen especially steeply since the mid-1970s. The two principal strategies for reduction of risk of melanoma and other skin cancers are sun avoidance and use of chemical sunscreens. Rising trends in the incidence of and mortality from melanoma have continued since the 1970s and 1980s, when sunscreens with high sun protection factors became widely used. Commonly used chemical sunscreens block ultraviolet B (UVB) but are virtually transparent to ultraviolet A (UVA), which makes up 90 to 95% of ultraviolet energy in the solar spectrum. Because sunscreens prevent erythema and sunburn, and inhibit accommodation of the skin to sunlight, their use may permit excessive exposure of the skin to portions of the solar spectrum other than UVB. If melanoma and basal cell carcinoma are initiated or promoted by solar radiation other than UVB, as laboratory data suggest, then UVB sunscreens might not be effective in preventing these cancers, and sunscreen use might increase the risk of their occurrence. Alternative explanations for the rapid rise in the incidence and mortality rates of melanoma, such as changes in patterns of recreational sun exposure, are discussed. Traditional means of limiting overexposure to the sun, such as wearing of hats and adequate clothing and avoidance of prolonged sunbathing, may be more prudent than reliance on chemical sunscreens.

摘要

自20世纪70年代中期以来,黑色素瘤的发病率急剧上升。降低黑色素瘤和其他皮肤癌风险的两个主要策略是避免日晒和使用化学防晒霜。自20世纪70年代和80年代高防晒系数的防晒霜广泛使用以来,黑色素瘤的发病率和死亡率持续呈上升趋势。常用的化学防晒霜可阻挡紫外线B(UVB),但对紫外线A(UVA)几乎是透明的,而UVA在太阳光谱的紫外线能量中占90%至95%。由于防晒霜可预防红斑和晒伤,并抑制皮肤对阳光的适应,其使用可能会使皮肤过度暴露于UVB以外的部分太阳光谱。如果如实验室数据所提示的,黑色素瘤和基底细胞癌是由UVB以外的太阳辐射引发或促进的,那么UVB防晒霜可能无法有效预防这些癌症,且使用防晒霜可能会增加其发生风险。文中还讨论了黑色素瘤发病率和死亡率快速上升的其他解释,如休闲日晒模式的变化。限制过度日晒的传统方法,如戴帽子、穿适当的衣服以及避免长时间日光浴,可能比依赖化学防晒霜更为审慎。

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