Green A, Battistutta D, Hart V, Leslie D, Weedon D
Queensland Institute of Medical Research, Australia.
Am J Epidemiol. 1996 Dec 1;144(11):1034-40. doi: 10.1093/oxfordjournals.aje.a008875.
Because it is not possible to monitor skin cancer accurately using routine methods, special surveys have been undertaken in Nambour, a typical subtropical community in Queensland, Australia. Estimates of incidence reported here are based on skin cancers medically treated between 1985 and 1992 and new cases diagnosed by dermatologists in two examination clinics in 1986 and 1992. Among men and women aged 18-69 years in 1986, age-adjusted incidence rates of basal cell carcinoma were 2,074 and 1,579 per 100,000 per year, respectively-the highest incidence rates of a specific cancer ever reported. Squamous cell carcinoma occurred at half the rate of basal cell carcinoma among men and at about one third the rate among women. Although as expected, fair skin, a history of repeated sunburns, and nonmalignant solar skin damage diagnosed by dermatologists were strongly associated with both types of skin cancer, outdoor occupation was not. Significant self-selection was observed among outdoor workers, whereby people with fair or medium complexions and a tendency to sunburn were systematically underrepresented among those in long-term outdoor occupations although they accounted for more than 80 percent of the community study sample. The mitigating effect of this selection bias may partly explain the paradox of the lack of quantitative evidence of a causal link between sun exposure and skin cancer in humans.
由于无法通过常规方法准确监测皮肤癌，因此在澳大利亚昆士兰州一个典型的亚热带社区楠伯进行了专项调查。这里报告的发病率估计值是基于1985年至1992年接受医学治疗的皮肤癌病例，以及1986年和1992年在两家检查诊所由皮肤科医生诊断出的新病例。在1986年年龄在18 - 69岁的男性和女性中，基底细胞癌的年龄调整发病率分别为每10万人每年2074例和1579例，这是有报道以来特定癌症的最高发病率。鳞状细胞癌在男性中的发病率是基底细胞癌的一半，在女性中约为基底细胞癌发病率的三分之一。正如预期的那样，白皙的皮肤、反复晒伤史以及皮肤科医生诊断出的非恶性日光性皮肤损伤与这两种皮肤癌都密切相关，但户外工作并非如此。在户外工作者中观察到明显的自我选择现象，即白皙或中等肤色且容易晒伤的人在长期户外职业人群中系统性地占比过低，尽管他们在社区研究样本中占比超过80%。这种选择偏倚的缓解作用可能部分解释了在人类中缺乏阳光暴露与皮肤癌之间因果关系定量证据的矛盾现象。
