English D R, Armstrong B K, Kricker A
University of Western Australia, Perth, Australia.
Cancer Epidemiol Biomarkers Prev. 1998 Oct;7(10):857-63.
We examined the reproducibility of the measurement of sun exposure in a cohort study of nonmelanocytic skin cancer in Geraldton, Western Australia. Two analyses were undertaken: a comparison of cutaneous sun damage with sun exposure reported at interview, and an analysis of test-retest reproducibility of reported exposure. Skin cancers and cutaneous indicators of sun damage (cutaneous microtopography and solar elastosis of the neck) were recorded at a survey in 1987. A case-control study was conducted in 1988 in which subjects were interviewed about their lifetime sun exposure. All subjects had European ancestry. A subset of these subjects was reinterviewed using the same interview schedule in 1993. The comparison of reported exposure with skin damage was restricted to 201 cases of basal cell carcinoma and 700 controls, all of whom were born in Australia and had no southern European ancestors. The analysis of test-retest reproducibility included 62 cases with basal cell carcinoma and 162 controls. After adjustment for the skin's sensitivity to sunlight, cutaneous microtopography explained 7% and solar elastosis of the back of the neck explained 13% of the variance in the reported time spent outdoors. The intraclass correlation between time spent outdoors reported in the two interviews was 0.77 [95% confidence interval (CI), 0.71-0.83], whereas for exposure to a specific anatomical site, it was 0.65 (95% CI, 0.55-0.73). The reported site-specific exposure was lower on the second occasion in controls but higher in cases. The hours of exposure on vacations and the proportion of exposure that occurred on nonworking days had poor reproducibility. Furthermore, cases reported a more intermittent pattern of weekly exposure on the first occasion than on the second, whereas the controls showed little difference in their pattern on the two occasions. The weighted kappa statistic for lifetime painful sunburns was 0.53 (95% CI, 0.41-0.66), and for lifetime number of blistering sunburns, it was 0.54 (95% CI, 0.44-0.65). Thus, the reported sun exposure showed only moderate agreement with biological markers of sun damage. Total sun exposure and, to a lesser extent, site-specific exposure showed good agreement on the two occasions. However, indicators of intermittent sun exposure had poor agreement, and sunburn had only fair agreement.
在西澳大利亚州杰拉尔顿开展的一项非黑素细胞性皮肤癌队列研究中，我们检验了阳光暴露测量的可重复性。进行了两项分析：一是将皮肤阳光损伤与访谈时报告的阳光暴露进行比较，二是分析报告暴露的重测可重复性。1987年的一项调查记录了皮肤癌和阳光损伤的皮肤指标（皮肤微观形貌和颈部的日光性弹力组织变性）。1988年开展了一项病例对照研究，期间就受试者一生的阳光暴露情况进行了访谈。所有受试者均有欧洲血统。1993年，使用相同的访谈提纲对这些受试者中的一部分进行了再次访谈。报告的暴露与皮肤损伤之间的比较仅限于201例基底细胞癌病例和700名对照，他们均出生于澳大利亚且没有南欧祖先。重测可重复性分析纳入了62例基底细胞癌病例和162名对照。在对皮肤对阳光的敏感性进行校正后，皮肤微观形貌解释了报告的户外时间差异的7%，颈部后侧的日光性弹力组织变性解释了13%。两次访谈中报告的户外时间的组内相关系数为0.77 [95%置信区间（CI），0.71 - 0.83]，而对于特定解剖部位的暴露，组内相关系数为0.65（95% CI，0.55 - 0.73）。在对照中，第二次报告的特定部位暴露较低，而在病例中则较高。假期的暴露时长以及非工作日的暴露比例的可重复性较差。此外，病例在第一次访谈时报告的每周暴露模式比第二次更具间歇性，而对照在两次访谈中的模式差异不大。终生疼痛性晒伤的加权kappa统计量为0.53（95% CI，0.41 - 0.66），终生水疱性晒伤次数的加权kappa统计量为0.54（95% CI，0.44 - 0.65）。因此，报告的阳光暴露与阳光损伤的生物学标志物之间仅显示出中等程度的一致性。两次访谈中，总的阳光暴露以及在较小程度上特定部位的暴露显示出良好的一致性。然而，间歇性阳光暴露的指标一致性较差，晒伤的一致性仅为一般。
