Sun Exposure Prior to Diagnosis is Associated With Improved

8/17/2019 Sun Exposure Prior to Diagnosis is Associated With Improved

1/27

E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1

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Sun exposure prior o !i"#nosis is "sso$i"e! %i& i'proe! suri" in'e"no'" p"iens* Resus +ro' " on#,er' +oo%,up su!- o+ ."i"n

p"iens

Se+"no Rosso"/

/ Fr"n$es$o Ser"

/ Nereo Se#n"n$/ Roero "nei

"

"CPO/ C"n$er Preenion Cenre/ Pie!'on C"n$er Re#isr-/ 3i" S"n Fr"n$es$o !" P"o" 1/ 1012 urin/ ."-

6oe$u"r "n! Nuriion" Epi!e'ioo#- Uni/ CSPO/ S$ieni+i$ .nsiue o+ us$"n-/ 3i" Cosi'o i 3e$$&io 2/ 501 Foren$e/ ."- $CPO/ C"n$er

Preenion Cenre/ C"n$er Epi!e'ioo#- Uni/ 3i" S"n Fr"n$es$o !" P"o" 1/ 1012 urin/ ."-

A R . C L E . N F O

Ari$e &isor-*

Re$eie! 21 Noe'er 2007

Re$eie! in reise! +or' 1 6"r$&

2008

A$$epe! 17 6"r$& 2008 A"i"e

onine 10 Apri 2008

e-%or!s*

Cu"neous 'e"no'"

Ris9 +"$ors

Re"ie suri"

3i"'in :

Sun exposure

A ; S R A C

$onro su!- in urin/ ."-? 0?8)? Ou!oor %or9 %"s no "sso$i"e! %i& "n in$re"se! ris9 o+ !e"&?

6ui"ri"e 'o!es in$u!in# "n"o'i$ sie/ 'e"no'" &i$9ness "n! &isoo#-/ s&o%e! &" iner'ien sun


2/27

exposure &"! " en!en$- o e

inerse- "sso,$i"e! %i& &e ris9

o+ !e"& +ro' 'e"no'" %i& " R

o+ 0?=0 (5C. B 0?24>1?5) in &e

p"iens %i& 1 o 5 %ee9s "n! "

R o+ 0?54 (5C. B 0?2>1?2) in

p"iens %i& 'ore &"n =0 %ee9s

spen on &e e"$& !urin# &eir

i+ei'e?

&is su!-/ %i& si'i"r 'e&o!s "n! " on#er +oo%,up/ $on+ir's &e +in!in# &" sun exposure prior o

!i"#nosis o+ 'e"no'" is "sso$i"e! %i& i'proe! suri"?

2008 Eseier L!? A ri#&s resere!?

.nro!u$ion

6e"no'"/ "'on#s C"u$"si"n popu"ions/ &"s s&o%n o e one o+ &e

+"ses #ro%in# in$re"se in in$i!en$e in &e "s 50 -e"rs? Sin$e &e

seenies/ 'e"no'" in$i!en$e in USA (in %&ies) in$re"se! +ro' 8?7 per

100/000 in&"i"ns in 175 o 22? in 2001 %i& "n "nnu" per$en"#e

$&"n#e (APC) o+ "ou 5?8? .n Europe/ "n "nnu" in$re'en o+ 4>15

%"s o,sere!/2 %i& " !i++eren p"ern o+ in$re"se "'on#s Nor&,ern

$ounries/ %&ere &e in$re"se %"s 'ore !r"'"i$/ "n! "'on#s Sou&ern

$ounries/ %&ere &e in$re"se %"s 'ore 'o!es?4/5

.n Ausr"i"/ &e

$ounr- &" &"s su++ere! &e &i#&es o/ &e "nnu" per$en in$re"se %"s

"ou 4 +ro' &e ei#&ies o &e en! o+ 2000/ !espie &e prior in$i!en$e

r"e %"s "re"!- &e &i#&es in &e %or!?=/7

Forun"e-/ so'e re,

$en !"" s&o% " s"iis"ion o+ &e in$re"sin# ren! or een " s'"

!e$re"se in Nor& A'eri$" "n! in Ausr"i" in &e -oun#es $o&ors o+

ir&?1/=/7

On &e $onr"r-/ 'or"i- !i! no p"r"e &e in$re"se in in$i!en$e* in

USA/ &ere %ere 2? 'e"no'" !e"&s per 100/000 in 175 "n! ?0 in

200? .n Ausr"i"/ 'or"i- r"es pe"9e! in 185 "n! &en soppe!

risin#?8/

&is !is$rep"n$- %"s #ener"- "s$rie! o &e in$re"se o+

&inner 'e"no'"/ e"sier o re'oe " "n e"r- s"#e "n! &ere+ore %i& "

'ore +"our"e pro#nosis/ %&is &i$9er 'e"no'" in$re"se! " " o%er

r"e "n! %"s pro"- responsie +or &e $ons"n 'or"i-? . &"s "so

een su##ese! &" &e i'proe! sur,i" "sso$i"e! %i& in$re"se!

in$i!en$e/ "n! osere! "$ross seer" $ounries/ %"s !ue o " !i++eren

"n! 'ore eni#n -pe o+ 'e"no'"?10

r"!iion"-/ in$re"se! 'e"no'"

in$i!en$e

Correspon!in# "u&or* e?* D 0115==551 +"x* D 011=8=1? E,'"i "!!ress* se+"no?rosso$po?i (S? Rosso)?

05,804GH , see +ron '"er 2008 Eseier L!? A ri#&s resere!? !oi*10?101=GI?eI$"?2008?0?00

mailto:[email protected]:[email protected]


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127= E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1

%"s &ou#& o e "sso$i"e! %i& &e 'ore

%i!espre"! &"i o+ exposin# &e s9in o &e sun

!urin# eisure "$iiies %i&ou "n "!eu"e

proe$ion or o " per'"nen "n/ &e so,$"e!

Kiner'ien sun exposure?11

Re$en-/ "no&er &-po&esis %"s pu +or%"r!12

* &e

in,$re"se! nu'er o+/ '"in- &in/ 'e"no'"/ "n!

&e i',proe! suri" %ere o& re"e! o sun

exposure e$"use o+ " possie 'e"oi$ p"&%"-

in9in# sun exposure o i",'in : in!u$ion/ %&i$&

is suppose! o &"e "n inr",$eu"r "ni,oxi!"ie

"n! pro,"poposis e++e$? &is &-po&esis "rose +ro'

&e resus o+ &e +oo%,up o+ 'e"no'" p"iens in

Conne$i$u preious- inerie%e! in " $"se>

$onro su!-?1

&e "u&ors +oun! " posiie

"sso$i"ion e%een iner'i,en sun exposure

in!i$"ors "n! on#er suri"? An in!ire$

$on+ir'"ion o+ &ese +in!in#s %"s re$en- seen"n"-sin# &e +""i- o+ 'e"no'" in Ne% Sou&

2/ %i& " p"ri$ip"ion r"e o+ 85 %ere

inerie%e! ou o+ 05 ei#ie p"iens? &e ori#in"

su!- &"! " o" o+ 2=0 $"ses"n! 41= $on,ros?

A'on#s &ese $"ses/ 18= %ere %o'en "n! 74 'en*

su$& "n i'""n$e! sex r"io %"s !ue o &e +"$ &"

&e re$rui,'en o+ %o'en %"s proon#e! in or!er o

#e s"isi$" po%er +or su!-in# &e roe o+ or"

$onr"$epies in 'e"no'"?18

:"" $oe$ion "n! su!- "ri"es

A inerie%s %ere $"rrie! ou - r"ine!

inerie%ers usin# " uesionn"ire/ %&i$& in$u!e!

so$io,!e'o#r"p&i$ "ri"es ("#e " 'e"no'"

!i"#nosis/ sex/ ee o+ e!u$"ion "n! o$$u,p"ion)/

&os +"$ors (pi#'en"ion "n! s9in re"$ion o sun

exposure) "n! sun exposure &isor-? &e ee o+

e!u$"ion %"s use! "s " prox- o+ SES? .n &e

preious su!ies on &e e+,+e$ o+ so$i" !epri"ion

"n! suri" +ro' $"n$er/ &e ee o+ e!u$"ion in

."- proe! o e &e es in!i$or o+ SES?1

Pi#,

'en"ion %"s 'e"sure! - "ssessin# &"ir "n! e-e

$oour?


4/27

"$ii-/ %e esi'"e! $u'u"ie sun exposure

su''in# up &e nu'er o+ %ee9s spen !urin#

i+ei'e/ "n! in$i!en exposure (%ee9sG-e"r) "s &e

r"io o+ $u'u"ie exposure o -e"rs o+ "$ii-? For

&e "n"-ses/ %e &en #roupe! &e ori#in" "ues in

per$enies o+ &e $u'u",ie !isriuions in

expose! $"ses? Ou!oor spors %ere $"ssi,+ie! "s

o%/ 'e!iu' "n! &i#& ris9 "n! suIe$ "ssi#ne! o

one o+ &ese $"e#ories? P"&oo#- repors "n!

$ini$" re$or!s o+ " &e 2=0 p"iens proi!e! &e

nee!e! in+or'"ion on esion &i$9ness/ C"r9s

s"#in#/ &isoo#- -pe "n! sie o+ 'e"no'" (&e"!"n! ne$9/ run9/ upper i' "n! o%er i')?

A&ou#& presen in &e ori#in" p"&oo#- repors/

in+or'"ion on u$er"ion/ on so"r e"sosis "n! on

o&er $&"r"$erisi$s o+ &e esion "n! &e

surroun!in# issue %"s no re$or!e!? .n &e "n"-ses/

%e use! in+or'"ion on esions &i$9ness sin$e i

%"s 'ore $o'pee (18 'issin#) &"n C"r9s

s"#in# (20 'issin#) "n! #roupe! is +irs %o

$"e#ories (0?75 '' "n! 0?75>1?50 '') sin$e %e

&"! no '"n- &in esions (14) o Ius,i+- &eir use

"s &e re+eren$e $"e#or-?


5/27


1277

i" o+ " #roup in &e #ener" popu"ion $o'p"r"e - "#e "n! sex/ "n!

"ssu'e! o e pr"$i$"- +ree +ro' $"n$er? o $"$u"e &e expe$e!

nu'er o+ !e"&s/ %e use! 1,-e"r "#e $"ss i+e "es sr"i+ie! - sex?

&e i+e "es o+ &e ur,in proin$e %ere proi!e! - &e ."i"n

N"ion" .nsiue o+ S"isi$s (.SA) +or &e perio!s 18=>10/ 11>

15/ 1=> 2000 "n! 2001>2005? For &e -e"rs 184>185 %&en &e

re$rui,'en "n! +oo%,up o+ 'e"no'" p"iens s"re!/ %e use! &e i+e

"es o+ &e $oses ""i"e perio! (185>10)? o inesi#"e &e!i++ereni" ris9 in re"ie suri" "'on#s &e +"$ors su!ie!/ %e use!

#ener"ise! ine"r 'o!es %i& " Poisson error/ "n! " o# o++se o+ person>

-e"rs " ris9?20


6/27

" &e e#innin# o+ +oo%,up

!e"&s ()

!e"&s ()"

A#e " !i"#nosis (-e"rs)

Less &"n =5

175

=1 (45)

1= (17)

Re+eren$e

=5 "n! oer

7=

=7 (5)

4 (=0)

2?7

(1?4 5?1)

Sex

6en

7

45 (=2)

1= (22)

Re+eren$e


7/27

0?44

(0?25 0?78)

E!u$"ion

Up o &i#& s$&oo

225

118 (52)

4= (20)

Re+eren$e

Fur&er &"n &i#& s$&oo

2=

10 (8)

(1)

0?5

(0?20 1?78)

An"o'i$ sie o+ 'e"no'"

e"! "n! ne$9

=0

40 (=7)

20 (4)

Re+eren$e

Upper i's

=

17 (47)

10 (2=)

0?75

(0?27 2?1)

Lo%er i's

100


8/27

4 (4)

14 (14)

0?55

(0?1 1?=)

run9

5

2= (4)

= (12)

1?5

(0?5 ?7)

6e"no'" &i$9ness

1?50 ''

2

0 ()

1 (21)

Re+eren$e

1?50 ?00) ''

51

24 (47)

(18)

4?5

(0?82 22?2)

?00 ''

5

45 (7=)

11 (1)

12?8

(2?5 =4?=)

No ""i"e

4

2 (5)

10 (21)

=?5

(1?1 8?0)

isoo#i$ -pe o+ 'e"no'"


9/27

Super+i$i" spre"!in#

11

52 (40)

24 (18)

Re+eren$e

No!u"r

24

1= (=7)

2?1 (8?8)

2?0

(0?82 4?7)

A$r"

1

10 (77)

2?2 (17)

2?

(0?=2 8?4)

Leni#o

2=

1= (=2)

1 (50)

0?42

(0?04 4?4)

No ""i"e

57

4 (=0)

7? (14)

1?

(0?52 ?1)


10/27

Nu'er o+ !e"&s expe$e! in &e s"'e #roup o+ $"ses i+ &e- &"! experien$e! &e s"'e 'or"i- "s &e #ener" popu"ion on-?

"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or "#e/ sex/ e!u$"ion "n! +oo%,up perio!?


11/27


12/27

S9in -pe

.3

8

4

(5)

18 (22)

Re+eren$e

...

=7

0

(45)

11 (17)

0?75

(0?= 1?5)

..

75

4

(45)

1= (22)

0?57

(0?28 1?2)

.


13/27

1

11

(58)

2? (12)

1?4

(0?5= ?=)

E-e $oour

;"$9Gro%n

1=

5=

(41)

21 (15)

Re+eren$e

;ue

52

1

(=0)

12 (24)

1?7

(0?80 ?5)

Qreen

1

(58)

=?4 (1)

1?8

(0?77 4?4)

Qre-

2

22

(7=)

?8 (4)

1?

(0?7= 4?)

"ir $oour


14/27

;"$9Gro%n

178

88

(4)

8 (22)

Re+eren$e

;on!Gre!

=8

40

(5)

11 (1=)

1?5

(0?8 2?=)

Suns$reen use

No

14

8

(=2)

1 (2)

Re+eren$e

es

117

45

(8)

18 (1=)


15/27

0?75

(0?41 1?4)

Sunurns in $&i!&oo!

Neer

180

(52)

8 (21)

Re+eren$e

So'ei'esGo+en

=7

(4)

12 (17)

0?=

(0?51 1?8)

Seere sunurns i+eon#

Neer

175

1

(52)

(22)

Re+eren$e

So'ei'esGo+en

72


16/27

=

(50)

10 (14)

1?4

(0?7 2?5)

Ou!oor spors

No

17=

4

(5)

7 (21)

Re+eren$e

es

74

(45)

11 (15)

0?=4

(0?2 1?)

Ou!oor &oies

Neer

1

104

(52)

8 (1)

Re+eren$e


17/27

So'ei'esGo+en

52

24

(4=)

12 (22)

0?=0

(0?27 1?)

Ou!oor %or9

No

14

8

(4=)

(17)

Re+eren$e

es

57

(=8)

1= (28)

1?

(0?=5 2?5)

Nu'er o+ %ee9s on &e e"$& in " i+ei'e

0

70

52

(74)

18? (2=)


18/27

Re+eren$e

?

1>5

=7

27

(40)

?5 (14)

0?41

(0?18 0?0)

=0

114

4

(4)

22 (1)

0?

(0?1 0?7)

Nu'er o+ !e"&s expe$e! in &e s"'e #roup o+ $"ses i+ &e- &"! experien$e! &e s"'e 'or"i- "s &e #ener" popu"ion

on-?



19/27


127

in$re"se!/ "&ou#& no s"isi$"- si#ni+i$"n/ ris9 o+ !e"& +ro'

'e"no'" (R B 1? 5C. B 0?=5>2?5)?

.ner'ien sun exposure/ 'e"sure! - nu'er o+ %ee9s spen oer "

i+ei'e on &e e"$& ( "e 2)/ %"s inerse- "sso,$i"e! %i& &e ris9 o+

!e"&* p"iens %i& 1 o 5 %ee9s spen on &e e"$& !urin# &eir i+ei'e

&"! " si#ni+i$"n- !e,$re"se! ris9 o+ !-in# +ro' 'e"no'" (R B 0?41

5C. B 0?18>0?0) $o'p"re! o &ose %&o !i! no isi &e e"$& +or

&oi!"-s? A si'i"r/ u sron#er e++e$ %"s osere! +or &e p",iens %i&

'ore &"n =0 %ee9s spen on &e e"$& in &eir i+e,i'e (R B 0?

5C. B 0?1>0?7)/ %i& " si#ni+i$"n ine"r ren! (p,"ue B 0?015)? &e

$u,o++ " =0 %ee9s %"s !erie! +ro' &e u"rie o+ &e !isriuion o+

i'e spen " e"$&/ #roupin# o#e&er &e %o &i#&es u"ries +or

in$re"sin# &e nu'er o+ osere! eens?

Li+eon# exposure re+e$s " $o'posie p"ern o+ expo,sure?


20/27

(2?0 =?8)

$onro su!-? &e

"e > Join e++e$ o+ sun exposure on &e e"$& !urin# $&i!&oo! "n! "!u&oo! on ris9 o+ !e"& +or 'e"no'" in " popu"ion,"se! su!- o+ urin

resi!ens/ ."-

Nu'er o+ %ee9s on &e e"$& !urin# "!u&oo!

Nu'er o+ %ee9s on &e e"$& !urin# $&i!&oo!

0

1>5

=0

0


21/27

Osere!Gexpe$e!" !e"&s

52G18

G0?1

2G0?8

"@"r! r"io

"n! 5 C.

Re+eren$e

1?87 (0?4 7?2)

0?75 (0?10 5?7)

1>5


2G8?8

G1?1

1G0?2

"@"r! r"io

"n! 5 C.

0?40 (0?17 0?4)

0?14 (0?02 0?=)

0?1 (0?01 5?1)

=0


25G1

8G?4

11G?8

"@"r! r"io

"n! 5 C.

0?42 (0?18 0?8)

0?= (0?10 1?)

0?=8 (0?25 1?)

Nu'er o+ !e"&s expe$e! in &e s"'e #roup o+ $"ses i+ &e- &"! experien$e! &e s"'e 'or"i- "s &e #ener" popu"ion on-


22/27



23/27

1280 E U R O P E A N J O U R N A L O F C A N C E R 4 4 ( 2 0 0 8 ) 1 2 7 5 – 1 2 8 1

"e 5 > Join e++e$ o+ iner'ien sun exposure/

'e"no'" &i$9ness/ sex "n! e!u$"ion on ris9 o+

!e"& +or 'e"no'" in " popu"ion,"se! su!- o+

urin resi!ens/ ."-

.ner'ien sun exposure

Neer

So'ei'esGo+en

6e"no'" &i$9ness"

?00 ''

Re+eren$e

0?4=

(0?18 1?2)

?00 ''

?4 (1?4 8?0)

1?8 (0?71 4?7)

Sex

6en

Re+eren$e

0?2

(0?14 0?7=)


24/27

"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or

"#e/ e!u$"ion/ 'e"no'" &i$9ness "n! +oo%,up perio!?

"@"r! r"ios esi'"e! +ro' o#,ine"r 'o!es "!Iuse! +or

"#e/ sex/ 'e"no'" &i$9ness "n! +oo%,up perio!?

$"se>$onro su!-/ $on!u$e! !urin# &e ei#&ies in "

6e!ier,r"ne"n popu"ion (urin/ ."-) +oun! "

sron# "sso$i"ion o+ s9in sensiii- o sun (OR 5?0

in 'en "n! 2?2 in %o'en) "n! sun exposure !urin#

re$re"ion" "$iiies (OR 4?1 in 'en "n! 2?7 in

%o'en) %i& 'e"no'" ris9?1=

Fur&er'ore/ in &e

ori#in" $"se>$onro su!-/ %e +oun! "n in$re"se!

ris9 o+ 'e"no'" +or &e &isor- o+ sunurns in

$&i!&oo! (OR 5?)/ e"in# "n in!epen!en e++e$ +or

re$re"ion" sun exposure !urin# o& "!u "n!

$&i!&oo!?17

&e resus o+ suri" "n"-sis

$on+ir'e! &e preious +in!in#s1

o+ " proe$ie

e++e$ o+ iner'ien sun exposure prior o &e

!eeop'en o+ 'e"no'" "#"ins 'or"i-? &e

"sso$i"ion %"s "so pres,en %i& "n in!ire$

'e"sure o+ iner'ien sun exposure su$& "s

$u'u"ie "'oun o+ i'e spen !urin# eisure "$i,

iies (&oi!"-s on &e e"$&)? .n seer" su!ies "$ross

&e %or! &is sun exposure &"i %"s "so +reuen-

"sso$i"e! %i& "n in$re"se! ris9 o+ !eeopin#

'e"no'" "n! " 'e","n"-sis21

esi'"e! " ris9 o+

1?= (5C.* 1?4 2?0)?

A&ou#& " repro!u$iii- su!-22

s&o%e! &" sun

expo,sure &isor- $ou! rei"- e esi'"e! &rou#&

" uesion,n"ire "!'inisere! - proper- r"ine!

inerie%ers/ " $er"in "'oun o+ un!erreporin#/

pro"- !ue o pui$ "%"reness "ou ris9 +"$ors

"s s&o%n in " $"se>$onro su!- on sune! use "n!

'e"no'"2

'"- e si presen? o%eer/ in ."-

!urin# &e ei#&ies/ %&en &e inerie%s %ere $on,

!u$e! "n! in+or'"ion on ris9 +"$ors %"s $oe$e!/

&ere %ere no -e e!u$"ion" $"'p"i#ns on 'e!i"

"ou 'e",no'" preenion/ nor p"ri$u"r pressure

+or usin# U3 e++e$,ie s9in proe$ion or "oi!in#

sun exposure? o%eer/ een i+ !i++ereni"

'is$"ssi+i$"ion $"n e ess i'por"n sin$e &ere %e"re !e"in# on- %i& 'e"no'" $"ses/ &e i'in# o+

inerie%s i'is our in+or'"ion " &e i'e o+

!i"#nosis "n! e+ore* sun exposure e&"iours $"n

&"e $&"n#e! sin$e &en "n! in+uen$e!/ in so'e

%"-/ p"iens suri"?

&e "sso$i"ion e%een suri" "n! iner'ien

sun exposure %"s no exp"ine! - $on+oun!in# %i&

so$i" $"ss/

represene! &ere - " &i#& e!u$"ion ee/ %&i$&

%"s "so in,erse- "sso$i"e! %i& ris9 o+ !-in# o+

'e"no'"? .n "!!iion/ &e re"ie suri"

"ppro"$& "so oo9 ino "$$oun &e !i+,+eren$es in

'or"i- +or " $"uses - "#e "n! sex/ $onsi!erin#

&e %i!e "#e r"n#e o+ in$i!en $"ses in$u!e! in &is

su!-? Een "+er "!Ius'en +or "n"o'i$ sie/

'e"no'" &i$9ness "n! -pe o+ 'e"no'"/

iner'ien sun exposure $on+ir'e! " en!en$- o e

inerse- "sso$i"e! %i& &e ris9 o+ !e"&?

&e i'proe! suri" "'on#s suIe$s %i& "n

iner'i,en sun exposure $"n "so e !ue o &eir

in$re"se! s9in sur,ei"n$e/ "&ou#& &e preious

su!ies1/14

s&o%e! &" &is %"s in!epen!en-

"sso$i"e! %i& suri"? .n &e presen su!-/ &ere

%ere no 'e"sure o+ s9in surei"n$e "n! &us %e

%ere un"e o !ire$- e"u"e is i'p"$ on

suri"? o%eer/ seer" su!ies &"e "re"!-

s&o%e! &" s9in sur,ei"n$e %"s sus"ni"-

"sso$i"e! %i& &i#& so$i" $"ss "n!Gor &i#&

e!u$"ion?24/25

As " '"er o+ +"$/ in our su!- &e

proe$ie e++e$ o+ iner'ien sun exposure %"s

si presen "so "'on#s ess e!u$"e! peope? .n

"!!iion/ &e proe$ie e++e$ o+ sun exposure on ris9

o+ !e"& +ro' 'e",no'" %"s si'i"r %&eneer &e

p"iens &"! " &in or &i$9 esion?

O+ $ourse &is su!-/ "n! si'i"r su!ies/ $"nno

exp"in &e ioo#i$" p"usiii- o+ &e e++e$ o+ sun

exposure on p",ien suri"? o%eer/ i %"s

i'por"n o +in! " $on+ir'",ion o+ &e su!- -

;er%i$9 "n! $oe"#ues in " !i++eren popu"ion/%i& !i++eren/ "&ou#& si'i"r/ !"" $oe$ion

'e&o!s/ " on#er +oo%,up ('e!i"n i'e 17 -e"rs)/

"n! " o% per$en"#e o+ 'isse! o +oo%,up $"ses

(?5)? An! i %"s "so uie ineresin# &" our

esi'"es o+ " proe$ie e++e$/ 'e"sure! in er's o+

&"@"r! r"ios/ %ere r"&er si'i,"r o &ose

preious- +oun!* " R o+ 0?= (5C. 0?>1?0) +or

&i#& ersus o% iner'ien sun exposure? On &e

o&er &"n!/ ;er%i$9 "n! $oe"#ues +oun! "n

i'proe'en o+ sur,i" "so in &e presen$e o+

so"r e"sosis/ &" $"n e ie%e! "s " surro#"e +or

$&roni$ sun exposure/ %&is in &e presen su!-/

%&ere so"r e"sosis %"s no re$or!e! +ro' &e

p"&oo#- repors/ "n in!i$"or o+ $&roni$ sun

exposure su$& "s exposure !urin# o$$up"ion/ !i!no s&o% "n- e++e$? A possie exp"n"ion o+ &e

ioo#i$" 'e$&"nis' e-on! &e proe$ie e++e$ o+

sun exposure on 'e"no'" 'or"i- %"s propose!

o ie in &e "ni,proi+er"ie/ pro,"popoi$ "n! pro,

!i++ereni"ion e++e$s o+ i"'in :/2=

%&i$& in,

$re"ses "+er sun exposure? E$oo#i$" su!ies pu in

re"ion suni#& "n! $"n$er suri"27

"n! 'or"i-/

u &ere is ei,!en$e "so +ro' o&er su!ies &"

person" &"is o+ &i#& sun exposure '"- i'proe

ou$o'e "so +or re"s/ $oon "n! pros"e $"n$er

(+or " reie% o+ &e su!ies on suni#& "n! $"n$er

see "so ri$9er "n! Ar'sron#)?28

o%eer/ &e

&-po&esis o+ " posiie roe p"-e! - i"'in : is/

in so'e %"-/ in $onr"!i$ion %i& our resu o+ "nin$re"se! ris9 o+ !e"&/ "&ou#& no s"isi$"-

si#ni+i$"n/ +or $&roni$ expo,sure/ 'e"sure! %i&


25/27

$u'u"ie i'e o+ sun exposure !urin# ou!oor

%or9? Aso in &is $"se &e "'oun o+ s-n&esis o+ 25,

&-!rox- i"'in : s&ou! e in$re"se! "s %e "s

!urin# iner'ien sun exposure?

.n #ener"/ "s E#"n12

re'"r9e! Kno one . . . is

su##esin# &" sun"&in# is &e roue o . . . " eer

$"n$er ou$o'e. . ./ &o%,eer/ i re'"ins ineresin#

o expore &e &-po&esis o+ " pos,sie roe o+

i"'in : in 'e"no'" suri" or &e presen$e o+


26/27


1281

" #enei$ pre!isposiion $onsisen %i& &e %o p"&%"-s +or 'e"no'"?2

Con+i$ o+ ineres s"e'en

None !e$"re!?

A$9no%e!#e'ens

&e ori#in" $"se>$onro su!-/ +ro' %&i$& &is "n"-sis se's/ %"s

p"ri"- suppore! - &e ."i"n Asso$i"ion +or C"n$er Rese"r$& "n! &e

."i"n Le"#ue A#"ins C"n$er?

17* risin# ren!s in

in$i!en$e "n! 'or"i- u re$en s"ii@"ions in 2=?

Seeri Q/ Qies QQ/ Roerson C/ ;o-e P/ Auier P? 6or"i- +ro' $u"neous

'e"no'"* ei!en$e +or $onr"sin# ren!s e%een popu"ions? ;r J C"n$er

200082*1887>1?

Cro$ei E/ C"po$"$$i" R/ C"se" C/ e "? Popu"ion,"se! in$i!en$e "n!

'or"i- $"n$er ren!s (18=>17) +ro' &e ne%or9 o+ ."i"n $"n$erre#isries? Eur J C"n$er Pre 20041*287>5?

Coor- 6/ ;""!e P/ Ai9en J/ S'i&ers 6/ 6$Leo! QR/ Rin# .? ren!s +or in

siu "n! in"sie 'e"no'" in Mueens"n!/ Ausr"i"/ 182>2002? C"n$er

C"use Conro 200=17*21>7?

6"rre L:/ N#u-en L/ Ar'sron# ;? ren!s in &e in$i!en$e o+ $u"neous

'"i#n"n 'e"no'" in Ne% Sou& =2?

;""!e P/ Coor- 6? ren!s in 'e"no'" 'or"i- in Ausr"i"* 150>2002 "n!

&eir i'pi$"ions +or 'e"no'" $onro? Aus N J Pui$ e"&

20052*8>=?

Qies QQ/ Ar'sron# ;/ ;uron RC/ S"pes 6P/ &urs+ie! 3J? "s

'or"i- +ro' 'e"no'" soppe! risin# in Ausr"i"T An"-sis o+ ren!s

e%een 11 "n! 14? ;6J 1=12*1121>5?

;uron RC/ Ar'sron# ;? Curren 'e"no'" epi!e'i$* " non'e"s"si@in#

+or' o+ 'e"no'"T ?

Ar'sron# ;/ ri$9er A? o% 'u$& 'e"no'" is $"use! - sun exposureT

6e"no'" Res 1*5>401?

E#"n 6/ Sos'"n JA/ ;o ?

;onio 6/ Ar'sron# ;/ :ore JF? 3"ri"ion in in$i!en$e "n! +""i- o+

'e"no'" - se"son o+ !i"#nosis in Ne% Sou&


27/27

&o'"s NE/ ;er%i$9 6/ Cor!eiro,Sone 6? Cou! ;RAF 'u"ions in

'e"no$-i$ esions "rise +ro' :NA !"'"#e in!u$e! - ur"ioe r"!i"ionT J

.nes :er'"o 200=12=*115>7?

"nei R/ Rosso S/ F"##i"no F/ Ro++ino R/ Coonn" S/ 6"rin" Q? A $"se,

$onro su!- on $u"neous '"i#n"n 'e"no'" in &e proin$e o+ urin/ ."-?

Re Epi!e' e S"ne Pu 188=*0>17?

"nei R/ Fr"n$es$&i S/ Rosso S/ Coonn" S/ ;i!oi E? Cu"neous 'e"no'"

"n! sunurns in $&i!&oo! in " sou&ern Europe"n popu"ion? Eur J C"n$er

1228A*1172>=?

"nei R/ Fr"n$es$&i S/ Rosso S/ ;i!oi E/ Coonn" S? Cu"neous '"i#n"n

'e"no'" in +e'"es* &e roe o+ &or'on" "n! repro!u$ie +"$ors? .n J

Epi!e'io 101*522>=?

Rosso S/ F"##i"no F/ "nei R/ Cos" Q? So$i" $"ss "n! $"n$er suri" in

urin/ ."-? J Epi!e'io Co''un e"& 1751*0>4?

:i$9'"n P=4?

Q"n!ini S/ Ser" F/ C""ru@@" 6S/ e "? 6e","n"-sis o+ ris9 +"$ors +or

$u"neous 'e"no'"* ..? Sun exposure? Eur J C"n$er 200541*45>=0?

Rosso S/ 6in"rro R/ S$&r"u S/ u'ino R/ Fr"n$es$&i S/ "nei R?

Repro!u$iii- o+ s9in $&"r"$erisi$ 'e"sure'ens "n! repore! sun exposure

&isor-? .n J Epi!e'io 20021*4>4=?

!e 3ries E/ ;onio 6/ Seeri Q/ e "? Pui$ "%"reness "ou ris9 +"$ors $ou!

pose proe's +or $"se,$onro su!ies* &e ex"'pe o+ sune! use "n!

$u"neous 'e"no'"? Eur J C"n$er 200541*2150>4?

A@@"reo L6/ J"$osen P;? F"$ors in+uen$in# p"ri$ip"ion in $u"neous

s$reenin# "'on# in!ii!u"s %i& " +"'i- &isor- o+ 'e"no'"? J A' A$"!

:er'"o 20075=*8>40=?

C"ri P/ :e Qior#i 3/ P"i :/ e "? Se+,!ee$e! $u"neous 'e"no'"s in

."i"n p"iens? Cin Exp :er'"o 20042*5>=?

Or!one@,6or"n P/ L"rri" 6J/ Pen!"s,Fr"n$o N/ Auier" O/ Qon@"es,

S"n$&o J6/ 6uno@ A? 3i"'in : "n! $"n$er* "n up!"e o+ in iro "n! in io

!""? Fron ;ios$i 200510*272>4?

Li' S/ Ro-$&ou!&uri R/ Peo J/ S$&%"r@ Q/ ;""!e P/ 6Ver ? C"n$er

suri" is !epen!en on se"son o+ !i"#nosis "n! suni#& exposure? .n J

C"n$er 200=11*150>=?

ri$9er A/ Ar'sron# ;? :oes suni#& &"e " ene+i$i" in+uen$e on $er"in

$"n$ersT Pro# ;iop&-s 6o ;io 200=2*12>?

Pur!ue 6P/ Fro' L/ Ar'sron# ;/ e "? Eioo#i$ "n! o&er +"$ors

pre!i$in# neus,"sso$i"e! $u"neous '"i#n"n 'e"no'"? C"n$er Epi!e'io

;io'"r9ers Pre 200514*2015>22?

Sun Exposure Prior to Diagnosis is Associated With Improved

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