Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.672
Filtrar
1.
Adv Exp Med Biol ; 1268: 19-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32918212

RESUMO

Vitamin D is the sunshine vitamin for good reason. During exposure to sunlight, the ultraviolet B photons enter the skin and photolyze 7-dehydrocholesterol to previtamin D3 which in turn is isomerized by the body's temperature to vitamin D3. Most humans have depended on sun for their vitamin D requirement. Skin pigment, sunscreen use, aging, time of day, season, and latitude dramatically affect previtamin D3 synthesis. Vitamin D deficiency was thought to have been conquered, but it is now recognized that more than 50% of the world's population is at risk for vitamin D deficiency. This deficiency is in part due to the inadequate fortification of foods with vitamin D and the misconception that a healthy diet contains an adequate amount of vitamin D. Vitamin D deficiency causes growth retardation and rickets in children and will precipitate and exacerbate osteopenia, osteoporosis and increase risk of fracture in adults. The vitamin D deficiency pandemic has other serious consequences including increased risk of common cancers, autoimmune diseases, infectious diseases, and cardiovascular disease. There needs to be a renewed appreciation of the beneficial effect of moderate sensible sunlight for providing all humans with their vitamin D requirement for health.


Assuntos
Saúde , Neoplasias Cutâneas , Luz Solar , Raios Ultravioleta , Vitamina D , Humanos , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/prevenção & controle , Medição de Risco , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Deficiência de Vitamina D/epidemiologia
2.
Adv Exp Med Biol ; 1268: 143-154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32918217

RESUMO

Solar UV exposure is critical and complex in the etiology and prognosis of skin cancer, particularly cutaneous malignant melanoma. Sun exposure and one of its "derivatives," vitamin D, have been implicated in protection against mortality from melanoma. However, the relationships are inconsistent. At this time, it is not possible to make clear recommendations for or against sun exposure in relationship to melanoma prognosis. However, this relationship deserves continued exploration.


Assuntos
Neoplasias Cutâneas/mortalidade , Raios Ultravioleta , Humanos , Melanoma/etiologia , Melanoma/mortalidade , Melanoma/prevenção & controle , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/mortalidade , Neoplasias Induzidas por Radiação/prevenção & controle , Prognóstico , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Raios Ultravioleta/efeitos adversos , Vitamina D
3.
Adv Exp Med Biol ; 1268: 257-283, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32918223

RESUMO

Nonmelanoma skin cancers including basal and squamous cell carcinomas (SCC and BCC) represent a significant clinical problem due to their relatively high incidence, imposing an economic burden to healthcare systems around the world. It is accepted that ultraviolet radiation (UVR: λ = 290-400 nm) plays a crucial role in the initiation and promotion of BCC and SCC with UVB (λ = 290-320 nm) having a central role in this process. On the other hand, UVB is required for vitamin D3 (D3) production in the skin, which supplies >90% of the body's requirement for this prohormone. Prolonged exposure to UVB can also generate tachysterol and lumisterol. Vitamin D3 itself and its canonical (1,25(OH)2D3) and noncanonical (CYP11A1-intitated) D3 hydroxyderivatives show photoprotective functions in the skin. These include regulation of keratinocyte proliferation and differentiation, induction of anti-oxidative responses, inhibition of DNA damage and induction of DNA repair mechanisms, and anti-inflammatory activities. Studies in animals have demonstrated that D3 hydroxyderivatives can attenuate UVB or chemically induced epidermal cancerogenesis and inhibit growth of SCC and BCC. Genomic and non-genomic mechanisms of action have been suggested. In addition, vitamin D3 itself inhibits hedgehog signaling pathways which have been implicated in many cancers. Silencing of the vitamin D receptor leads to increased propensity to develop UVB or chemically induced epidermal cancers. Other targets for vitamin D compounds include 1,25D3-MARRS, retinoic orphan receptors α and γ, aryl hydrocarbon receptor, and Wnt signaling. Most recently, photoprotective effects of lumisterol hydroxyderivatives have been identified. Clinical trials demonstrated a beneficial role of vitamin D compounds in the treatment of actinic keratosis. In summary, recent advances in vitamin D biology and pharmacology open new exciting opportunities in chemoprevention and treatment of skin cancers.


Assuntos
Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Vitamina D/química , Animais , Progressão da Doença , Humanos , Receptores de Calcitriol/metabolismo , Pele/efeitos dos fármacos , Pele/metabolismo , Pele/efeitos da radiação , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia , Raios Ultravioleta/efeitos adversos , Vitamina D/metabolismo , Vitamina D/farmacologia , Vitaminas/química , Vitaminas/metabolismo , Vitaminas/farmacologia
4.
Adv Exp Med Biol ; 1268: 355-379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32918228

RESUMO

Incidence rates of nonmelanoma skin cancer and melanoma have been on the rise in the USA for the past 25 years. UV radiation (UVR) exposure remains the most preventable environmental risk factor for these cancers. Aside from sun avoidance, sunscreens continue to provide the best alternative protection. UVR directly damages DNA and causes indirect cellular damage through the creation of reactive oxygen species, the sum of which leads to cutaneous immunosuppression and a tumorigenic milieu. The current generation of sunscreens protect from UVR through two main mechanisms: absorption and deflection. In the USA, the Food and Drug Association (FDA) regulates sunscreen products which are considered over-the-counter drugs. With the release of new FDA testing and labeling requirements in 2011 and the enactment of the Sunscreen Innovation Act in 2014, sunscreen manufacturers are now required to evaluate their products not only on the sun protection factor (SPF) but also on broad-spectrum UVA protection. The American Academy of Dermatology Association and the American Academy of Pediatrics have provided specific recommendations for proper sun protection and sunscreen usage with the continual goal of increasing public awareness and compliance with appropriate sun protective measures. Antioxidants, photolyases, and plant polyphenols remain an interesting avenue of research as additives to sunscreens or stand-alone topical or oral products that appear to modulate the immunosuppressive effects of UVR on the skin. Additionally, although UVR induces endogenous cutaneous production of vitamin D, its damaging effects overshadow this positive benefit, especially in light of the ease of achieving recommended amounts of vitamin D through diet and supplementation.


Assuntos
Protetores Solares/normas , Humanos , Incidência , Melanoma/epidemiologia , Melanoma/prevenção & controle , Medição de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/química , Raios Ultravioleta/efeitos adversos , Estados Unidos/epidemiologia , Vitamina D/administração & dosagem
5.
Hautarzt ; 71(10): 772-785, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32915242

RESUMO

The sun is of great importance for human health. One important reason for this is the production of vitamin D, endorphins and many other hormones by the skin due to stimulation by sunlight. Insufficient access to sunlight increases the risk for vitamin D deficiency, a pandemic which would affect more than one billion people worldwide and under which ca. 60% of the population in Germany would suffer. The skin has a unique position in vitamin D metabolism as elementary steps for vitamin D production take place here and it is furthermore a target organ for actions of vitamin D. Due to the many positive effects of the sun, a healthy balance must be found between UV protection to shield against skin cancer but also ensuring sufficient vitamin D production. For regulation of this fragile balance between photoprotection and vitamin D production, which has accompanied mankind throughout evolution, sunscreens are an integral part of the modern lifestyle, although critical reports on possible risks for their use have recently become more frequent. This article discusses the current state of knowledge on the importance of vitamin D metabolism in human skin and the use of sun creams.


Assuntos
Neoplasias Cutâneas/prevenção & controle , Luz Solar/efeitos adversos , Raios Ultravioleta/efeitos adversos , Vitamina D/uso terapêutico , Alemanha , Humanos , Protetores Solares , Terapia Ultravioleta , Deficiência de Vitamina D
6.
Environ Health Prev Med ; 25(1): 35, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738889

RESUMO

BACKGROUND: Raising awareness and educating people regarding practices for skin cancer or melanoma prevention are critical in the context of the adversely increasing effects of global climate change. This study aimed to explore the knowledge, attitudes, and practices regarding skin cancer prevention and to determine the associated factors to knowledge, attitudes, and practices among dermatological patients in Vietnam. METHODS: This cross-sectional study included 590 dermatological patients between 18 and 82 years of age, who received an examination or treatment from the National Hospital of Dermatology in Hanoi, Vietnam, from September to December 2018. The respondents' attitudes on skin cancer and cancer prevention were assessed via face-to-face interviews with a structured questionnaire conducted by trained interviewers. RESULTS: Of the 590 respondents, the majority of people had correct responses to the question regarding skin cancer knowledge. Among the total participants, 39.8% thought that they were at risk of skin cancer, and 13.8% believed their occupation increased their skin cancer risk. The majority of respondents used hats (94.9%) and sunscreen skin coats (89.5%) and went into the shade (86.3%) when exposed to the sun. Women were less likely to be aware of their skin cancer risk but were more likely to practice prevention behaviors. CONCLUSION: Our results show that dermatological patients have acceptable knowledge towards skin cancer prevention, but still need to change their behavior to prevent the risk of skin cancer. This study highlights the importance of education to raise awareness regarding skin cancer in order to promote practice prevention strategies for skin cancer in Vietnam.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cidades , Estudos Transversais , Feminino , Humanos , Masculino , Melanoma/prevenção & controle , Melanoma/psicologia , Pessoa de Meia-Idade , Dermatopatias/etiologia , Vietnã , Adulto Jovem
7.
Environ Health Prev Med ; 25(1): 39, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778053

RESUMO

BACKGROUND: The incidence of melanoma increased rapidly throughout the last decades, with overexposure to ultraviolet (UV) radiation being an established risk factor. Due to their intensive sun exposure, many student athletes (SAs) have an increased risk for skin cancer. The Clever in Sun and Shade Program (CSSP) aims at enforcing positive attitudes toward UV protection (UVP) and at supporting sports schools in establishing UVP strategies. METHODS: CSSP was developed in 2019 using participatory program planning (PPP) as well as following WHO recommendations for UVP at schools. After drafting first material, within a PPP groups were conducted at a partner school (convenience sample 1) with students (n = 20), teachers (n = 5), school administration (n = 2), and coaches (n = 5). Materials were then adapted. Program acceptance and feasibility were tested at two further schools (convenience sample 2) with PPP groups of students (n = 95) and school administration (n = 2). Content analyses and descriptive statistics were conducted. RESULTS: Less than 50% of SAs and coaches of sample 1 expressed positive attitudes toward UVP, less than 10% reported appropriate UVP behavior. By using PPP, program material was adapted to the target groups' needs, i.e., by including specific barriers and solutions. Only the most accepted video drafts were produced. The majority of SAs of sample 2 (80-86%) used predominantly positive adjectives such as "important" and "positive" to describe the completed videos and the behavior self-check poster. CONCLUSIONS: PPP process has greatly influenced concept and materials of CSSP for sports schools. Integration of future program participants has proven to be an important component in creating a fitting and feasible program. CSSP for sports schools is a program free of charge that enables sports schools to integrate UVP into their daily routine. It will be disseminated in cooperation with German Olympic Sports Confederation and German Cancer Aid in 2021.


Assuntos
Atletas , Melanoma/prevenção & controle , Desenvolvimento de Programas , Neoplasias Cutâneas/prevenção & controle , Raios Ultravioleta , Adolescente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Instituições Acadêmicas , Esportes
9.
Hautarzt ; 71(8): 572-579, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32494842

RESUMO

BACKGROUND: Ultraviolet radiation (UV)-induced malignancies, especially skin cancer, have continued to increase for decades. The main cause is natural and artificial UV radiation. The affected persons and the health care system are heavily burdened. The situation threatens to worsen, as climate change could lead to an increase in UV radiation exposure of the population and, thus, the risk of UV-related cancer in Germany as well. The prevention of UV-related diseases is, therefore, a health and radiation protection objective that needs to be considered. OBJECTIVE: Necessary and appropriate prevention measures for the precaution of UV-related cancer are presented. MATERIALS AND METHODS: The currently recommended and applied primary behavioral and structural preventive measures and potential, prevention-related relief for the health care system are examined and summarized. RESULTS: Numerous behavioral and structural preventive measures are already being applied. Sustainably designed, multicomponent and personalized behavioral preventive measures in combination with structural prevention modules are effective and have a high economic and health-related benefit. The use of modern media and multimedia measures is recommended. CONCLUSION: Structural prevention measures in addition to behavioral measures enable a reduction of the cancer risk caused by UV radiation. The aim must be to establish these measures nationwide for the entire population.


Assuntos
Melanoma/prevenção & controle , Proteção Radiológica , Neoplasias Cutâneas/prevenção & controle , Raios Ultravioleta/efeitos adversos , Exposição Ambiental/prevenção & controle , Alemanha , Promoção da Saúde , Humanos , Luz Solar/efeitos adversos , Protetores Solares/uso terapêutico
10.
Value Health ; 23(6): 775-781, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540236

RESUMO

OBJECTIVES: The usefulness of discrete choice experiments (DCEs) to inform clinical guidelines rests on the assumption that patients facing the same treatment choice at different points in time will express the same preferences. This study provides the first investigation, to our knowledge, to specifically focus on the stability of patients' treatment preferences over the course of a clinical trial. METHODS: The same DCE was completed by participants at baseline and final post-treatment assessment in a trial of the efficacy of alternative topical treatments for actinic keratosis as a means for the prevention of skin cancer. The study assesses both the consistency of stated treatment choices and the stability of population-level preference parameter estimates and analyzes how the former is influenced by design aspects of the DCE. RESULTS: No evidence was found of population-level preference parameter instability over the course of the trial despite only a moderate strength of choice consistency. Choice consistency is negatively related to task difficulty with weak evidence of the existence of ordering effects over the sequence of choice tasks. CONCLUSIONS: The results provide no evidence that the timing of a DCE within a clinical trial significantly influences population-level treatment preference estimates.


Assuntos
Comportamento de Escolha , Ceratose Actínica/tratamento farmacológico , Preferência do Paciente , Neoplasias Cutâneas/prevenção & controle , Administração Cutânea , Tomada de Decisões , Feminino , Humanos , Ceratose Actínica/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/etiologia , Fatores de Tempo
11.
Med Lav ; 111(2): 116-125, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32352425

RESUMO

BACKGROUND: Despite the relevant frequency of ultraviolet induced adverse health effects in workers, solar ultraviolet radiation (UVR) exposure is an occupational risk not adequately minimized in Italy. OBJECTIVE: To assess the characteristics and prevalence of sun exposure habits and behaviors in a group of students and outdoor workers (OW) from the agricultural and construction sectors of a north-Italian region. METHODS: Based on a previously developed standardized questionnaire, we collected full information on individual sun exposure habits at work and during leisure activities. RESULTS: In 2018, 380 high school students and OW from the agricultural and construction sectors participated in a sun-safety campaign. More than a third (39.0%) of OW reported never using sunglasses, 52.8% never applied sunscreens at work, and a quarter never wear a UV protective hat. Considering leisure-time, students reported more frequent sunburns compared to OW: 25.0% vs. 13.8%; half (51.6%) of students and a third (36.4%) of OW reported never wearing a UV protective hat. A third (30.1%) of students and 37.2% of OW never or only seldom applied sunscreens on holidays. DISCUSSION: The majority of OW in our study reported poor protective solar exposure habits. Young students of the construction and agricultural sectors indicated even worse sun-protective behaviors, both during apprenticeship and leisure activities. Our study highlights the low health literacy related to solar UVR in OW and apprentices. Further educational initiatives are required in Italy to improve the adoption of protective behaviors during outdoor activities.


Assuntos
Indústria da Construção , Fazendeiros , Exposição Ocupacional , Neoplasias Cutâneas , Hábitos , Comportamentos Relacionados com a Saúde , Humanos , Itália , Neoplasias Cutâneas/prevenção & controle , Estudantes , Luz Solar , Raios Ultravioleta
12.
PLoS One ; 15(5): e0233220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428021

RESUMO

BACKGROUND: Excessive exposure to ultraviolet radiation increases the risk of skin cancer and other conditions. SMS text reminders may be a useful tool to improve sun protection habits due to its massive reach, low cost, and accessibility. OBJECTIVE: To perform a systematic review of randomized controlled trials (RCTs) that evaluated the effects of SMS text reminders in promoting sun protection habits. METHODS: We performed a systematic search in PubMed, Central Cochrane Library, and Scopus; following the PRISMA recommendations to perform systematic reviews. We included RCTs published up to December 2018, which evaluated the benefits and harms of SMS text reminders to improve sun protection habits. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed for RCTs estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42018091661). RESULTS: Five RCTs were included in this review. When pooled, the studies found no effect of SMS text reminders in "sunburn anytime during follow-up" (two studies, risk ratio: 0.93; 95% confidence interval: 0.83-1.05). Contradictory results were obtained for sunscreen use (three RCTs) and sun protection habits (two RCTs), however, they could not be meta-analyzed because outcomes were measured differently across studies. The certainty of the evidence was very low for these three outcomes according to GRADE methodology. CONCLUSIONS: RCTs that assessed effects of SMS text reminders did not find a significant benefit on objective outcomes, such as having a sunburn, sunscreen use and composite score of sun protection habits. Since certainty of the evidence was very low, future high-quality studies are needed to reach a conclusion regarding the balance of desirable and undesirable outcomes. PROTOCOL REGISTRATION NUMBER: PROSPERO (CRD42018091661).


Assuntos
Sistemas de Alerta/tendências , Queimadura Solar/prevenção & controle , Envio de Mensagens de Texto/tendências , Telefone Celular/tendências , Hábitos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/farmacologia , Raios Ultravioleta/efeitos adversos
13.
Rev Med Suisse ; 16(688): 646-650, 2020 Apr 01.
Artigo em Francês | MEDLINE | ID: mdl-32239839

RESUMO

Actinic keratoses are the most frequent precancerous lesions on Caucasian skin, often giving rise to squamous cell carcinomas. Appropriate prophylaxis, screening, and early intervention can substantially reduce the incidence of the latter. While isolated actinic keratoses can easily be treated by means of cryotherapy or curettage, multiple lesions often occurring on chronically sun-damaged skin demand more potent therapeutic strategies, such as topical cytostatic or immunomodulatory drugs, or photodynamic therapy. In this review, we give a practice-oriented overview on clinical manifestations, prevention, and treatment of actinic keratoses, and we emphasise the role of general practitioners in the management of this important pathology.


Assuntos
Ceratose Actínica/terapia , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Fotoquimioterapia , Neoplasias Cutâneas/prevenção & controle
14.
Hautarzt ; 71(5): 365-373, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32157344

RESUMO

BACKGROUND: Skin cancer is the most common malignancy of the fair-skinned population worldwide. To reduce skin cancer's burden primary and secondary prevention are critical. However, various studies indicate an inadequate prevention behavior among rural populations. OBJECTIVE: To examine the risk and prevention behavior with respect to skin cancer and to identify subgroups in rural areas with specific need for prevention efforts. MATERIALS AND METHODS: In a cross-sectional study carried out in the first quarter of 2017, patients and their accompanying persons (≥18 years) were interviewed on the subject of primary and secondary prevention in waiting rooms of nondermatological medical practices in the Bavarian Forest, Germany. Data were collected using paper-based questionnaires. Associations were calculated using logistic regression models. RESULTS: In all, 880 persons (57.7% women, mean age = 49.5 years) were included in the analysis, of whom 53.6% had undergone a skin cancer screening at least once before. Sunscreen was the most frequently used sun protection measure. Male sex and being 18-34 years of age were significantly associated with not using prevention measures (depending on the measure: odds ratio [OR]: 1.4-2.4 and 1.8-3.7, respectively). In addition, not using skin cancer screening was associated with UV exposure more than 6 h daily in summer (OR: 1.8, 95%-CI [confidence interval]: 1.14-2.97). CONCLUSION: Future prevention strategies should increasingly focus on young adults, on men and people with high solar UV exposition particularly, to reduce the burden of skin cancer in rural areas.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Prevenção Secundária , Neoplasias Cutâneas/prevenção & controle , Protetores Solares/administração & dosagem , Raios Ultravioleta/efeitos adversos , Adolescente , Adulto , Estudos Transversais , Feminino , Florestas , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Inquéritos e Questionários , Adulto Jovem
15.
Hautarzt ; 71(6): 455-462, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32206841

RESUMO

BACKGROUND: The disease burden of actinic keratoses and keratinocyte carcinoma can be reduced by primary and secondary prevention. However, these measures are often poorly received, especially among the high-risk group of outdoor workers. OBJECTIVES: The aim of this follow-up study was to investigate whether an improvement in sun protection and awareness of skin changes could be observed among the study population, especially outdoor workers, one year after a prevention campaign focusing on this topic. MATERIALS AND METHODS: In 2017, all participants who initially participated in a study at the Bavarian Central Agricultural Festival 2016 and agreed to participate in the follow-up study were contacted by mail and received the same questionnaire and evaluation questions regarding possible behavioral changes. RESULTS: A total of 400 people took part in the follow-up study (response rate 52.8%). Of the 240 outdoor workers, 45.0% said they were more conscious of protecting themselves from the sun and 68.8% said they were more aware of skin changes. About 85.0% of outdoor workers indicated that they would consult a dermatologist earlier and 65.8% desired further prevention campaigns regarding skin cancer and sun protection. CONCLUSION: Overall, the majority of participants reported that they had improved sun protection behavior and awareness of skin changes after the intervention. Based on the participants' self-disclosure, especially outdoor workers tended to use sun protection measure more frequently. These findings underline the importance of target group-oriented awareness and prevention campaigns to reduce the burden of skin cancer.


Assuntos
Carcinoma de Células Escamosas/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Queratinócitos , Ceratose Actínica/prevenção & controle , Roupa de Proteção , Neoplasias Cutâneas/prevenção & controle , Humanos , Inquéritos e Questionários
16.
Aust N Z J Public Health ; 44(2): 111-115, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32190955

RESUMO

INTRODUCTION: A Melanoma Screening Summit was held in Brisbane, Australia, to review evidence regarding current approaches for early detection of melanomas and explore new opportunities. RESULTS: Formal population-based melanoma screening is not carried out in Australia, but there is evidence of considerable opportunistic screening as well as early detection. Biopsy rates are rising and most melanomas are now diagnosed when in situ. Based on evidence review and expert opinion, the Summit attendees concluded that there is currently insufficient information in terms of comparative benefits, harms and costs to support change from opportunistic to systematic screening. Assessment of gains in precision and cost-effectiveness of integrating total body imaging, artificial intelligence algorithms and genetic risk information is required, as well as better understanding of clinical and molecular features of thin fatal melanomas. CONCLUSIONS: Research is needed to understand how to further optimise early detection of melanoma in Australia. Integrating risk-based population stratification and more precise diagnostic tests is likely to improve the balance of benefits and harms of opportunistic screening, pending assessment of cost-effectiveness. Implications for public health: The Summit Group identified that the personal and financial costs to the community of detecting and treating melanoma are rising, and this may be mitigated by developing and implementing a more systematic process for diagnosing melanoma.


Assuntos
Detecção Precoce de Câncer , Programas de Rastreamento/métodos , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Austrália , Consenso , Detecção Precoce de Câncer/métodos , Política de Saúde , Humanos , Melanoma/prevenção & controle , Prática de Saúde Pública , Neoplasias Cutâneas/prevenção & controle
17.
Cochrane Database Syst Rev ; 3: CD005004, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32118296

RESUMO

BACKGROUND: This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (2009, Issue 3).Tea is one of the most commonly consumed beverages worldwide. Teas from the plant Camellia sinensis can be grouped into green, black and oolong tea, and drinking habits vary cross-culturally. C sinensis contains polyphenols, one subgroup being catechins. Catechins are powerful antioxidants, and laboratory studies have suggested that these compounds may inhibit cancer cell proliferation. Some experimental and nonexperimental epidemiological studies have suggested that green tea may have cancer-preventative effects. OBJECTIVES: To assess possible associations between green tea consumption and the risk of cancer incidence and mortality as primary outcomes, and safety data and quality of life as secondary outcomes. SEARCH METHODS: We searched eligible studies up to January 2019 in CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and reference lists of previous reviews and included studies. SELECTION CRITERIA: We included all epidemiological studies, experimental (i.e. randomised controlled trials (RCTs)) and nonexperimental (non-randomised studies, i.e. observational studies with both cohort and case-control design) that investigated the association of green tea consumption with cancer risk or quality of life, or both. DATA COLLECTION AND ANALYSIS: Two or more review authors independently applied the study criteria, extracted data and assessed methodological quality of studies. We summarised the results according to diagnosis of cancer type. MAIN RESULTS: In this review update, we included in total 142 completed studies (11 experimental and 131 nonexperimental) and two ongoing studies. This is an additional 10 experimental and 85 nonexperimental studies from those included in the previous version of the review. Eleven experimental studies allocated a total of 1795 participants to either green tea extract or placebo, all demonstrating an overall high methodological quality based on 'Risk of bias' assessment. For incident prostate cancer, the summary risk ratio (RR) in the green tea-supplemented participants was 0.50 (95% confidence interval (CI) 0.18 to 1.36), based on three studies and involving 201 participants (low-certainty evidence). The summary RR for gynaecological cancer was 1.50 (95% CI 0.41 to 5.48; 2 studies, 1157 participants; low-certainty evidence). No evidence of effect of non-melanoma skin cancer emerged (summary RR 1.00, 95% CI 0.06 to 15.92; 1 study, 1075 participants; low-certainty evidence). In addition, adverse effects of green tea extract intake were reported, including gastrointestinal disorders, elevation of liver enzymes, and, more rarely, insomnia, raised blood pressure and skin/subcutaneous reactions. Consumption of green tea extracts induced a slight improvement in quality of life, compared with placebo, based on three experimental studies. In nonexperimental studies, we included over 1,100,000 participants from 46 cohort studies and 85 case-control studies, which were on average of intermediate to high methodological quality based on Newcastle-Ottawa Scale 'Risk of bias' assessment. When comparing the highest intake of green tea with the lowest, we found a lower overall cancer incidence (summary RR 0.83, 95% CI 0.65 to 1.07), based on three studies, involving 52,479 participants (low-certainty evidence). Conversely, we found no association between green tea consumption and cancer-related mortality (summary RR 0.99, 95% CI 0.91 to 1.07), based on eight studies and 504,366 participants (low-certainty evidence). For most of the site-specific cancers we observed a decreased RR in the highest category of green tea consumption compared with the lowest one. After stratifying the analysis according to study design, we found strongly conflicting results for some cancer sites: oesophageal, prostate and urinary tract cancer, and leukaemia showed an increased RR in cohort studies and a decreased RR or no difference in case-control studies. AUTHORS' CONCLUSIONS: Overall, findings from experimental and nonexperimental epidemiological studies yielded inconsistent results, thus providing limited evidence for the beneficial effect of green tea consumption on the overall risk of cancer or on specific cancer sites. Some evidence of a beneficial effect of green tea at some cancer sites emerged from the RCTs and from case-control studies, but their methodological limitations, such as the low number and size of the studies, and the inconsistencies with the results of cohort studies, limit the interpretability of the RR estimates. The studies also indicated the occurrence of several side effects associated with high intakes of green tea. In addition, the majority of included studies were carried out in Asian populations characterised by a high intake of green tea, thus limiting the generalisability of the findings to other populations. Well conducted and adequately powered RCTs would be needed to draw conclusions on the possible beneficial effects of green tea consumption on cancer risk.


Assuntos
Camellia sinensis , Neoplasias/prevenção & controle , Fitoterapia/métodos , Extratos Vegetais/uso terapêutico , Chá , Neoplasias da Mama/prevenção & controle , Camellia sinensis/química , Estudos de Casos e Controles , Feminino , Flavonoides/farmacologia , Neoplasias Gastrointestinais/epidemiologia , Neoplasias Gastrointestinais/prevenção & controle , Humanos , Incidência , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/prevenção & controle , Masculino , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/prevenção & controle , Neoplasias/epidemiologia , Neoplasias/mortalidade , Fenóis/farmacologia , Extratos Vegetais/efeitos adversos , Polifenóis , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/prevenção & controle , Chá/efeitos adversos , Neoplasias Urogenitais/epidemiologia , Neoplasias Urogenitais/prevenção & controle
18.
Eur J Cancer ; 128: 60-82, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113941

RESUMO

Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography-computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Consenso , Dermatologia/normas , Oncologia/normas , Neoplasias Cutâneas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Humanos , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Estadiamento de Neoplasias/normas , Educação de Pacientes como Assunto/normas , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Roupa de Proteção/normas , Medição de Risco/normas , Pele/diagnóstico por imagem , Pele/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/prevenção & controle , Sociedades Médicas/normas , Luz Solar/efeitos adversos , Protetores Solares/administração & dosagem , Ultrassonografia/normas
19.
BMC Public Health ; 20(1): 131, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000743

RESUMO

BACKGROUND: People increase their risk of melanoma unless they are protected from the harmful effects of sun exposure during childhood and adolescence. We aimed to assess the feasibility of a three-component sun protection intervention- presentation, action planning, and SMS messages - and trial parameters. METHODS: This feasibility wait-list trial was conducted in the United Kingdom in 2018. Students aged 13-15 years were eligible. Feasibility outcomes were collected for recruitment rates; data availability rates for objective measurements of melanin and erythema using a Mexameter and self-reported sunburn occurrences, severity and body location, tanning, sun protection behaviours and Skin Self-Examination (SSE) collected before (baseline) and after the school summer holidays (follow-up); intervention reach, adherence, perceived impact and acceptability. Quantitative data were analysed using descriptive statistics; qualitative data were analysed thematically. RESULTS: Five out of eight schools expressing an interest in participating with four allocated to act as intervention and one control. Four parents/carers opted their child out of the study. Four hundred and eighty-seven out of 724 students on the school register consented to the study at baseline (67%). Three hundred and eighty-five were in intervention group schools. Objective skin measurements were available for 255 (66%) of the intervention group at baseline and 237 (61%) of the group at follow up. Melanin increased; erythema decreased. Complete self-report data were available for 247 (64%) students in the intervention group. The number of students on the school register who attended the presentation and given the booklet was 379 (98%) and gave their mobile phone number was 155 (40%). No intervention component was perceived as more impactful on sun protection behaviours. Adolescents did not see the relevance of sun protection in the UK or for their age group. CONCLUSIONS: This is the first study to use a Mexameter to measure skin colour in adolescents. Erythema (visible redness) lasts no more than three days and its measurement before and after a six week summer holiday may not yield relevant or meaningful data. A major challenge is that adolescents do not see the relevance of sun protection and SSE. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ISRCTN11141528. Date registered 0/2/03/2018; last edited 31/05/2018. Retrospectively registered.


Assuntos
Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Melanoma/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Luz Solar/efeitos adversos , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Intenção , Masculino , Melanoma/epidemiologia , Medição de Risco , Autorrelato , Autoexame/psicologia , Autoexame/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Banho de Sol/psicologia , Banho de Sol/estatística & dados numéricos , Queimadura Solar/epidemiologia , Queimadura Solar/prevenção & controle , Envio de Mensagens de Texto , Reino Unido/epidemiologia , Listas de Espera
20.
Cancer Control ; 27(4): 1073274819894008, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32107931

RESUMO

Our purpose was to examine the beliefs of college students about UV exposure and sunscreen use and their associations with skin cancer risk and protective behaviors in a cloudy climate. The sample was online survey participants (N = 334) recruited from a large university in Oregon. After fitting an initial measurement model, we fit a structural equation model including Health Beliefs About UV (HBAU) subscales (Health Benefits of Tanning, Seasonal Effects, Tanning Through the Winter, and Sunscreen Toxicity), outcome variables (sunscreen use, indoor tanning, and outdoor tanning), and covariates (eg, tanning and sunscreen use). A minority of participants held the beliefs represented by 3 HBAU subscales, but beliefs about negative health effects of the local weather (Tanning Through the Winter) were common. The measurement and adjusted models provided good fit to the data (χ2 = 143.30; P = .29; df = 136; Root-Mean Square Error of Approximation = .014; Comparative Fit Index = .992; Tucker-Lewis Index = .981). After adjusting for covariates, Sunscreen Toxicity predicted reduced sunscreen use (ß = -.12, P = .021), Health Benefits of Tanning predicted outdoor tanning (ß = .43, P < .001), and Tanning Through the Winter predicted indoor tanning (ß = .31, P = .02). The small sample size, nonresponse rate, and cross-sectional nature of this study mean these findings should be interpreted cautiously. Beliefs about health benefits of sun exposure, the regional weather, and sunscreen safety play a role in skin cancer risk and protective behaviors.


Assuntos
Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Neoplasias Cutâneas/psicologia , Protetores Solares/administração & dosagem , Raios Ultravioleta/efeitos adversos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA