曬太陽怕皮膚癌,不曬太陽又怕骨質疏鬆?醫師帶你看仔細!

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每次看到窗外的陽光,就好想出去戶外走走,希望藉此活動活動筋骨、呼吸新鮮空氣,順便還能增進骨質!然而,是否同時內心又有另一個聲音,顧忌著陽光的致癌風險呢?對於這樣的矛盾,筆者會分成兩個部分討論,一起看下去吧:


【曬太陽與皮膚癌的關係】

過往已經有很充分的科學證據證實,太陽輻射為致癌因子,並且被世界衛生組織(WHO)轄下的國際癌症研究署(IARC),認定為第 1 級致癌因子(詳細解釋請見先前文章【對於癌症我們該早一點作準備】),其中,太陽輻射對應到的癌症主要為皮膚癌。

但,我們應該更深入地去了解太陽輻射的致癌性,以避免因為過度地避開太陽照射,而失去了太陽光對於身體健康的好處。

針對太陽輻射與皮膚癌的劑量關係,在論文《The relationship between UV exposure and incidence of skin cancer》中有很詳細地討論。此論文中探討了三種不同類型的皮膚癌:Squamous Cell Carcinoma (SCC), Basal Cell Carcinoma (BCC), Cutaneous Melanoma (CM),將皮膚上每單位面積的皮膚癌發生率以 Relative Tumor Density (RTD)的方式作量化,並把 UV 光的暴露強度以每平方公尺接收的焦耳數作量化,最後,利用迴歸模型分析 UV 光暴露強度與皮膚癌發生率之間的關係。

由論文中的圖表可看出, UV 光暴露強度與三種皮膚癌發生率的關係,很貼近線性正相關、或指數線性正相關,意即兩者之間有明確的劑量效應:每多暴露一些 UV 光、皮膚癌的發生率便會跟著上升,劑量關係約為: UV 光暴露強度增為 2 倍、三種皮膚癌的發生率則增為 2~4 倍不等。

BUT!!! 若再將探討地深入,便可以知道太陽輻射對於不同人種皮膚癌的致癌性是不同的!在 WHO 官網上提到,皮膚癌的人種相關風險因子包含有:(1)白人 (2)藍、綠、或淡褐色眼睛 (3)淺色頭髮,而這也在美國疾病管制與預防中心提供的數據得到證實,由下圖可見,亞洲人的發生率遠低於白人:

不過,雖然太陽輻射對於亞洲人的皮膚癌致癌性較弱,我們亦須留意 WHO 官網 提到的其他風險因子,如:較容易曬傷的膚質、過往有過重大曬傷、有很多痣或雀斑、有皮膚癌家族病史,如果你具有上述這些風險因子,那麼太陽輻射對你的致癌性又會相對提高。


【曬太陽對於骨骼的影響】

參考論文《Determinants of bone health in adults Polish women: The influence of physical activity, nutrition, sun exposure and biological factors》,其研究團隊很難能可貴地將受試者的生理活動強度、營養狀態、太陽光暴露強度皆進行量化,並且針對前臂的近端及遠端作骨質密度測量,最後將上述數據同時納入模型分析,進而更明確了解骨質密度與這些上述因子的關係。

該論文結果顯示,具有正常的骨骼密度與下列幾項因子有顯著相關
(OR 代表勝算比,有興趣的讀者請再自行翻閱生物統計的書籍)

(1) 針對遠端前臂
– 足夠的鈣質攝取(OR = 5.95)
– “過往”中強度(OR = 1.88)或高強度(OR = 14.0)的生理活動
– “現在”中強度(OR = 4.97)或高強度(OR = 18.9)的生理活動
– “過往”足夠的太陽光照(OR = 5.15)
– “現在”足夠的太陽光照(OR = 10.0)

(2) 針對近端前臂
– 足夠的鈣質攝取(OR = 9.57)及維他命 D 攝取(OR = 2.68)
– “過往”中強度(OR = 4.20)或高強度(OR = 68.4)的生理活動
– “現在”中強度(OR = 6.13)或高強度(OR = 10.0)的生理活動
– “過往”足夠的太陽光照(OR = 10.6)
– “現在”足夠的太陽光照(OR = 9.09)。

由上述的結果,可以發現無論對於前臂的近端或遠端的骨質密度,生理活動強度、太陽光照、鈣質攝取皆為重要的影響因子,其中,高強度生理活動之勝算比明顯較高。因此,若想要擁有正常的骨質密度,便會建議維持高強度戶外活動的習慣、並且於飲食中攝取足夠的鈣質


綜合上述可知,對於亞洲人來說,太陽輻射在皮膚癌方面的致癌性是相對低的,若同時考慮太陽光照對於骨質密度的好處,筆者認為不應該因噎廢食地拼命待在室內,尤其在辦公室工作為主的近代都市生活中,人們普遍缺乏生理活動的強度,因此,筆者鼓勵大家多從事戶外活動或運動,但須避免過度日曬而導致曬傷,並且,應於飲食中攝取足夠的鈣質及維他命 D (多數人是攝取不足的)。

最後,祝福大家都能擁有良好的骨骼健康唷!

〈筆者為前台大主治醫師、台大公衛學院碩士〉

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