Non-Melanoma Skin Cancers

Indoor tanning has also been associated with non-melanoma skin cancers. A meta-analysis of 12 studies that included 80,661 participants found that ever use of indoor tanning was significantly associated with both squamous cell carcinoma (SCC; SRR, 1.67; 95% CI, 1.29-2.17) and basal cell carcinoma (BCC; SRR, 1.29; 95% CI, 1.08-1.53) compared with never users.11 The risk for BCC was highest among individuals who began indoor tanning before age 25 (SRR, 1.40; 95% CI, 1.29-1.52), but was not significant for SCC (SRR, 2.02; 95% CI, 0.70-5.86).


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Since the meta-analysis, an analysis of 106,548 women from the Norwegian-Swedish Women’s Lifestyle and Health Cohort study with a mean follow-up of 17.9 years demonstrated a significant increase in SCC with ever use of indoor tanning between ages 10 to 49 compared with never use (SRR, 1.93; 95% CI, 1.27-2.95).12 Similarly, a population-based case-control study conducted in the United States demonstrated that indoor tanning was associated with early-onset BCC (OR, 1.6; 95% CI, 1.3-2.1), with a stronger association among individuals exposed as an adolescent or young adult.13 For each year of younger age at first exposure, the risk of BCC increased by 10% (OR per year of age ≤ 23, 1.1; 95% CI, 1.0-1.2).

Other Cancers

An analysis of 73,358 women from the Nurses’ Health Study II with a follow-up of 20 years found no association between indoor tanning and the risk of total cancer (hazard ratio [HR], 0.99; 95% CI, 0.95-1.04); or with internal cancers such as those of the breast, thyroid, and endometrium; or colorectal cancer and non-Hodgkin lymphoma (NHL).14 A case-control study in California, however, found an association with indoor tanning and cutaneous NHL, albeit with a very small sample size.15 In this study, indoor tanning was not associated with an increased risk of B-cell NHLs overall, but there was a nonsignificant increase in the risk of cutaneous NHL with indoor tanning use (OR, 1.77; 95% CI, 0.17-18.24). A sunburn with indoor tanning significantly increased the risk of cutaneous NHL (OR, 15.75; 95% CI, 2.56-96.87).

Conclusions

All meta-analyses conducted to date show a significant association between indoor tanning use and an increased risk of melanoma or non-melanoma skin cancers. The risks appear to be highest for individuals who begin tanning at a younger age. It is important to consider that most studies in this space are considered low quality due to difficulties with adjusting for potential confounders and recall bias. However, the data are generally consistent across studies and are supported by the known mechanism of DNA damage caused by UV exposure. Therefore, the current data suggest that indoor tanning increases the risk of developing melanoma or non-melanoma skin cancers.

References

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  2. Vogel RI, Ahmed RL, Nelson HH, et al. Exposure to indoor tanning without burning and melanoma risk by sunburn history. J Natl Cancer Inst. 2014;106. doi: 10.1093/jnci/dju112
  3. El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens — Part D: Radiation. Lancet Oncol. 2009;10:751-752.
  4. U.S. Food and Drug Administration, HSS. General and plastic surgery devices: Reclassification of ultraviolet lamps for tanning, henceforth to be known as sunlamp products and ultraviolet lamps intended for use in sunlamp products. Final order. Fed Regist. 2014;79:31205-31214.
  5. U.S. Food and Drug Administration. General and plastic surgery devices: Sunlamp products and ultraviolet lamps intended for use in sunlamp products. Fed Regist. 2014;79:31213.
  6. The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. Int J Cancer. 2006;120:1116-1122. doi: 10.1002/ijc.22453
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  10. Ghiasvand R, Rueegg CS, Weiderpass E, et al. Indoor tanning and melanoma risk: Long-term evidence from a prospective population-based cohort study. Am J Epidemiol. 2017;185:147-156. doi: 10.1093/aje/kww148
  11. Wehner MR, Shive ML, Chren M-M et al.. Indoor tanning and non-melanoma skin cancer: Systematic review and meta-analysis. BMJ. 2012;345:e5909. doi: 10.1136/bmj.e5909
  12. Veierød MB, Cuoto E, Lund E et al. Host characteristics, sun exposure, indoor tanning and risk of squamous cell carcinoma of the skin. Int J Cancer. 2014;135:413-422. doi: 10.1002/ijc.28657
  13. Karagas MR, Zens MS, Li Z, et al. Early-onset basal cell carcinoma and indoor tanning: A population-based study. Pediatrics. 2014;134:e4-e12. doi: 10.1542/peds.2013-3559
  14. Zhang M, Song F, Hunter DJ et al. Tanning bed use is not associated with internal cancer risk: Evidence from a large cohort study. Cancer Epidemiol Biomarkers Prev. 2013;22:2425-2429. doi: 10.1158/1055-9965.EPI-13-0906
  15. Wang SS, Luo J, Cozen W, et al. Sun sensitivity, indoor tanning and B-cell non-Hodgkin lymphoma risk among Caucasian women in Los Angeles County. Br J Haematol. 2017;177:153-156. doi: 10.1111/bjh.14051