Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population

Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 06/2010; 19(6):1557-68. DOI: 10.1158/1055-9965.EPI-09-1249
Source: PubMed


Indoor tanning has been only weakly associated with melanoma risk; most reports were unable to adjust for sun exposure, confirm a dose-response, or examine specific tanning devices. A population-based case-control study was conducted to address these limitations.
Cases of invasive cutaneous melanoma, diagnosed in Minnesota between 2004 and 2007 at ages 25 to 59, were ascertained from a statewide cancer registry; age-matched and gender-matched controls were randomly selected from state driver's license lists. Self-administered questionnaires and telephone interviews included information on ever use of indoor tanning, types of device used, initiation age, period of use, dose, duration, and indoor tanning-related burns. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for known melanoma risk factors.
Among 1,167 cases and 1,101 controls, 62.9% of cases and 51.1% of controls had tanned indoors (adjusted OR 1.74; 95% CI, 1.42-2.14). Melanoma risk was pronounced among users of UVB-enhanced (adjusted OR, 2.86; 95% CI, 2.03-4.03) and primarily UVA-emitting devices (adjusted OR, 4.44; 95% CI, 2.45-8.02). Risk increased with use: years (P < 0.006), hours (P < 0.0001), or sessions (P = 0.0002). ORs were elevated within each initiation age category; among indoor tanners, years used was more relevant for melanoma development.
In a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. Elevated risks were observed across devices.
This study overcomes some of the limitations of earlier reports and provides strong support for the recent declaration by the IARC that tanning devices are carcinogenic in humans.

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Available from: Deann Lazovich,
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    • "Approximately 90% of nonmelanoma skin cancers and 65% of melanomas are caused by exposure to ultraviolet (UV) rays (Armstrong & Kricker, 1993). The popularity of getting a tan, particularly the wide interest in this trend among young girls of ages 14–16, the psychological motivation to " look beautiful, " the belief that a tan is a sign of health, as well as the increase in vacation and leisure time activities have all resulted in an increased impact of UV rays on human health (Lazovich et al., 2010). Parallel to these changing trends in the population, skin cancer risks associated with unprotected exposure to long-term or intermittent or intense sunrays and a history of sunburn in childhood have increased (Veierød, Adami, Lund, Armstrong, & Weiderpass, 2010). "
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    ABSTRACT: Background: Sun protection is important for skin cancer prevention, but many adolescents do not protect themselves from the sun. Instrumentation derived from the transtheoretical model (TTM) can be used to study the process of change in health behaviors like sun protection. Objective: The purpose of this study was to translate and adapt TTM-based decisional balance and self-efficacy for sun protection scales from English to Turkish and assess psychometric properties of scores when the scales are used among Turkish adolescents. Methods: The Decisional Balance Scale (DBS) and the Self-Efficacy Scale (SES) for sun protection were adapted to Turkish culture using translation and back-translation. The scales were administered to a total of 900 adolescents in two Turkish schools. Confirmatory factor analysis was used to assess dimensionality. External validity was evaluated by comparing subscale scores across reported stages of change for sun protection. Results: Reliability estimates for scores on the DBS Pros and DBS Cons and the SES Sunscreen Use scales were high and SES Hat Use and Sun Avoidance were moderate. The two-factor correlated model for the DBS and the three-factor correlated model for the SES reported in other studies were confirmed. Means increased across the stages of change for sun protection and sunscreen use for the DBS Pros and the SES subscales as predicted by the TTM, but the pattern of DBS Cons means did not. Discussion: Scores from the Turkish version of the DBS and SES for sun protection were valid, reliable, and appropriate for Turkish culture. The pattern of means for the SES and DBS Pros across the stages of change supported propositions of the TTM. Theoretical inconsistencies in the pattern of DBS Cons scores across the stages of change suggest that greater attention to conceptualization and measurement of the DBS Cons for sun protection and sunscreen use is needed.
    Nursing Research 09/2014; 63(5):309-319. DOI:10.1097/NNR.0000000000000048 · 1.36 Impact Factor
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    • "hours (Po0.001), or sessions (P ¼ 0.001). Odds ratios were elevated within each initiation age category; years of use among indoor tanners was more relevant for melanoma development (Lazovich et al., 2010). More comprehensive analyses and reviews have recently been published that examine the relationship between indoor tanning and non-melanoma skin cancer and melanoma (Boniol et al., 2012; Wehner et al., 2012). "
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    ABSTRACT: Teenage use of indoor tanning has reached epidemic proportions. There is no Federal ban on teen use; rather, it is left to each state to determine policy. We conducted a state-by-state analysis using data from each state's statutes and regulations and supplementary information from the National Conference of State Legislatures. First, we refined an earlier 35-item instrument to now include 56 items that extensively measures age bans, parental involvement, warnings/information, enforcement, and operating requirements. To grade each tanning law, we developed a uniform scoring system with a goal of providing performance data for future comparisons. As of August 2012, 13 states had no tanning facility statute or regulation for minors. In states with some regulations, teen bans are lax -nearly uniformly, most young children under the age of 14 can legally tan with or without suboptimal parental consent or accompaniment laws. Strong Food and Drug Administration involvement alone can simplify and unify the inconsistencies that exist among states' indoor tanning laws. Until consistent regulations are promulgated and enforced, such an instrument can provide a benchmark for state investigations into the deficiencies and progress of their laws, as well as facilitate direct comparison between states for research and educational purposes.Journal of Investigative Dermatology accepted article preview online, 23 August 2013. doi:10.1038/jid.2013.357.
    Journal of Investigative Dermatology 08/2013; 134(3). DOI:10.1038/jid.2013.357 · 7.22 Impact Factor
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    • "Recent studies offer evidence to support two different mechanisms by which early onset of indoor tanning affects melanoma risk. Initiation of the behavior at a young age may increase the cumulative exposure, leading to greater likelihood of melanoma [9] [10]. For a subset of persons genetically predisposed to melanoma, earlier use of indoor tanning may accelerate melanoma development and cause it to occur at a younger age [10]. "
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    ABSTRACT: Indoor tanning usually begins during adolescence, but few strategies exist to discourage adolescent use. We developed and tested a parent-teenager intervention to decrease indoor tanning use. Through focus groups, we identified key messages to enhance parent-teenager communication about indoor tanning, and then developed a pamphlet for parents and postcards for adolescents to use in a direct mail experiment with randomly selected households. Two weeks after the mailing, we asked intervention parents (n = 87) and adolescents (n = 69) and nonintervention parents (n = 31) and adolescents (n = 28) about intervention receipt and content recall, parental concern, monitoring, parent-teenager conversations, and indoor tanning intention. In intervention households, 54% of mothers and 56% of girls recalled receipt and reported reading materials, but few boys and no fathers did. Among mothers, 57% in intervention households indicated concern about daughters' indoor tanning, and 25% would allow daughters to tan indoors, whereas 43% of nonintervention mothers had concerns and 46% would allow indoor tanning. Fewer girls in intervention households than in nonintervention households thought parents would allow indoor tanning (44% vs. 65%), and fewer intended to tan indoors (36% vs. 60%). Most mothers and daughters who read the intervention materials also reported discussions about indoor tanning. Moreover, the less likely girls were to think that their mothers would allow indoor tanning, the less likely it was that they intended to tan indoors, a relationship mediated by perceptions of maternal monitoring. A systematic qualitative and quantitative research approach yielded well-received indoor tanning prevention messages for mothers and female adolescents. Enhancing maternal monitoring has potential to decrease adolescent indoor tanning.
    Journal of Adolescent Health 05/2013; 52(5 Suppl):S76-82. DOI:10.1016/j.jadohealth.2012.08.009 · 3.61 Impact Factor
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