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.
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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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    • "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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