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Meta-Analysis
. 2012 Jul 24:345:e4757.
doi: 10.1136/bmj.e4757.

Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis

Mathieu Boniol  1 , Philippe Autier, Peter Boyle, Sara Gandini
Affiliations
Meta-Analysis

Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis

Mathieu Boniol et al. BMJ. .

Abstract

Objective: To estimate the burden of melanoma resulting from sunbed use in western Europe.

Design: Systematic review and meta-analysis.

Data sources: PubMed, ISI Web of Science (Science Citation Index Expanded), Embase, Pascal, Cochrane Library, LILACS, and MedCarib, along with published surveys reporting prevalence of sunbed use at national level in Europe.

Study selection: Observational studies reporting a measure of risk for skin cancer (cutaneous melanoma, squamous cell carcinoma, basal cell carcinoma) associated with ever use of sunbeds.

Results: Based on 27 studies ever use of sunbeds was associated with a summary relative risk of 1.20 (95% confidence interval 1.08 to 1.34). Publication bias was not evident. Restricting the analysis to cohorts and population based studies, the summary relative risk was 1.25 (1.09 to 1.43). Calculations for dose-response showed a 1.8% (95% confidence interval 0% to 3.8%) increase in risk of melanoma for each additional session of sunbed use per year. Based on 13 informative studies, first use of sunbeds before age 35 years was associated with a summary relative risk of 1.87 (1.41 to 2.48), with no indication of heterogeneity between studies. By using prevalence data from surveys and data from GLOBOCAN 2008, in 2008 in the 15 original member countries of the European Community plus three countries that were members of the European Free Trade Association, an estimated 3438 cases of melanoma could be attributable to sunbed use, most (n=2341) occurring among women.

Conclusions: Sunbed use is associated with a significant increase in risk of melanoma. This risk increases with number of sunbed sessions and with initial usage at a young age (<35 years). The cancerous damage associated with sunbed use is substantial and could be avoided by strict regulations.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of studies on sunbed use and risk of cutaneous melanoma
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Fig 2 Forest plot of risk for melanoma associated with ever use of sunbeds. Heterogeneity I²=57% for all studies combined
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Fig 3 Forest plot of risk for melanoma associated with ever use of sunbeds when first use was before age 35 years. No heterogeneity (I2=0)
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Fig 4 Forest plot of risk for melanoma associated with high use of sunbeds. Heterogeneity I²=47%
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Fig 5 Risk for melanoma associated with ever use of sunbeds as a function of latitude
See this image and copyright information in PMC

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