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Meta-Analysis
. 2012 Oct 2:345:e5909.
doi: 10.1136/bmj.e5909.

Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis

Mackenzie R Wehner  1 , Melissa L Shive, Mary-Margaret Chren, Jiali Han, Abrar A Qureshi, Eleni Linos
Affiliations
Meta-Analysis

Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis

Mackenzie R Wehner et al. BMJ. .

Abstract

Objective: To synthesise the literature on indoor tanning and non-melanoma skin cancer.

Design: Systematic review and meta-analysis.

Data sources: PubMed (1966 to present), Embase (1974 to present), and Web of Science (1898 to present).

Study selection: All articles that reported an original effect statistic for indoor tanning and non-melanoma skin cancer were included. Articles that presented no data, such as review articles and editorials, were excluded, as were articles in languages other than English.

Data extraction: Two investigators independently extracted data. Random effects meta-analysis was used to summarise the relative risk of ever use versus never use of indoor tanning. Dose-response effects and exposure to indoor tanning during early life were also examined. The population attributable risk fraction for the United States population was calculated.

Results: 12 studies with 9328 cases of non-melanoma skin cancer were included. Among people who reported ever using indoor tanning compared with those who never used indoor tanning, the summary relative risk for squamous cell carcinoma was 1.67 (95% confidence interval 1.29 to 2.17) and that for basal cell carcinoma was 1.29 (1.08 to 1.53). No significant heterogeneity existed between studies. The population attributable risk fraction for the United States was estimated to be 8.2% for squamous cell carcinoma and 3.7% for basal cell carcinoma. This corresponds to more than 170 000 cases of non-melanoma skin cancer each year attributable to indoor tanning. On the basis of data from three studies, use of indoor tanning before age 25 was more strongly associated with both squamous cell carcinoma (relative risk 2.02, 0.70 to 5.86) and basal cell carcinoma (1.40, 1.29 to 1.52).

Conclusions: Indoor tanning is associated with a significantly increased risk of both basal and squamous cell skin cancer. The risk is higher with use in early life (<25 years). This modifiable risk factor may account for hundreds of thousands of cases of non-melanoma skin cancer each year in the United States alone and many more worldwide. These findings contribute to the growing body of evidence on the harms of indoor tanning and support public health campaigns and regulation to reduce exposure to this carcinogen.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest 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; MMC does consultancy for Genentech; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 PRISMA flow diagram of literature search and study selection for meta-analysis of indoor tanning and non-melanoma skin cancer. BCC=basal cell carcinoma; NMSC=non-melanoma skin cancer; SCC=squamous cell carcinoma
None
Fig 2 Relative risk of basal cell carcinoma and squamous cell carcinoma in participants ever exposed to indoor tanning compared with participants never exposed to indoor tanning
See this image and copyright information in PMC

References

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