Sunbeds are not associated with melanoma in the U.S. - tanTALK

Bob Wagner · 01-20-2004, 08:09 AM

This posted today in EPA SUNPROTECTION LISTSERVER:

William B. Grant, Ph.D.
Newport News, VA, USA
wbgrant@infionline.net

The 13 studies reviewed in the paper by Young [2004], indicate that those who use sunbeds or artificial UV sources have a 50% increased risk of developing melanoma compared to the general population. This increase is after considering such confounding factors as skin type, number of nevi, and sun exposure and sunburning. However, the two studies conducted in the U.S. found no increased risk: a study in California found an odds ratio of 0.94 (95% confidence interval 0.74-1.2) [Holly et al., 1995], while a study in Connecticut found an odds ratio of 1.13 (95% C.I. 0.82-1.54) [Chen et al., 1998]. While I do not know what regulations govern use of sunbeds in other countries, it appears from these results that the regulations in effect in the U.S. have adequately protected the indoor tanning users from one of the more serious problems that could arise from abuse of such devices.

However, there are several confounding factors that the studies did not consider, such as diet and body mass index. Total retinol (vitamin A) intake appeared protective within a subgroup of women who were otherwise at low risk based on non dietary factors (relative risk (RR)=0.39, 95% confidence interval
(CI) 0.22-0.71 for >/=1,800 vs 400 microg day(-1), P for linear trend=0.01) [Feskanich et al., 2003]. Body mass index (weight (kg)/height (m)2) was significantly related to melanoma risk; cases were more obese than controls (for highest quartile vs. lowest quartile, age-, sex-, and education-adjusted OR = 1.90, 95% CI 1.10-3.27; p for trend = 0.02) [Kirkpatrick et al., 2004].
As stated in Young [2004], “However, based on current evidence, it is still difficult to categorically state that sunbed use results in malignant melanoma, although the evidence is increasingly, and perhaps not surprisingly, supporting this view.”

Even if sunbed use were associated with a 50% increased risk of developing melanoma, should this be a concern? It is estimated that 54,200 Americans would develop melanoma in 2003 [Simmonds, 2003]. If every American were to use a sunbed, there might be 27,000 additional cases of melanoma annually, and 3,800 deaths due to melanoma. With a population of 285 million, the risk of developing melanoma is 1.9/10,000/year. Comparable risks for other things are falls 391/10,000/year, transportation accidents 166/10,000/year, cutting, piercing instruments 105/10,000/year, and poisoning 61/10,000/year. Thus, the risk of melanoma is minor compared to the risks associated with everyday life.

Going further, we can compare the risks of developing melanoma with the health benefits from indoor and outdoor UV exposure. 400,000 Americans have multiple sclerosis. Recent studies indicate that 50% of the cases can be prevented through UVB (280-315 nm) radiation exposure through the production of vitamin D [Goldacre et al., 2004]. Thus, 200,000 cases of multiple sclerosis in the U.S. could have been prevented through more UVR.

In the U.S., 1,334,100 new cases and 556,500 deaths were expected from cancer in 2003 [Simmons, 2003]. My work analyzing the geographic variation in cancer mortality rates with respect to solar UVB for July indicated that there were 23,000 premature cancer deaths annually due to insufficient UVB and vitamin D [Grant, 2002]. This translates to about 67,000 preventable cases. More recently, I have shown that living in an urban region essentially doubles the risk by further shielding against UVB [Grant, in preparation]. Thus, there are approximately 45,000 premature deaths and 130,000 preventable cases of cancer annually through additional UVB exposure and/or vitamin D.

Psoriasis is another disease for which UVB and vitamin D are beneficial. An uncontrolled study of the use of commercial indoor tanning facilities to treat those with psoriasis found 30-50% improvements in symptoms [Fleischer et al., 1997]. 1.4 million Americans suffer from psoriasis.

There are many other benefits from UVB exposure, such as improvement of musculoskeletal system, reduction in risk of diabetes mellitus, heart disease, hypertension, risk of being born with schizophrenia, etc. There are a number of good recent reviews on the topic: Ponsonby et al. [2002], Barthela and Scharla [2003], Calvo and Whiting [2003], Grant and de Gruijl [2003], Hayes et al. [2003], Heaney [2003], Holick [2003], and Zitterman [2003].

Melanoma is much more related to recreational UVR exposure than to occupational UVR exposure [Kennedy et al., 2003]. One of the advantages of indoor tanning is that it can provide a tan in a controlled manner so that when one does take that vacation trip to the beach, one is much less likely to sunburn than otherwise. It should also be noted that use of sunscreen has not been shown to reduce the risk of melanoma [Dennis et al., 2003].

In conclusion, indoor tanning has been found to be associated with about a 50% increase in melanoma rates in studies in Europe and Canada, while no increased risk was found in the U.S. The difference may be due to better regulations governing the use of indoor tanning facilities in the U.S. Even if indoor tanning were associated with an increased risk of developing melanoma, the risk is small and pales in comparison to the health benefits resulting from vitamin D production from the UVB in tanning lamps. The American diet does not contain enough vitamin D to reduce the risk of most vitamin D affected diseases, and it is impossible to produce any vitamin D from sunlight for five months each year in Boston [Webb et al., 1988]. Thus, those who want to use indoor tanning facilities in the U.S. should feel confident that the health benefits greatly outweigh the health risks, which remain to be demonstrated.

References
Barthel HR, Scharla SH. [Benefits beyond the bones -- vitamin D against falls, cancer, hypertension and autoimmune diseases] Dtsch Med Wochenschr. 2003;128:440-6.

Calvo MS, Whiting SJ. Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use. Nutr Rev. 2003;61:107-13.

Chen YT, Dubrow R, Zheng T, Barnhill RL, Fine J, Berwick M. Sunlamp use and the risk of cutaneous malignant melanoma: a population-based case-control study in Connecticut, USA. Int J Epidemiol. 1998;27:758-65.

Dennis LK, Beane Freeman LE, VanBeek MJ. Sunscreen use and the risk for
melanoma: a quantitative review. Ann Intern Med. 2003;139:966-78.

Feskanich D, Willett WC, Hunter DJ, Colditz GA. Dietary intakes of vitamins A, C, and E and risk of melanoma in two cohorts of women. Br J Cancer, 2003;88:1381-7.

Fleischer AB Jr, Clark AR, Rapp SR, Reboussin DM, Feldman SR. Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial. J Invest Dermatol. 1997;109:170-4.

Goldacre MJ, Seagroatt V, Yeates D, Acheson ED. Skin cancer in people with multiple sclerosis: a record linkage study. J Epidemiol Community Health 2004;58:142-144.

Grant WB. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002;94:1867-75.

Grant WB, de Gruijl FR, Health benefits of solar UV-B radiation through the production of vitamin D, Comment and response, Photochem Photobiol Sci. 2003;2:1307-10.

Hayes CE, Nashold FE, Spach KM, Pedersen LB. The immunological functions of the vitamin D endocrine system. Cell Mol Biol (Noisy-le-grand). 2003:49:277-300.

Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 2003;78:912-9.

Holick MF. Vitamin D: A millenium perspective. J Cell Biochem. 2003;88:296-307.

Holly EA, Aston DA, Cress RD, Ahn DK, Kristiansen JJ. Cutaneous melanoma in women. I. Exposure to sunlight, ability to tan, and other risk factors related to ultraviolet light. Am J Epidemiol. 1995;141:923-33.

Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003;120:1087-93.

Kirkpatrick CS, White E, Lee JA. Case-control study of malignant melanoma in Washington State. II. Diet, alcohol, and obesity. Am J Epidemiol. 1994;139:869-80.

Ponsonby AL, McMichael A, van der Mei I. Ultraviolet radiation and autoimmune
disease: insights from epidemiological research. Toxicology. 2002;181-182:71-8.

Simmonds MA. Cancer statistics, 2003: further decrease in mortality rate, increase in persons living with cancer. CA Cancer J Clin. 2003;53:4.

Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67:373-8.

Young AR. Tanning devices - fast track to skin cancer? Pigment Cell Res. 2004;17:2-9.

Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89:552-72.

pam · 01-20-2004, 08:18 AM

Thanks for posting this Bob. This is great information to have on hand.

Pam

MJ · 01-20-2004, 08:39 AM

Yeah ditto.... thanks BOB..great info!!
OHH WAIT A SECOND.....look he can post online..image that!!!!

mouthybrat · 01-21-2004, 08:46 PM

Quote:it appears from these results that the regulations in effect in the U.S. have adequately protected the indoor tanning users from one of the more serious problems that could arise from abuse of such devices.

Quote:In conclusion, indoor tanning has been found to be associated with about a 50% increase in melanoma rates in studies in Europe and Canada, while no increased risk was found in the U.S. The difference may be due to better regulations governing the use of indoor tanning facilities in the U.S.

This is exactly why I think we should all be working with the states to get reasonable regulations in place and enforced!

TanningEmporium · 01-21-2004, 08:58 PM

Good info..keep it coming...my brain needs all the help it can.

Neon Beach · 10-15-2006, 09:13 AM

Paulastone · 10-16-2006, 04:56 AM

I'm still new to all of this, but has there ever ben a study done comparing people who live in a totally different kind of location--i.e. Los Angeles-elevation above sea level 1 and say Denver- elevation above 5000? Just curious?

Nigelappler · 10-17-2006, 05:58 PM

OMG! thx I love this article!!! NOICE!

Neon Beach · 10-17-2006, 06:15 PM

And look what Forum it's in, post your positve finds here!!

Sherin · 10-17-2006, 06:15 PM

OK.... Can someone point me to where the evidence is that: "indoor tanning has been found to be associated with about a 50% increase in melanoma rates in studies in Europe and Canada, while no increased risk was found in the U.S."

I have never seen any statistics anywhere that shows any correlation to tanning having any association with melanoma rates?

01-20-2004, 08:09 AM	#1 (permalink)
Bob Wagner Join Date: Jun 30 2001 Posts: 26 Rep Power: 0	Sunbeds are not associated with melanoma in the U.S. This posted today in EPA SUNPROTECTION LISTSERVER: William B. Grant, Ph.D. Newport News, VA, USA wbgrant@infionline.net The 13 studies reviewed in the paper by Young [2004], indicate that those who use sunbeds or artificial UV sources have a 50% increased risk of developing melanoma compared to the general population. This increase is after considering such confounding factors as skin type, number of nevi, and sun exposure and sunburning. However, the two studies conducted in the U.S. found no increased risk: a study in California found an odds ratio of 0.94 (95% confidence interval 0.74-1.2) [Holly et al., 1995], while a study in Connecticut found an odds ratio of 1.13 (95% C.I. 0.82-1.54) [Chen et al., 1998]. While I do not know what regulations govern use of sunbeds in other countries, it appears from these results that the regulations in effect in the U.S. have adequately protected the indoor tanning users from one of the more serious problems that could arise from abuse of such devices. However, there are several confounding factors that the studies did not consider, such as diet and body mass index. Total retinol (vitamin A) intake appeared protective within a subgroup of women who were otherwise at low risk based on non dietary factors (relative risk (RR)=0.39, 95% confidence interval (CI) 0.22-0.71 for >/=1,800 vs 400 microg day(-1), P for linear trend=0.01) [Feskanich et al., 2003]. Body mass index (weight (kg)/height (m)2) was significantly related to melanoma risk; cases were more obese than controls (for highest quartile vs. lowest quartile, age-, sex-, and education-adjusted OR = 1.90, 95% CI 1.10-3.27; p for trend = 0.02) [Kirkpatrick et al., 2004]. As stated in Young [2004], “However, based on current evidence, it is still difficult to categorically state that sunbed use results in malignant melanoma, although the evidence is increasingly, and perhaps not surprisingly, supporting this view.” Even if sunbed use were associated with a 50% increased risk of developing melanoma, should this be a concern? It is estimated that 54,200 Americans would develop melanoma in 2003 [Simmonds, 2003]. If every American were to use a sunbed, there might be 27,000 additional cases of melanoma annually, and 3,800 deaths due to melanoma. With a population of 285 million, the risk of developing melanoma is 1.9/10,000/year. Comparable risks for other things are falls 391/10,000/year, transportation accidents 166/10,000/year, cutting, piercing instruments 105/10,000/year, and poisoning 61/10,000/year. Thus, the risk of melanoma is minor compared to the risks associated with everyday life. Going further, we can compare the risks of developing melanoma with the health benefits from indoor and outdoor UV exposure. 400,000 Americans have multiple sclerosis. Recent studies indicate that 50% of the cases can be prevented through UVB (280-315 nm) radiation exposure through the production of vitamin D [Goldacre et al., 2004]. Thus, 200,000 cases of multiple sclerosis in the U.S. could have been prevented through more UVR. In the U.S., 1,334,100 new cases and 556,500 deaths were expected from cancer in 2003 [Simmons, 2003]. My work analyzing the geographic variation in cancer mortality rates with respect to solar UVB for July indicated that there were 23,000 premature cancer deaths annually due to insufficient UVB and vitamin D [Grant, 2002]. This translates to about 67,000 preventable cases. More recently, I have shown that living in an urban region essentially doubles the risk by further shielding against UVB [Grant, in preparation]. Thus, there are approximately 45,000 premature deaths and 130,000 preventable cases of cancer annually through additional UVB exposure and/or vitamin D. Psoriasis is another disease for which UVB and vitamin D are beneficial. An uncontrolled study of the use of commercial indoor tanning facilities to treat those with psoriasis found 30-50% improvements in symptoms [Fleischer et al., 1997]. 1.4 million Americans suffer from psoriasis. There are many other benefits from UVB exposure, such as improvement of musculoskeletal system, reduction in risk of diabetes mellitus, heart disease, hypertension, risk of being born with schizophrenia, etc. There are a number of good recent reviews on the topic: Ponsonby et al. [2002], Barthela and Scharla [2003], Calvo and Whiting [2003], Grant and de Gruijl [2003], Hayes et al. [2003], Heaney [2003], Holick [2003], and Zitterman [2003]. Melanoma is much more related to recreational UVR exposure than to occupational UVR exposure [Kennedy et al., 2003]. One of the advantages of indoor tanning is that it can provide a tan in a controlled manner so that when one does take that vacation trip to the beach, one is much less likely to sunburn than otherwise. It should also be noted that use of sunscreen has not been shown to reduce the risk of melanoma [Dennis et al., 2003]. In conclusion, indoor tanning has been found to be associated with about a 50% increase in melanoma rates in studies in Europe and Canada, while no increased risk was found in the U.S. The difference may be due to better regulations governing the use of indoor tanning facilities in the U.S. Even if indoor tanning were associated with an increased risk of developing melanoma, the risk is small and pales in comparison to the health benefits resulting from vitamin D production from the UVB in tanning lamps. The American diet does not contain enough vitamin D to reduce the risk of most vitamin D affected diseases, and it is impossible to produce any vitamin D from sunlight for five months each year in Boston [Webb et al., 1988]. Thus, those who want to use indoor tanning facilities in the U.S. should feel confident that the health benefits greatly outweigh the health risks, which remain to be demonstrated. References Barthel HR, Scharla SH. [Benefits beyond the bones -- vitamin D against falls, cancer, hypertension and autoimmune diseases] Dtsch Med Wochenschr. 2003;128:440-6. Calvo MS, Whiting SJ. Prevalence of vitamin D insufficiency in Canada and the United States: importance to health status and efficacy of current food fortification and dietary supplement use. Nutr Rev. 2003;61:107-13. Chen YT, Dubrow R, Zheng T, Barnhill RL, Fine J, Berwick M. Sunlamp use and the risk of cutaneous malignant melanoma: a population-based case-control study in Connecticut, USA. Int J Epidemiol. 1998;27:758-65. Dennis LK, Beane Freeman LE, VanBeek MJ. Sunscreen use and the risk for melanoma: a quantitative review. Ann Intern Med. 2003;139:966-78. Feskanich D, Willett WC, Hunter DJ, Colditz GA. Dietary intakes of vitamins A, C, and E and risk of melanoma in two cohorts of women. Br J Cancer, 2003;88:1381-7. Fleischer AB Jr, Clark AR, Rapp SR, Reboussin DM, Feldman SR. Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial. J Invest Dermatol. 1997;109:170-4. Goldacre MJ, Seagroatt V, Yeates D, Acheson ED. Skin cancer in people with multiple sclerosis: a record linkage study. J Epidemiol Community Health 2004;58:142-144. Grant WB. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002;94:1867-75. Grant WB, de Gruijl FR, Health benefits of solar UV-B radiation through the production of vitamin D, Comment and response, Photochem Photobiol Sci. 2003;2:1307-10. Hayes CE, Nashold FE, Spach KM, Pedersen LB. The immunological functions of the vitamin D endocrine system. Cell Mol Biol (Noisy-le-grand). 2003:49:277-300. Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 2003;78:912-9. Holick MF. Vitamin D: A millenium perspective. J Cell Biochem. 2003;88:296-307. Holly EA, Aston DA, Cress RD, Ahn DK, Kristiansen JJ. Cutaneous melanoma in women. I. Exposure to sunlight, ability to tan, and other risk factors related to ultraviolet light. Am J Epidemiol. 1995;141:923-33. Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol. 2003;120:1087-93. Kirkpatrick CS, White E, Lee JA. Case-control study of malignant melanoma in Washington State. II. Diet, alcohol, and obesity. Am J Epidemiol. 1994;139:869-80. Ponsonby AL, McMichael A, van der Mei I. Ultraviolet radiation and autoimmune disease: insights from epidemiological research. Toxicology. 2002;181-182:71-8. Simmonds MA. Cancer statistics, 2003: further decrease in mortality rate, increase in persons living with cancer. CA Cancer J Clin. 2003;53:4. Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988;67:373-8. Young AR. Tanning devices - fast track to skin cancer? Pigment Cell Res. 2004;17:2-9. Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89:552-72.

10-15-2006, 09:13 AM	#6 (permalink)
Neon Beach Join Date: Nov 30 2000 Location: Ontario Age: 55 Posts: 38,593 Rep Power: 101	Re: Sunbeds are not associated with melanoma in the U.S. bump __________________ www.talktimmins.com -- http://www.drjawnswebworx.com/

10-16-2006, 04:56 AM	#7 (permalink)
Paulastone Join Date: Oct 14 2006 Posts: 72 Rep Power: 0	Re: Sunbeds are not associated with melanoma in the U.S. I'm still new to all of this, but has there ever ben a study done comparing people who live in a totally different kind of location--i.e. Los Angeles-elevation above sea level 1 and say Denver- elevation above 5000? Just curious?

10-17-2006, 05:58 PM	#8 (permalink)
Nigelappler I love Derf!! Join Date: Jul 21 2006 Location: LaSalle Posts: 3,042 Rep Power: 24	Re: Sunbeds are not associated with melanoma in the U.S. OMG! thx I love this article!!! NOICE!

10-17-2006, 06:15 PM	#9 (permalink)
Neon Beach Join Date: Nov 30 2000 Location: Ontario Age: 55 Posts: 38,593 Rep Power: 101	Re: Sunbeds are not associated with melanoma in the U.S. And look what Forum it's in, post your positve finds here!! __________________ www.talktimmins.com -- http://www.drjawnswebworx.com/

01-20-2004, 08:18 AM	#2 (permalink)
pam I'm Banned Join Date: Oct 29 2001 Location: USA Posts: 3,893 Rep Power: 0	Thanks for posting this Bob. This is great information to have on hand. Pam

01-20-2004, 08:39 AM	#3 (permalink)
MJ Join Date: Jan 21 2002 Posts: 2,709 Rep Power: 17	Yeah ditto.... thanks BOB..great info!! OHH WAIT A SECOND.....look he can post online..image that!!!!

01-21-2004, 08:46 PM	#4 (permalink)
mouthybrat Join Date: Nov 9 2003 Posts: 589 Rep Power: 15	Quote:it appears from these results that the regulations in effect in the U.S. have adequately protected the indoor tanning users from one of the more serious problems that could arise from abuse of such devices. Quote:In conclusion, indoor tanning has been found to be associated with about a 50% increase in melanoma rates in studies in Europe and Canada, while no increased risk was found in the U.S. The difference may be due to better regulations governing the use of indoor tanning facilities in the U.S. This is exactly why I think we should all be working with the states to get reasonable regulations in place and enforced!

01-21-2004, 08:58 PM	#5 (permalink)
TanningEmporium Join Date: Jul 15 2003 Location: 213 Skyland Shp Ctr Posts: 2,613 Rep Power: 17	Good info..keep it coming...my brain needs all the help it can.

10-17-2006, 06:15 PM	#10 (permalink)
Sherin I love Derf!! Join Date: Aug 10 2004 Location: Puget Sound Posts: 2,870 Rep Power: 18	Re: Sunbeds are not associated with melanoma in the U.S. OK.... Can someone point me to where the evidence is that: "indoor tanning has been found to be associated with about a 50% increase in melanoma rates in studies in Europe and Canada, while no increased risk was found in the U.S." I have never seen any statistics anywhere that shows any correlation to tanning having any association with melanoma rates? __________________ War does not determine who is right, war determines who is left.

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