Adolescent Use of Tanning Salons and Melanoma Risk

Abstract & Commentary

By William B. Ershler, MD

Synopsis: The use of sunlamps or sunbeds for tanning purposes has grown in popularity, such that their use is very common among teenagers and young adults. In a well-conducted Australian multicenter, case-controlled study, it is clear that such use among teenagers is associated with a significantly higher risk of cutaneous melanoma. In fact, the risk is higher than it is for middle-aged sunbed users.

Source: Cust AE, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011;128:2425-2435.

It previously has been reported that artificial tanning, for example by use of sunlamp or sunbed such as one might find at a tanning salon, is associated with an increased risk of melanoma. Previously, a meta-analysis of 19 studies revealed that ever-use of sunbeds was associated with 15% increased risk of melanoma compared with never having used a sunbed.1 There has been concern about the common use of such equipment among adolescents and young adults, estimated to be 20%-40% in these age groups in the United States,2,3 and whether this is associated with melanoma occurring in younger age groups.

To address the question of whether younger people are more susceptible to the carcinogenic effects of UV radiation, Cust and colleagues from three major centers in Australia investigated the association between sunbed use and risk of early-onset cutaneous malignant melanoma. For this study, they capitalized on data available within the Australian Melanoma Family Study, a multicenter, population-based, case-control family epidemiologic study.4 They analyzed data from 604 cases diagnosed between ages 18 and 39 years and 479 matched controls. Data were collected by interview. Associations were estimated as odds ratios (ORs) using unconditional logistic regression, adjusting for age, sex, city, education, family history, skin color, usual skin response to sunlight, and sun exposure.

Compared with having never used a sunbed, the OR for melanoma associated with ever-use was 1.41 (95% confidence interval [CI] 1.01-1.96) and 2.01 (95% CI 1.22-3.31) for more than 10 lifetime sessions (P trend 0.01 with cumulative use). The association was stronger for earlier age at first use (P trend 0.02). The association also was stronger for melanoma diagnosed when aged 18-29 years (OR for more than 10 lifetime sessions = 6.57, 95% CI 1.41-30.49) than for melanoma diagnosed between the ages of 30-39 years (OR 1.60, 95% CI 0.92-2.77; P interaction 0.01). Among those who had ever used a sunbed and were diagnosed between 18-29 years of age, three-fourths (76%) of melanomas were attributable to sunbed use.

Commentary

Melanoma occurs with increased frequency in middle-aged and older people. The median age at diagnosis is 60 years.5 Yet, this disease remains among the leading causes of cancer deaths in young adults.5 Although the association with UV radiation exposure has been well established, this is the first report examining the risk of early-onset melanoma with sunbed use. It was unknown whether the risks were greater for those exposed early in life compared with those with similar sunbed use in middle-age and whether early use was associated with early-onset melanoma (i.e., before the age of 40 years). The data presented demonstrate that adolescent sunbed use is associated with increased risk of early-onset melanoma and that the risk increases the earlier one starts and with greater use. Furthermore, there is greater risk of melanoma when the first use is at an earlier age and that risk increases with greater use. The popularity of tanning salons, particularly among adolescents, should raise high concerns among public health agencies and the medical community at large.

References

1. The International Agency for Research on Cancer Working Group on artifical ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. Int J Cancer 2007;120:1116-1122.

2. Geller AC, et al. Use of sunscreen, sunburning rates, and tanning bed use among more than 10,000 US children and adolescents. Pediatrics 2002;109: 1009-1014.

3. Lazovich D, et al. Prevalence of indoor tanning use in Minnesota, 2002. Arch Dermatol 2005;141:523-524.

4. Cust AE, et al. Population-based, case-control-family design to investigate genetic and environmental influences on melanoma risk: Australian Melanoma Family Study. Am J Epidemiol 2009;170:1541-1554.

5. Jemal A, et al. Cancer statistics, 2009. Cancer 2009;59:225-249.