February 10, 2016
JAMA dermatology (Chicago, Ill.)
Abstract
IMPORTANCE
In the United States and Minnesota, melanoma incidence is rising more steeply among women than men younger than 50 years. To our knowledge, no study has examined age- and sex-specific associations between indoor tanning and melanoma to determine if these trends could be due to greater indoor tanning use among younger women.
OBJECTIVE
To examine associations between indoor tanning and melanoma among men and women younger than 50 years.
DESIGN, SETTING, AND PARTICIPANTS
Population-based case-control study conducted in Minnesota of 681 patients (465 [68.3%] women) diagnosed as having melanoma between 2004 and 2007, and 654 controls (446 [68.2%] women), ages 25 to 49 years.
EXPOSURE
Indoor tanning, defined as any use, first age of use, and total sessions.
MAIN OUTCOMES AND MEASURES
Crude and adjusted odds ratios (ORs) and 95% CIs were calculated for melanoma in relation to indoor tanning exposure for men and women by diagnosis or reference age (<30, 30-39, 40-49 years). Sex-specific associations for indoor tanning and melanoma by anatomic site were examined.
RESULTS
Compared with women aged 40 to 49 years, women younger than 40 years initiated indoor tanning at a younger age (16 vs 25 years, P < .001) and reported more frequent indoor tanning (median number of sessions, 100 vs 40, P < .001). Women younger than 30 years were 6 times more likely to be in the case than the control group if they tanned indoors (crude OR, 6.0; 95% CI, 1.3-28.5). Odds ratios were also significantly elevated among women, ages 30 to 49 years (adjusted OR, 3.5; 95% CI, 1.2-9.7 for women 30-39 years; adjusted OR, 2.3; 95% CI, 1.4-3.6 for women 40-49 years); a dose response was observed among women regardless of age. Among men, results by age were inconsistent. The strongest OR for indoor tanning by anatomic site was for melanomas arising on the trunk of women (adjusted OR, 3.7; 95% CI, 1.9-7.2).
CONCLUSIONS AND RELEVANCE
Indoor tanning is a likely factor for the steeper increase in melanoma rates in the United States among younger women compared with men, given the timing of when women initiated indoor tanning relative to diagnosis. The melanoma epidemic can be expected to continue unless indoor tanning is restricted and reduced.
Dermatology
We all like to keep things simple when translating medical studies to our patients. We all have patients who admit to tanning regularly now or that they did so in the past. The common question from these patients is, “Is/was it really that bad?” This study is added evidence that the risk of non-melanoma (there has been ample evidence on this front) and even melanoma is increased in those who have tanned significantly in their lives. The two- to sixfold increased risk for women is clear, although the lack of evidence in this dataset for men might be due to low numbers in the lowest age group.
When translating questions of risk to patients, we try to put them in perspective and ask about other risks they might address: Do they smoke? Do they wear seatbelts? Do they skydive? Do they wear helmets when biking? We remind them that these data on risks for skin cancer support that indoor tanning is another risk to be aware of and that melanomas, while highly curable if caught early, are deadly if caught late. These data are a reminder for our patients to minimize or stop indoor tanning and reinforce that a heightened level of awareness and screening are appropriate if they have a history of indoor tanning.
While I respect Dr. Mostow’s and Dr. Bhatia’s opinions about this article, I take a little different stance on educating patients about “risk” as they choose to “tan or not to tan.” I believe that most individuals who use tanning parlors also exhibit risky behavior with regard to natural sun. For individuals with a fair complexion, this lack of respect for the sun WILL result in wrinkles, brown spots, premalignant actinic keratosis, and skin cancers in a significant majority of individuals; therefore, it is not a risk—rather, it is a certainty.
For this reason, I believe we should support laws and regulations that prevent minors from going to tanning parlors. We should also stress to all fair-skinned patients that they should avoid UV radiation to prevent the certain damage to their skin, not to mention the less certain risk of basal cell carcinoma and even melanoma. Not everyone will listen, but the more physicians stress the hazards of tanning, the more individuals will come to their senses.