Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review

Barbara Burgard, Jakob Schöpe, Isabel Holzschuh, Claudia Schiekofer, Sandra Reichrath, Wagenpfeil Stefan, Stefan Pilz, Jose Ordonez-Mena, Winfried März, Thomas Vogt, J. rg Reichrath

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background: There is an ongoing debate whether solarium use (indoor tanning/artificial UV) may increase the risk for primary cutaneous malignant melanoma. Aim: A systematic literature search was conducted using MEDLINE and ISI Web of Science. Included studies were critically assessed regarding their risk of bias, and methodological shortcomings. Levels of evidence and grades of recommendation were determined according to guidelines of the Oxford Centre for Evidence-Based Medicine. Summary risk estimates and 95% confidence intervals for four different outcomes (ever exposure, exposure at younger age, high/low exposure vs. non-exposure) were derived from random-effects meta-analyses to account for possible heterogeneity across studies. Results: Two cohort and twenty-nine case-controlstudies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95% confidence interval (CI)=1.04- 1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95%CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95%CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95%CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a-) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding. Conclusion: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.
Original languageEnglish
Pages (from-to)1187-1199
JournalAnticancer Research
Volume38
Issue number2
DOIs
Publication statusPublished - 2018

Cite this

Burgard, B., Schöpe, J., Holzschuh, I., Schiekofer, C., Reichrath, S., Stefan, W., ... Reichrath, J. R. (2018). Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review. Anticancer Research, 38(2), 1187-1199. https://doi.org/10.21873/anticanres.12339
Burgard, Barbara ; Schöpe, Jakob ; Holzschuh, Isabel ; Schiekofer, Claudia ; Reichrath, Sandra ; Stefan, Wagenpfeil ; Pilz, Stefan ; Ordonez-Mena, Jose ; März, Winfried ; Vogt, Thomas ; Reichrath, J. rg. / Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review. In: Anticancer Research. 2018 ; Vol. 38, No. 2. pp. 1187-1199.
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title = "Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review",
abstract = "Background: There is an ongoing debate whether solarium use (indoor tanning/artificial UV) may increase the risk for primary cutaneous malignant melanoma. Aim: A systematic literature search was conducted using MEDLINE and ISI Web of Science. Included studies were critically assessed regarding their risk of bias, and methodological shortcomings. Levels of evidence and grades of recommendation were determined according to guidelines of the Oxford Centre for Evidence-Based Medicine. Summary risk estimates and 95{\%} confidence intervals for four different outcomes (ever exposure, exposure at younger age, high/low exposure vs. non-exposure) were derived from random-effects meta-analyses to account for possible heterogeneity across studies. Results: Two cohort and twenty-nine case-controlstudies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95{\%} confidence interval (CI)=1.04- 1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95{\%}CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95{\%}CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95{\%}CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a-) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding. Conclusion: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.",
author = "Barbara Burgard and Jakob Sch{\"o}pe and Isabel Holzschuh and Claudia Schiekofer and Sandra Reichrath and Wagenpfeil Stefan and Stefan Pilz and Jose Ordonez-Mena and Winfried M{\"a}rz and Thomas Vogt and Reichrath, {J. rg}",
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language = "English",
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Burgard, B, Schöpe, J, Holzschuh, I, Schiekofer, C, Reichrath, S, Stefan, W, Pilz, S, Ordonez-Mena, J, März, W, Vogt, T & Reichrath, JR 2018, 'Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review' Anticancer Research, vol. 38, no. 2, pp. 1187-1199. https://doi.org/10.21873/anticanres.12339

Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review. / Burgard, Barbara; Schöpe, Jakob; Holzschuh, Isabel; Schiekofer, Claudia; Reichrath, Sandra; Stefan, Wagenpfeil; Pilz, Stefan; Ordonez-Mena, Jose; März, Winfried; Vogt, Thomas; Reichrath, J. rg.

In: Anticancer Research, Vol. 38, No. 2, 2018, p. 1187-1199.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review

AU - Burgard, Barbara

AU - Schöpe, Jakob

AU - Holzschuh, Isabel

AU - Schiekofer, Claudia

AU - Reichrath, Sandra

AU - Stefan, Wagenpfeil

AU - Pilz, Stefan

AU - Ordonez-Mena, Jose

AU - März, Winfried

AU - Vogt, Thomas

AU - Reichrath, J. rg

PY - 2018

Y1 - 2018

N2 - Background: There is an ongoing debate whether solarium use (indoor tanning/artificial UV) may increase the risk for primary cutaneous malignant melanoma. Aim: A systematic literature search was conducted using MEDLINE and ISI Web of Science. Included studies were critically assessed regarding their risk of bias, and methodological shortcomings. Levels of evidence and grades of recommendation were determined according to guidelines of the Oxford Centre for Evidence-Based Medicine. Summary risk estimates and 95% confidence intervals for four different outcomes (ever exposure, exposure at younger age, high/low exposure vs. non-exposure) were derived from random-effects meta-analyses to account for possible heterogeneity across studies. Results: Two cohort and twenty-nine case-controlstudies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95% confidence interval (CI)=1.04- 1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95%CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95%CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95%CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a-) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding. Conclusion: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.

AB - Background: There is an ongoing debate whether solarium use (indoor tanning/artificial UV) may increase the risk for primary cutaneous malignant melanoma. Aim: A systematic literature search was conducted using MEDLINE and ISI Web of Science. Included studies were critically assessed regarding their risk of bias, and methodological shortcomings. Levels of evidence and grades of recommendation were determined according to guidelines of the Oxford Centre for Evidence-Based Medicine. Summary risk estimates and 95% confidence intervals for four different outcomes (ever exposure, exposure at younger age, high/low exposure vs. non-exposure) were derived from random-effects meta-analyses to account for possible heterogeneity across studies. Results: Two cohort and twenty-nine case-controlstudies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95% confidence interval (CI)=1.04- 1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95%CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95%CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95%CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a-) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding. Conclusion: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29374757

U2 - 10.21873/anticanres.12339

DO - 10.21873/anticanres.12339

M3 - Review article

VL - 38

SP - 1187

EP - 1199

JO - Anticancer Research

JF - Anticancer Research

SN - 0250-7005

IS - 2

ER -