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Challenges in assessing the sunscreen-melanoma association.

  • Rueegg CS Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
  • Stenehjem JS Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
  • Egger M Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
  • Ghiasvand R Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
  • Cho E Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI.
  • Lund E Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
  • Weiderpass E Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
  • Green AC QIMR Berghofer Medical Research Institute, Brisbane, Australia.
  • Veierød MB Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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  • 2018-11-18
Published in:
  • International journal of cancer. - 2019
melanoma
meta-analysis
skin cancer
sun protection
sunscreen
Humans
Melanoma
Observational Studies as Topic
Odds Ratio
Proportional Hazards Models
Randomized Controlled Trials as Topic
Research Design
Risk Factors
Skin Neoplasms
Sunlight
Sunscreening Agents
Treatment Outcome
English Whether sunscreen use affects melanoma risk has been widely studied with contradictory results. To answer this question we performed a systematic review of all published studies, accounting for sources of heterogeneity and bias. We searched for original articles investigating the sunscreen-melanoma association in humans to February 28, 2018. We then used random-effects meta-analysis to combine estimates of the association, stratified by study design. Stratified meta-analysis and meta-regression were used to identify sources of heterogeneity. We included 21,069 melanoma cases from 28 studies published 1979-2018: 23 case-control (11 hospital-based, 12 population-based), 1 ecological, 3 cohort and 1 randomised controlled trial (RCT). There was marked heterogeneity across study designs and among case-control studies but adjustment for confounding by sun exposure, sunburns and phenotype systematically moved estimates toward decreased melanoma risk among sunscreen users. Ever- vs. never-use of sunscreen was inversely associated with melanoma in hospital-based case-control studies (adjusted odds ratio (OR) = 0.57, 95%confidence interval (CI) 0.37-0.87, pheterogeneity < 0.001), the ecological study (rate ratio = 0.48, 95%CI 0.35-0.66), and the RCT (hazard ratio (HR) = 0.49, 95%CI 0.24-1.01). It was not associated in population-based case-control studies (OR = 1.17, 95%CI 0.90-1.51, pheterogeneity < 0.001) and was positively associated in the cohort studies (HR = 1.27, 95%CI 1.07-1.51, pheterogeneity = 0.236). The association differed by latitude (pinteraction = 0.042), region (pinteraction = 0.008), adjustment for naevi/freckling (pinteraction = 0.035), and proportion of never-sunscreen-users (pinteraction = 0·012). Evidence from observational studies on sunscreen use and melanoma risk was weak and heterogeneous, consistent with the challenges of controlling for innate confounding by indication. The only RCT showed a protective effect of sunscreen.
Language
  • English
Open access status
hybrid
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https://sonar.ch/global/documents/298
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