Sunscreen Use and the Risk for Melanoma: A Quantitative Review

16 December 2003 | Volume 139 Issue 12 | Pages 966-978

Background: Originally developed to protect against sunburn, sunscreen has been assumed to prevent skin cancer. However, conflicting reports include claims that sunscreen increases risk for melanoma.

Objective: To examine the strength and consistency of associations between melanoma and sunscreen use in the published literature.

Data Sources: A comprehensive MEDLINE search of articles published from 1966 to 2003 that reported information on sunscreen use and melanoma in humans.

Study Selection: Analytic studies reporting data on sunscreen use before diagnosis of melanoma.

Data Extraction: Two independent reviewers extracted data. Inconsistencies were rereviewed until agreement was achieved. When necessary, a third party resolved discrepancies.

Data Synthesis: Odds ratios were pooled across studies by using standard meta-analytic techniques. Pooled odds ratios for ever use among 18 heterogeneous studies did not support an association between melanoma and sunscreen use. Variation among odds ratios was explained by studies that did not adjust for confounding effects of sun sensitivity. The lack of a dose–response effect with frequency of use (never, sometimes, or always) or years of use provided further evidence of a null association.

Conclusions: No association was seen between melanoma and sunscreen use. Failure to control for confounding factors may explain previous reports of positive associations linking melanoma to sunscreen use. In addition, it may take decades to detect a protective association between melanoma and use of the newer formulations of sunscreens.

Editors' Notes Context Reports that sunscreen use increases risks for melanoma have led to controversy. Contribution This meta-analysis of 18 case–control studies found no good evidence for an increased risk for melanoma with sunscreen use. Several studies did not account for patients' sensitivity to sunlight, which could increase both sunscreen use and melanoma. A few studies found protective relationships between sunscreen use and melanoma. Implications Previous reports of increased risk for melanoma with sunscreen use were misleading. Cautions Studies that were reviewed did not evaluate newer sunscreens with a sun protection factor greater than 15, protection against ultraviolet A radiation, or water resistance. –The Editors

 

Author and Article Information

From the College of Public Health and College of Medicine, University of Iowa, Iowa City, Iowa.

Grant Support: In part by the National Cancer Institute, grant number 1R03CA88834-01.

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Leslie K. Dennis, MS, PhD, Department of Epidemiology, College of Public Health, University of Iowa, 200 Hawkins Drive, C21H-GH, Iowa City, IA 52242; e-mail, leslie-dennis{at}uiowa.edu.

Current Author Addresses: Dr. Dennis: Department of Epidemiology, College of Public Health, University of Iowa, 200 Hawkins Drive, C21H-GH, Iowa City, IA 52242.

Dr. Beane Freeman: Cancer Prevention Fellowship Program, Division of Cancer Prevention, NCI, Executive Plaza North, Suite 3109, 6130 Executive Boulevard, MSC 7361, Bethesda, MD 20892-7361.

Dr. VanBeek: Department of Dermatology, College of Medicine, University of Iowa, 200 Hawkins Drive, BT2045-1, Iowa City, IA 52242.

Author Contributions: Conception and design: L.K. Dennis.

Analysis and interpretation of the data: L.K. Dennis, L.E. Beane Freeman, M.J. VanBeek.

Drafting of the article: L.K. Dennis, L.E. Beane Freeman, M.J. VanBeek.

Critical revision of the article for important intellectual content: L.K. Dennis, L.E. Beane Freeman, M.J. VanBeek.

Final approval of the article: L.K. Dennis, L.E. Beane Freeman, M.J. VanBeek.

Provision of study materials or patients: L.K. Dennis.

Statistical expertise: L.K. Dennis.

Obtaining of funding: L.K. Dennis.

Administrative, technical, or logistic support: L.K. Dennis, M.J. VanBeek.

Collection and assembly of data: L.K. Dennis, L.E. Beane Freeman, M.J. VanBeek.