Skip to main content
SpringerLink
Log in

Indoor tanning and the risk of developing non-cutaneous cancers: a systematic review and meta-analysis

  • Review article
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

Despite a strong association between indoor tanning and the risk of cutaneous cancers, the relationship between indoor tanning and non-cutaneous cancers is unknown. Our objective was to estimate the association of indoor tanning with developing non-cutaneous cancers.

Methods

We conducted a systematic literature review and meta-analysis of the association between indoor tanning and non-cutaneous cancer sites. Associations were estimated using random effects models. Heterogeneity was investigated through subgroup analyses and the Q-test and I2 statistics.

Results

From 15 identified studies, 33 effect estimates for 12 cancer sites were included in the review. Adjustment for sun exposure was a significant source of heterogeneity in the association of indoor tanning and non-cutaneous cancer risk (meta-regression p = 0.0043). When restricting to studies that adjusted for solar ultraviolet radiation (7 studies and 19 effect estimates) a potential increased risk was observed among ever users of indoor tanning devices with the risk of hematologic malignancies (pooled relative risk = 1.11; 95% CI 0.96–1.28), with differing effects observed by hematologic types and subtypes of non-Hodgkin lymphoma. No association was observed among solid non-cutaneous cancers (pooled relative risk = 0.98; 95% CI 0.94–1.19). Neither study design nor geographical region was significant sources of heterogeneity in these associations.

Conclusion

When controlling for sun exposure, indoor tanning does not protect against solid non-cutaneous cancers and may increase the risk of some hematologic malignancies. Given the well-established relationship with skin cancer and potential relationship with hematologic malignancies, efforts to reduce the use of indoor tanning devices should continue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

CI:

Confidence interval

HL:

Hodgkin lymphoma

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

NHL:

Non-Hodgkin lymphoma

UVA:

Ultraviolet A

UVB:

Ultraviolet B

UVR:

Ultraviolet radiation

References

  1. IARC Working Group on the Evaluation of Carcinogenic Risk to Humans (2012) A review of human carcinogens. IARC monographs—radiation 100D. World Health Organization, Lyon

    Google Scholar 

  2. van der Rhee H, Coebergh JW, de Vries E (2013) Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies. Eur J Cancer 49:1422–1436

    Article  CAS  PubMed  Google Scholar 

  3. Webb AR, Holick MF (1988) The role of sunlight in the cutaneous production of vitamin D3. Annu Rev Nutr 8:375–399

    Article  CAS  PubMed  Google Scholar 

  4. Stevens RG (2005) Circadian disruption and breast cancer: from melatonin to clock genes. Epidemiology 16:254–258

    Article  PubMed  Google Scholar 

  5. Gerber B, Mathys P, Moser M, Bressoud D, Braun-Fahrländer C (2002) Ultraviolet emission spectra of sunbeds. Photochem Photobiol 76:664–668

    Article  CAS  PubMed  Google Scholar 

  6. Sallander E, Wester U, Bengtsson E, Wiegleb Edström D (2013) Vitamin D levels after UVB radiation: effects by UVA additions in a randomized controlled trial. Photodermatol Photoimmunol Photomed 29:323–329

    Article  CAS  PubMed  Google Scholar 

  7. Gambichler T, Bader A, Vojvodic M et al (2002) Impact of UVA exposure on psychological parameters and circulating serotonin and melatonin. BMC Dermatol 2:6

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mead MN (2008) Benefits of sunlight: a bright spot for human health. Environ Health Perspect 116:A160

    PubMed  PubMed Central  Google Scholar 

  9. Nilsen L, Hannevik M, Veierød M (2016) Ultraviolet exposure from indoor tanning devices: a systematic review. Br J Dermatol 174:730–740

    Article  CAS  PubMed  Google Scholar 

  10. Miyamura Y, Coelho SG, Schlenz K et al (2011) The deceptive nature of UVA tanning versus the modest protective effects of UVB tanning on human skin. Pigm Cell Melanoma Res 24:136–147

    Article  Google Scholar 

  11. Whitmore SE, Morison WL, Potten CS (2001) Tanning salon exposure and molecular alterations. J Am Acad Dermatol 44:775–780

    Article  CAS  PubMed  Google Scholar 

  12. Shen J, Song R, Wan J et al (2017) Global methylation of blood leukocyte DNA and risk of melanoma. Int J Cancer 140:1503–1509

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Grant WB, Mohr SB (2009) Ecological studies of ultraviolet B, vitamin D and cancer since 2000. Ann Epidemiol 19:446–454

    Article  PubMed  Google Scholar 

  14. Lippi G, Cervellin G, Danese E (2018) Indoor tanning a gianus bifrons: vitamin D and human cancer. In: Advances in clinical chemistry. Elsevier, Burlington, pp 183–196

    Google Scholar 

  15. Orlova T, Moan J, Lagunova Z, Aksnes L, Terenetskaya I, Juzeniene A (2013) Increase in serum 25-hydroxyvitamin-D3 in humans after sunbed exposures compared to previtamin D3 synthesis in vitro. J Photochem Photobiol B 122:32–36

    Article  CAS  PubMed  Google Scholar 

  16. Holman DM, Berkowitz Z, Guy GP Jr, Hartman AM, Perna FM (2014) The association between demographic and behavioral characteristics and sunburn among US adults—National Health Interview Survey, 2010. Prev Med 63:6–12

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gies P, Javorniczky J, Henderson S et al (2011) UVR emissions from solaria in Australia and implications for the regulation process. Photochem Photobiol 87:184–190

    Article  CAS  PubMed  Google Scholar 

  18. Colantonio S, Bracken MB, Beecker J (2014) The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 70:847–857

    Article  PubMed  Google Scholar 

  19. Tavani A, La Vecchia C, Franceschi S, Serraino D, Carbone A (2000) Medical history and risk of Hodgkin’s and non-Hodgkin’s lymphomas. Eur J Cancer Prev 9:59–64

    Article  CAS  PubMed  Google Scholar 

  20. Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135:1301–1309

    Article  CAS  PubMed  Google Scholar 

  21. Wang SS, Luo J, Cozen W et al (2017) Sun sensitivity, indoor tanning and B-cell non-Hodgkin lymphoma risk among Caucasian women in Los Angeles County. Br J Haematol 177:153–156

    Article  PubMed  Google Scholar 

  22. Zhang M, Song F, Hunter DJ, Qureshi AA, Han J (2013) Tanning bed use is not associated with internal cancer risk: Evidence from a large cohort study. Cancer Epidemiol Prev Biomark cebp. 0906.2013

  23. Yang L, Veierød MB, Löf M, Sandin S, Adami H-O, Weiderpass E (2011) Prospective study of UV exposure and cancer incidence among Swedish women. Cancer Epidemiol Prev Biomark 20:1358–1367

    Article  CAS  Google Scholar 

  24. Edvardsen K, Veierød MB, Brustad M, Braaten T, Engelsen O, Lund E (2011) Vitamin D-effective solar UV radiation, dietary vitamin D and breast cancer risk. Int J Cancer 128:1425–1433

    Article  CAS  PubMed  Google Scholar 

  25. Kelly JL, Friedberg JW, Calvi LM, van Wijngaarden E, Fisher SG (2010) A case–control study of ultraviolet radiation exposure, vitamin D, and lymphoma risk in adults. Cancer Causes Control 21:1265–1275

    Article  PubMed  PubMed Central  Google Scholar 

  26. Veierød MB, Smedby KE, Lund E, Adami H-O, Weiderpass E (2010) Pigmentary characteristics, UV radiation exposure, and risk of non–Hodgkin lymphoma: a prospective study among Scandinavian women. Cancer Epidemiol Prev Biomark 19:1569–1576

    Article  CAS  Google Scholar 

  27. Gilbert R, Metcalfe C, Oliver SE et al (2009) Life course sun exposure and risk of prostate cancer: population-based nested case–control study and meta-analysis. Int J Cancer 125:1414–1423

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Epstein E, Lindqvist P, Geppert B, Olsson H (2009) A population-based cohort study on sun habits and endometrial cancer. Br J Cancer 101:537–540

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Grandin L, Orsi L, Troussard X et al (2008) UV radiation exposure, skin type and lymphoid malignancies: results of a French case–control study. Cancer Causes Control 19:305–315

    Article  CAS  PubMed  Google Scholar 

  30. Boffetta P, van der Hel O, Kricker A et al (2008) Exposure to ultraviolet radiation and risk of malignant lymphoma and multiple myeloma—a multicentre European case–control study. Int J Epidemiol 37:1080–1094

    Article  PubMed  Google Scholar 

  31. Zhang Y, Holford TR, Leaderer B et al (2007) Ultraviolet radiation exposure and risk of non-Hodgkin’s lymphoma. Am J Epidemiol 165:1255–1264

    Article  PubMed  Google Scholar 

  32. Knight JA, Lesosky M, Barnett H, Raboud JM, Vieth R (2007) Vitamin D and reduced risk of breast cancer: a population-based case-control study. Cancer Epidemiol Prev Biomark 16:422–429

    Article  CAS  Google Scholar 

  33. Weihkopf T, Becker N, Nieters A et al (2007) Sun exposure and malignant lymphoma: a population-based case–control study in Germany. Int J Cancer 120:2445–2451

    Article  CAS  PubMed  Google Scholar 

  34. Hartge P, Lim U, Freedman DM et al (2006) Ultraviolet radiation, dietary vitamin D, and risk of non-Hodgkin lymphoma (United States). Cancer Causes Control 17:1045–1052

    Article  PubMed  Google Scholar 

  35. Smedby KE, Hjalgrim H, Melbye M et al (2005) Ultraviolet radiation exposure and risk of malignant lymphomas. J Natl Cancer Inst 97:199–209

    Article  PubMed  Google Scholar 

  36. Ezzedine K, Malvy D, Mauger E et al (2008) Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults. J Eur Acad Dermatol Venereol 22:186–194

    Article  CAS  PubMed  Google Scholar 

  37. Julian AK, Bethel JW, Odden MC, Thorburn S (2016) Sex differences and risk behaviors among indoor tanners. Prev Med Rep 3:283–287

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kricker A, Armstrong BK, Hughes AM et al (2008) Personal sun exposure and risk of non Hodgkin lymphoma: a pooled analysis from the Interlymph Consortium. Int J Cancer 122:144–154

    Article  CAS  PubMed  Google Scholar 

  39. Lu D, Xu F, Hu K et al (2017) Occupational ultraviolet exposure and risk of non-Hodgkin’s lymphomas: a meta-analysis. Oncotarget 8:62358

    PubMed  PubMed Central  Google Scholar 

  40. Ullrich SE (2005) Mechanisms underlying UV-induced immune suppression. Mutat Res/Fundam Mol Mech Mutagen 571:185–205

    Article  CAS  Google Scholar 

  41. Jiang W, Ananthaswamy HN, Muller HK et al (2001) UV irradiation augments lymphoid malignancies in mice with one functional copy of wild-type p53. Proc Natl Acad Sci 98:9790–9795

    Article  CAS  PubMed  Google Scholar 

  42. Perez-Gomez B, Pollan M, Gustavsson P, Plato N, Aragonés N, López-Abente G (2004) Cutaneous melanoma: hints from occupational risks by anatomic site in Swedish men. Occup Environ Med 61:117–126

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Pillai S, Oresajo C, Hayward J (2005) Ultraviolet radiation and skin aging: roles of reactive oxygen species, inflammation and protease activation, and strategies for prevention of inflammation-induced matrix degradation–a review. Int J Cosmet Sci 27:17–34

    Article  CAS  PubMed  Google Scholar 

  44. Brenner DR, Scherer D, Muir K et al (2014) A review of the application of inflammatory biomarkers in epidemiologic cancer research. Cancer Epidemiol Prev Biomark cebp. 0064.2014

  45. Nair-Shalliker V, Dhillon V, Clements M, Armstrong BK, Fenech M (2014) The association between personal sun exposure, serum vitamin D and global methylation in human lymphocytes in a population of healthy adults in South Australia. Mutat Res/Fundam Mol Mech Mutagen 765:6–10

    Article  CAS  Google Scholar 

  46. Wheless L, Black J, Alberg AJ (2010) Nonmelanoma skin cancer and the risk of second primary cancers: a systematic review. Cancer Epidemiol Prev Biomark 19:1686–1695

    Article  Google Scholar 

Download references

Acknowledgments

Dylan O’Sullivan is supported by a Queen Elizabeth II Scholarship and an Empire Life Fellowship. Troy Hillier is supported by an Empire Life Fellowship. Darren Brenner holds a Canadian Cancer Society Cancer Prevention Capacity Development Award (#703917).

Author information

Authors and Affiliations

  1. Department of Public Health Sciences, Queen’s University, Carruthers Hall, 62 Fifth Field Company Lane, 2nd floor, Kingston, ON, K7L 3N6, Canada

    Dylan E. O’Sullivan, Troy W. R. Hillier & Will D. King

  2. Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Holy Cross Centre, 2210-2nd Street SW, Box ACB, Calgary, AB, T2S 3C3, Canada

    Darren R. Brenner & Cheryl E. Peters

  3. Department of Oncology, University of Calgary, Calgary, AB, Canada

    Darren R. Brenner & Cheryl E. Peters

Authors
  1. Dylan E. O’Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Troy W. R. Hillier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darren R. Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheryl E. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Will D. King
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dylan E. O’Sullivan.

Ethics declarations

Conflict of interest

No conflicts of interest exist.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 139 KB)

Supplementary material 2 (DOCX 14 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

O’Sullivan, D.E., Hillier, T.W.R., Brenner, D.R. et al. Indoor tanning and the risk of developing non-cutaneous cancers: a systematic review and meta-analysis. Cancer Causes Control 29, 937–950 (2018). https://doi.org/10.1007/s10552-018-1070-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-018-1070-8

Keywords

Search

Navigation