A prospective cohort study exploring the joint influence of sunlight exposure and tanning bed use on basal cell carcinoma, squamous cell carcinoma, and melanoma risk
Megan M. Tran1 · Elisabeth A. George-Washburn2 · Jongeun Rhee1 · Wen-Qing Li1,3 · Abrar Qureshi1,4 · Eunyoung Cho1,4,5
Received: 2 March 2024 / Revised: 23 April 2024 / Accepted: 2 May 2024 / Published online: 25 May 2024 © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024
Abstract
Exposure to solar ultraviolet (UV) radiation and use of UV-emitting tanning devices are known risk factors for skin cancer. Few studies have explored the interaction between these risk factors, namely how the risk of skin cancer increases among those who both have been exposed to high levels of natural sunlight and regularly use tanning beds. Nurses’ Health Study II followed 116,430 women, aged 25–42, from 1991 to 2011. Cumulative average UV exposure was based on partici- pants’ residences at follow-up periods. History of severe sunburn during ages 15–20 was used as a proxy for early-life sunlight exposure. Tanning bed use in early life data was collected. Participants reported melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) diagnoses. We built multivariable Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of skin cancer associated with joint effects of sunlight exposure and tanning bed use. Participants with high sunlight exposure and tanning bed use during high school/college had an increased risk of BCC (HR = 1.53, 95% CI 1.37–1.71, Pinteraction=0.01; vs. low sun exposure and no tanning bed use). Participants with a history of severe sunburns and tanning bed use during high school/college were at increased risk of BCC (HR = 1.62, 95% CI 1.47–1.79, Pinteraction=0.02; vs. no sunburns and no tanning bed use). No significant interactions were found between sunlight exposure and tanning bed use on SCC and melanoma risk. We found significant interactions between sunlight exposure and tanning bed use on the risk of BCC.
Keywords Skin cancer risk factors · Indoor tanning beds · Skin cancer prevention · Geospatial analysis (GIS) · action analysis
GKB-NON-2024-00555