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    Challenges in assessing the sunscreen - Melanoma Association.

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    Authors
    Rueegg, CS
    Stenehjem, JS
    Egger, M
    Ghiasvand, R
    Cho, E
    Lund, E
    Weiderpass, E
    Green, Adèle C
    Veierod, MB
    Affiliation
    Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway
    Issue Date
    2018
    
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    Abstract
    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 28.02.2018. 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 randomized 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 towards decreased melanoma risk amongst 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. KEYWORDS: Sunscreen; melanoma; meta-analysis; skin cancer; sun protection
    Citation
    Rueegg CS, Stenehjem JS, Egger M, Ghiasvand R, Cho E, Lund E, et al. Challenges in assessing the sunscreen - Melanoma Association. Int J Cancer. 2018 Nov 16.
    Journal
    Int J Cancer
    URI
    http://hdl.handle.net/10541/621383
    DOI
    10.1002/ijc.31997
    PubMed ID
    30447006
    Additional Links
    https://dx.doi.org/10.1002/ijc.31997
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1002/ijc.31997
    Scopus Count
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    All Paterson Institute for Cancer Research

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