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dc.contributor.authorRueegg, Corina Silvia
dc.contributor.authorStenehjem, Jo S.
dc.contributor.authorEgger, Matthias
dc.contributor.authorGhiasvand, Reza
dc.contributor.authorCho, Eunyoung
dc.contributor.authorLund, Eiliv
dc.contributor.authorWeiderpass, Elisabete
dc.contributor.authorGreen, Adele
dc.contributor.authorVeierød, Marit Bragelien
dc.date.accessioned2019-02-08T07:37:54Z
dc.date.available2019-02-08T07:37:54Z
dc.date.issued2018-11-16
dc.description.abstractWhether 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, <i>P</i><sub>heterogeneity</sub> < 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, <i>P</i><sub>heterogeneity</sub> < 0.001) and was positively associated in the cohort studies (HR = 1.27, 95%CI 1.07–1.51, <i>P</i><sub>heterogeneity</sub> = 0.236). The association differed by latitude (<i>P</i><sub>interaction</sub> = 0.042), region (<i>P</i><sub>interaction</sub> = 0.008), adjustment for naevi/freckling (<i>P</i><sub>interaction</sub> = 0.035), and proportion of never‐sunscreen‐users (<i>P</i><sub>interaction</sub> = 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.en_US
dc.description.sponsorshipThe Institute of Basic Medical Sciences University of Oslo Kreftforeningen (Norwegian Cancer Society) National Institutes of Healthen_US
dc.descriptionSource at <a href=https://doi.org/10.1002/ijc.31997> https://doi.org/10.1002/ijc.31997</a>.en_US
dc.identifier.citationRueegg, C.S., Stenehjem, J.S., Egger, M., Ghiasvand, R., Cho, E., Lund, E., ... Veierød, M.B. (2018). Challenges in assessing the sunscreen-melanoma association. <i>International Journal of Cancer</i>. https://doi.org/10.1002/ijc.31997en_US
dc.identifier.cristinIDFRIDAID 1660496
dc.identifier.doi10.1002/ijc.31997
dc.identifier.issn0020-7136
dc.identifier.issn1097-0215
dc.identifier.urihttps://hdl.handle.net/10037/14650
dc.language.isoengen_US
dc.publisherWileyen_US
dc.relation.journalInternational Journal of Cancer
dc.relation.projectIDinfo:eu-repo/grantAgreement/EC/FP7-PEOPLE/609020/EU/SCIENTIA-FELLOWS: International Postdoctoral Fellowship Programme/SCIENTIA-FELLOWS/en_US
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Oncology: 762en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Onkologi: 762en_US
dc.subjectskin canceren_US
dc.subjectsunscreenen_US
dc.subjectmelanomaen_US
dc.subjectmeta‐analysisen_US
dc.subjectsun protectionen_US
dc.titleChallenges in assessing the sunscreen-melanoma associationen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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