LNSLNS

For our analysis on attributable cancer burden (1), we selected risk factors for which there is convincing evidence for a causal relationship with cancer. Ultraviolet (UV) radiation from UV-emitting devices, such as solariums, is considered to be causally related to malignant melanoma (2). Based on this, we calculated the proportions of melanoma due to solarium use.

The risk estimates used to calculate these population-attributable fractions have been taken from a published meta-analysis. In this study, the selection of risk estimates from the individual studies took into account the adjustment of all reported confounding variables (3). This is particularly important as sunbed users tend to be more likely to expose themselves to natural sunlight. As individual studies have also adjusted for exposure to natural UV radiation, it is unlikely that the summary risk estimates for solarium use reflect only higher levels of sunlight exposure among sunbed users (3).

Additionally, the meta-analysis mentioned by Reichrath et al., in which they themselves participated (4), showed a significantly increased risk of melanoma among sunbed users. In extensive subgroup analyses, a higher melanoma risk among sunbed users was consistently found in all subgroups, although not all subgroup results reached statistical significance. Overall, the results of this meta-analysis thus also support such a correlation.

It is vital for us to point out possible conflicts of interest in such studies and correspondences. We see such a potential conflict of interest in the meta-analysis cited by Reichrath et al., which received financial support from the Jörg Wolff Foundation, whose foundation funds come from JW Holding GmbH, which in turn is active in the business area “indoor tanning” and includes suppliers of UV tanning lamps and solariums.

DOI: 10.3238/arztebl.2019.0135b

Thomas Gredner MPH

Klinische Epidemiologie und Alternsforschung,

Deutsches Krebsforschungszentrum (DKFZ), Heidelberg

Medizinische Fakultät Heidelberg, Universität Heidelberg

t.gredner@dkfz-heidelberg.de

PD Dr. sc. hum. Ute Mons

Klinische Epidemiologie und Alternsforschung;

Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ),

Heidelberg

Prof. Dr. med. Hermann Brenner

Klinische Epidemiologie und Alternsforschung,

Deutsches Konsortium für Translationale Krebsforschung (DKTK),

Deutsches Krebsforschungszentrum (DKFZ); Abteilung Präventive Onkologie (DKFZ) und Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg

Conflict of interest statement
The authors declare that no conflict of interest exists.

1.
Gredner T, Behrens G, Stock C, Brenner H, Mons U: Cancers due to infection and selected environmental factors—estimation of the attributable cancer burden in Germany. Dtsch Arztebl Int 2018; 115: 586–93 VOLLTEXT
2.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: A review of human carcinogens. Part D: Radiation. IARC Monogr Eval Carcinog Risks Hum 2009.
3.
Boniol M, Autier P, Boyle P, Gandini S: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345: e4757 CrossRef MEDLINE PubMed Central
4.
Burgard B, Schöpe J, Holzschuh I, et al.: Solarium use and risk for malignant melanoma: meta-analysis and evidence-based medicine systematic eeview. Anticancer Res 2018; 38: 1187–99. Review MEDLINE
1.Gredner T, Behrens G, Stock C, Brenner H, Mons U: Cancers due to infection and selected environmental factors—estimation of the attributable cancer burden in Germany. Dtsch Arztebl Int 2018; 115: 586–93 VOLLTEXT
2. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: A review of human carcinogens. Part D: Radiation. IARC Monogr Eval Carcinog Risks Hum 2009.
3. Boniol M, Autier P, Boyle P, Gandini S: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345: e4757 CrossRef MEDLINE PubMed Central
4. Burgard B, Schöpe J, Holzschuh I, et al.: Solarium use and risk for malignant melanoma: meta-analysis and evidence-based medicine systematic eeview. Anticancer Res 2018; 38: 1187–99. Review MEDLINE

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