Abstract
This study uses weighted national survey data to examine the prevalence of skin cancer examinations among users of indoor tanning beds.
Skin cancer examinations may be critical for the early detection and treatment of skin cancer.1 Although no general population-level screening guidelines exist,2 many US medical organizations advise that individuals at an increased risk of skin cancer, including users of indoor tanning beds, may benefit from routine screening.3 In addition, policy changes have advocated for regular skin cancer examinations in this high-risk group. In 2014, the US Food and Drug Administration4 issued a reclassification of UV lamps for tanning from low-risk class I medical devices—the same designation as elastic bandages and dental floss—to moderate- to high-risk class II devices. The order also put into place stricter requirements for device labeling, including the warning directive recommending, “Persons repeatedly exposed to UV radiation should be regularly evaluated for skin cancer.”4 Given the renewed discussion about skin cancer screening among users of indoor tanning beds, the purpose of this investigation was to assess the prevalence of professional skin cancer examinations (PSEs) and skin cancer self-examinations (SSEs) among those who engage in indoor tanning behavior using estimates from a recent national survey.
Methods
Data were obtained from the National Cancer Institutes’ Health Information National Trends Survey (HINTS), administered from January through April 2017, to 3285 participants. HINTS is a nationally representative survey of civilian, noninstitutionalized adults in the United States.5 Participants indicated whether they had engaged in indoor UV tanning in the past 12 months and whether they ever conducted SSEs or had PSEs for signs of cancer. Skin cancer examination items were phrased in present tense (ie, “Do you ever check your skin for signs of cancer?” and “Do you ever have your skin examined by a health professional for signs of skin cancer?”). Values represent the proportion of population selecting responses of “Yes, regularly” or “Yes, but not regularly.” Responses of “I don’t know” and multiple responses selected in error were coded as missing (53 for SSE and 91 for PSE). Multivariable logistic regression models assessed whether indoor tanning was associated with the likelihood of SSEs and PSEs, controlling for relevant covariates (age, sex, race, educational level, and frequency of medical visits [in the PSE analysis only]). All analyses were weighted to be nationally representative and accounted for the complex sampling design. The National Institutes of Health Office of Human Research Protections has determined that analyses of publicly available HINTS data meet criteria for exempted human subjects research; all original data collection for HINTS was conducted in full accordance with National Institutes of Health Office of Human Research Protections policies and practices.
Results
The 3285 respondents included 1327 men (40.4%) and 1958 women (59.6%); mean (SD) age, 56.3 (16.1) years. The data were weighted to be nationally representative and showed that 3.5% (SE, 0.6%) of adults reported using an indoor tanning bed at least once during the previous 12 months. Among users, 75.3% (SE, 6.9%) reported having performed an SSE, compared with 55.4% (SE, 1.5%) of nonusers (Table 1). Fewer people reported ever having had a PSE; however, examinations were more common among users of indoor tanning beds (60.0% [SE, 8.5%]) compared with nonusers (40.1% [SE, 1.4%]).
Table 1. Reported Prevalence of SSEs and PSEs by Indoor Tanning Status and Demographic Variablesa.
| Variable | Use of Indoor Tanning Beds, Weighted Prevalence (SE), % | |||
|---|---|---|---|---|
| Users | Nonusers | |||
| SSE | PSE | SSE | PSE | |
| Overall | 75.3 (6.9) | 60.0 (8.5) | 55.4 (1.5) | 40.1 (1.4) |
| Sex | ||||
| Male | 62.0 (15.4) | 54.8 (15.1) | 48.7 (2.4) | 37.2 (2.2) |
| Female | 79.4 (7.0) | 61.6 (9.9) | 62.1 (1.7) | 42.9 (1.7) |
| Race | ||||
| White | 79.1 (6.9) | 59.0 (9.0) | 62.9 (1.8) | 47.1 (1.7) |
| Black or African American | 0 | 100 | 29.7 (3.5) | 16.9 (2.3) |
| Other | 37.0 (21.0) | 64.1 (19.0) | 33.8 (3.7) | 18.5 (2.6) |
| Educational level | ||||
| Less than high school | 76.5 (20.0) | 78.1 (19.7) | 30.1 (4.5) | 21.3 (4.3) |
| High school | 70.9 (12.6) | 44.6 (12.6) | 50.5 (2.6) | 33.9 (2.4) |
| Some college | 77.5 (10.9) | 69.6 (12.7) | 62.3 (3.9) | 44.0 (3.7) |
| College graduate or higher | 80.3 (7.1) | 71.1 (8.5) | 61.0 (2.0) | 47.2 (2.0) |
| Age, y | ||||
| 18-29 | 87.5 (9.5) | 62.8 (25.8) | 43.9 (5.5) | 22.4 (4.0) |
| 30-39 | 76.2 (11.4) | 51.9 (14.6) | 49.8 (4.1) | 30.5 (3.3) |
| 40-49 | 66.5 (20.7) | 50.3 (16.3) | 49.0 (3.5) | 38.2 (3.6) |
| 50-64 | 79.7 (10.3) | 75.2 (10.7) | 60.9 (2.4) | 43.4 (2.3) |
| 64-75 | 76.6 (12.8) | 57.1 (16.0) | 67.9 (2.4) | 56.5 (2.5) |
| ≥75 | 0 | 0 | 64.9 (3.4) | 59.6 (3.4) |
Abbreviations: PSE, professional skin cancer examination; SSE, skin cancer self-examination.
Data are weighted to be nationally representative.
Among users of indoor tanning beds, 30.7% (SE, 9.3%) reported engaging in SSEs regularly (compared with 17.2% [SE, 1.0%] of nonusers). Only 9.6% (SE, 9.6%) of indoor tanning bed users indicated having regular PSEs (compared with 13.7% [SE, 0.9%] of nonusers); however, 48.7% (SE, 8.8%) of users indicated having PSEs but not regularly (compared with 25.8% [SE, 1.2%] of nonusers). Forty-six respondents indicated they did not know whether they had a PSE.
In the adjusted model, users of indoor tanning beds were significantly more likely to have conducted an SSE (odds ratio, 2.60; 95% CI, 1.03-6.53; P = .04) than nonusers. Users were also more likely to report having had a PSE (odds ratio, 3.28; 95% CI, 1.26-8.52; P = .02) than were nonusers (Table 2). Thirty-eight individuals reported having been diagnosed with melanoma. Of these, 37 (97.4%) reported conducting SSEs and 35 (92.1%) reported having a PSE. Only 1 individual reported engaging in indoor tanning in the past 12 months. Among 145 individuals having undergone radiation therapy for a cancer diagnosis, 105 (71.9%) reported engaging in SSEs and 78 (54.5%) reported having a PSE. Only 1 individual reported engaging in indoor tanning in the previous 12 months.
Table 2. Logistic Regression Models for Associations With Skin Cancer Screening.
| Variable | SSE Screening | PSE Screening | ||
|---|---|---|---|---|
| OR (95% CI) | P Value | OR (95% CI) | P Value | |
| Sex | ||||
| Male | 0.56 (0.43-0.72) | <.001 | 0.81 (0.63-1.04) | >.99 |
| Female | 1 [Reference] | NA | 1 [Reference] | NA |
| Race | ||||
| White | 1 [Reference] | NA | 1 [Reference] | NA |
| Black or African American | 0.25 (0.17-0.37) | <.001 | 0.26 (0.18-0.38) | <.001 |
| Other | 0.30 (0.21-0.42) | <.001 | 0.23 (0.14-0.39) | <.001 |
| Educational level | ||||
| Less than high school | 1 [Reference] | NA | 1 [Reference] | NA |
| High school graduate | 2.16 (1.28-3.64) | .004 | 1.48 (0.79-2.79) | .22 |
| Some college | 3.22 (1.82-5.71) | <.001 | 2.43 (1.27-4.65) | .008 |
| College graduate or higher | 4.20 (2.52-6.98) | <.001 | 3.99 (2.15-7.41) | <.001 |
| Age | 1.02 (1.01-1.03) | <.001 | 1.04 (1.03-1.04) | <.001 |
| Frequency of medical visits | NA | NA | 1.18 (1.09-1.26) | <.001 |
| Indoor tanning | ||||
| No | 1 [Reference] | NA | 1 [Reference] | NA |
| Yes | 2.60 (1.03-6.53) | .04 | 3.28 (1.26-8.52) | .02 |
Abbreviations: NA, not applicable; OR, odds ratio; PSE, professional skin cancer examination; SSE, skin cancer self-examination.
Discussion
These data provide insight into the frequency of skin cancer examinations among users of indoor tanning beds. Individuals who engaged in indoor tanning behavior were more likely to have checked their skin for signs of cancer and to have had a PSE of their skin. This higher prevalence rate may be attributable to greater knowledge of the risks of UV exposure among users of indoor tanning beds that is reinforced by US Food and Drug Administration–mandated warning labels on tanning devices. Limitations of this study include unknown individual differences in skin type (ie, sun sensitivity) or condition (ie, number of pigmented lesions) that may be associated with indoor tanning and skin cancer examinations. In addition, the temporal nature of these associations cannot be determined from cross-sectional data. Although the framing of survey items about skin cancer examinations refers to present behavior, it does not specify a time frame, and whether skin cancer examinations and indoor tanning occurred during the same period is unknown. Future research is needed to monitor relative frequency and type of skin cancer examinations undertaken by high-risk groups and to gauge the effect of policy changes on the behavior of indoor UV tanning device users.
References
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