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1、ACritiqueoftheIARCMeta-AnalysisoftheAssociationofSunbedUse withMelanomaWilliamB.Grant,Ph.D.Director,SUNARCPresentationtotheFDA,March25,2010MainPointsAcausallinkbetweensunbeduseandriskofmelanomahasnotbeenmade,sinceseveralofthecriteriaforcausalityinabiologicalsystemhavenotbeensatisfied.Theheal
2、thbenefitsofsunbedusegreatlyoutweighanyhealthrisks.CriticismNo.1TheIARCreportincludedstudiesfromtheUKwithoutcorrectionforskintypeandgeneticrisk(variantoftheMC1Rgene)formelanoma.Whenthe5UKstudiesareomitted,theoddsratioofmelanomafromeveruseofsunbedsdropstoabout1.05(95%CI,0.93-1.19).WBGrant.Cri
3、tiqueoftheInternationalAgencyforResearchonCancermeta-analysesoftheassociationofsunbedusewithriskofcutaneousmalignantmelanoma.Dermato-Endocrinology,Nov-Dec2009;1(1)epub.TheFiveUKStudiesTheOther14Studies+1: NotStatisticallySignificantCriticismNo.2IntheonlyUSstudyofmelanomaincidencewithrespectt
4、ofirstuseofsunbedspriortoage35yearsintheIARCreport,thecommercialsunbeddatawereconflatedwiththosefromhomesunlampuse.ThelampsandusepatternsdifferforthetwoUVsystems.Anestimatefortheoddsratioforcommercialsunbeddatapriortoage30yearsbasedon23caseswas0.80(95%CI,0.43-1.49),not1.3asusedintheIARCrepor
5、t.ChenYT,DubrowR,ZhengT,BarnhillRL,FineJ,BerwickM.Sunlampuseandtheriskofcutaneousmalignantmelanoma:apopulation-basedcase-controlstudyinConnecticut,USA.IntJEpidemiol.1998Oct;27(5):758-65.GraphofRelativeRiskforMelanomaforFirstUseBeforeAge35Yearsvs.LatitudeRRIIIIIICriticismNo.3UsingstudiesfromN
6、orthernEuropeforfirstuseofsunbedspriortoage35yearstoguidepoliciesintheU.Sisincorrect:SunbedsusedinEuropearelimitedto1.5%UVBoftotalUV;thoseintheU.S.generallyhave3-5%UVB,asdoesmidlatitude,middaysolarUV.UVBinmoderationandvitaminDreducetheriskofmelanoma.CriticismNo.4ManyofthestudiesintheIARCmeta
7、-analysisdidnotcontrolforconfoundingfactors.SeveralauthorsadmittedthatitisverydifficulttoseparateouttheeffectsofsolarUVirradiancefromsunbeduse.ConfoundingFactorsforMelanomaRiskfactors:Skintype1,variantoftheMC1RgeneamongthosewithCelticancestry(redha
