Alcohol Drinking and Cutaneous Melanoma Risk: A Systematic Review and Dose–Risk Meta-analysis

M. Rota; E. Pasquali; R. Bellocco; V. Bagnardi; L. Scotti; F. Islami; E. Negri; P. Boffetta; C. Pelucchi; G. Corrao; C. La Vecchia

Disclosures

The British Journal of Dermatology. 2014;170(5):1021-1028. 

In This Article

Abstract and Introduction

Abstract

It has been suggested that alcohol intake increases sunburn severity, a major risk factor for cutaneous melanoma (CM). Several epidemiological studies have investigated the relationship between alcohol consumption and CM, but the evidence is inconsistent. Therefore, we aimed to quantify this relationship better, using a meta-analytical approach. The dose–risk relationship was also modelled through a class of flexible nonlinear meta-regression random effects models. The present meta-analysis included 16 studies (14 case–control and two cohort investigations) with a total of 6251 cases of CM. The pooled relative risk (RR) for any alcohol drinking compared with no/occasional drinking was 1·20 [95% confidence interval (CI) 1·06–1·37]. The risk estimate was similar in case–control (RR 1·20, 95% CI 1·01–1·44) and cohort studies (RR 1·26, 95% CI 1·19–1·35). The pooled RR was 1·10 (95% CI 0·96–1·26) for light alcohol drinking (≤ 1 drink per day) and 1·18 (95% CI 1·01–1·40) for moderate-to-heavy drinking. The pooled RR from 10 studies adjusting for sun exposure was 1·15 (95% CI 0·94–1·41), while the RR from six unadjusted studies was 1·27 (95% CI 1·20–1·35). No evidence of publication bias was detected. This meta-analysis of published data reveals that alcohol consumption is positively associated with the risk of CM. However, caution in interpreting these results is required, as residual confounding by sun exposure cannot be ruled out.

Introduction

Cutaneous melanoma (CM) accounted for about 5% of all newly diagnosed cases of cancer in the U.S.A. in 2013, being slightly more frequent in men than in women.[1] Data from population-based cancer registries showed that CM accounted for 3% of all cancer cases in Europe in 2012.[2] Stable trends in incidence rates and a decrease in mortality rates have recently been observed in Australia, New Zealand, the U.S.A., Canada and Western European countries as a result of primary and secondary prevention campaigns, while incidence and mortality rates are still increasing in selected Eastern European countries.[3]

Exposure to ultraviolet (UV) radiation from the sun is the main established cause of CM.[4] A meta-analysis of 57 published studies investigating the pattern of sun exposure found that intermittent sun exposure and sunburn history played a key role in melanoma, with relative risks (RRs) of 1·61 [95% confidence interval (CI) 1·31–1·99] and 2·03 (95% CI 1·73–2·37), respectively.[5] Among host factors, phenotypic measures of sun sensitivity such as fair skin, number of naevi and freckling confer an approximate twofold increased risk of CM.[6]

Alcohol consumption is one of the most important, and potentially avoidable, risk factors of human cancers.[7] About 3·6% of all cancers (5·2% in men, 1·7% in women) are attributable to alcohol drinking worldwide.[8] In Western societies, consumption of alcoholic beverages during outdoor leisure activities such as barbecuing and sunbathing is common.[9] Alcohol intake may increase sunburn severity, which, in turn, increases the risk of CM.[10] The relationship between alcohol drinking and CM risk has been investigated in several, mainly case–control, studies,[11–26] but results have been inconsistent. Only two cohort studies have investigated this association.[19,25] Freedman et al.[19] found a positive, nonsignificant association in a large cohort of 68 588 white U.S. radiological technologists. Similarly, the Million Women Study cohort showed a 4% increase (95% CI −3% to 12%) in the risk of CM for an increment of 10 g per day of alcohol intake.[25]

To provide a quantitative assessment of the association in larger numbers of CM cases and control groups, we performed a systematic review and meta-analysis of observational studies investigating the relationship between alcohol drinking and CM.

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