Abstract
In this ecological study, we drew upon recently published melanoma prevalence data, and compared them with historical market data and published socio-economic data to test for an association between historical sunscreen sales (1997-1999) and recent melanoma incidences (2008 and 2012) in 24 countries in Northern Europe. We also explored associations between current melanoma incidences and historical data on the following socio-demographic indicators: income, urbanization, and population aging. Melanoma incidences were higher in high-income countries where sales of sunscreen were also higher. Our results show that, at the population level, income was significantly associated with melanoma incidences, β = 0.0003, t(19) = 3.104, p < .006, and that increased sunscreen sales has not prevented higher income populations from being at higher risk of melanoma.
Highlights
The overall global incidence of cutaneous malignant melanoma has been sharply growing over the past 50 years, with the highest rates outside of Australia and New Zealand being seen in a number of Northern European countries (Erdmann et al, 2013)
We drew upon recently published melanoma prevalence data, and compared these data with historical market data and published socio-economic data to test for an association between historical sunscreen sales and recent melanoma incidence in 24 countries in Northern Europe
Contrary to our hypothesis, higher sunscreen sales were associated with higher melanoma incidences
Summary
The overall global incidence of cutaneous malignant melanoma has been sharply growing over the past 50 years, with the highest rates outside of Australia and New Zealand being seen in a number of Northern European countries (Erdmann et al, 2013). Recent 10-year follow-up evidence from a randomized controlled trial suggests that melanoma may be prevented by using sunscreen, provided it is used optimally (i.e., applied every morning and reapplied after heavy sweating, bathing, or long sun exposure; Green, Williams, Logan, & Strutton, 2011). Despite Green et al.’s (2011) study providing strong evidence for the effectiveness of sunscreen under trial conditions (Robinson & Bigby, 2011), historical evidence from the late 1990s has shown that, in practice, many people do not apply sunscreen optimally (Robinson & Rademaker, 1998; Wartha Wright, Wright, & Wagner, 2001). One of the main limitations of such case–control studies is that they are based on sunscreen use questionnaires, which use broad and sometimes subjective categories to measure the frequency of sunscreen use (e.g., “often”/“rarely”/“always,” Wolf et al, 1998) and are subject to recall bias. There have been no cross-national, population-based ecological studies exploring the association between melanoma prevalence and sunscreen sales data
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