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Exposure to solar ultraviolet (UV) radiation is a known cause of skin cancer. Sunbed use represents an increasingly frequent source of artificial UV exposure in light‐skinned populations. To assess the available evidence of the association between sunbed use and cutaneous malignant melanoma (melanoma) and other skin cancers, a systematic review of the literature till March 2006 on epidemiological and biological studies on sunbed use was performed in Pubmed, ISI Web of Science, Embase, Pascal, Cochrane library, Lilacs and Medcarib. Search for keywords in the title and in the abstract was done systematically and supplemented by manual searches. Only case–control, cohort or cross‐sectional studies were selected. Data were abstracted by means of a standardized data‐collection protocol. Based on 19 informative studies, ever‐use of sunbeds was positively associated with melanoma (summary relative risk, 1.15; 95% CI, 1.00–1.31), although there was no consistent evidence of a dose–response relationship. First exposure to sunbeds before 35 years of age significantly increased the risk of melanoma, based on 7 informative studies (summary relative risk, 1.75; 95% CI, 1.35–2.26). The summary relative risk of 3 studies of squamous cell carcinoma showed an increased risk. For basal cell carcinoma, the studies did not support an association. The evidence does not support a protective effect of the use of sunbeds against damage to the skin from subsequent sun exposure. Young adults should be discouraged from using indoor tanning equipment and restricted access to sunbeds by minors should be strongly considered. © 2006 Wiley‐Liss, Inc.

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Background: Lower risk of breast cancer has been reported among physically active women, but the risk in women using hormone replacement therapy (HRT) appears to be higher. We quantified the association between physical activity and breast cancer, and we examined the influence that HRT use and other risk factors had on this association. Methods: After a systematic literature search, prospective studies were meta-analysed using random-effect models applied on highest vs. lowest level of physical activity. Dose-response analyses were conducted with studies reporting physical activity either in hours/week or in hours of metabolic equivalent per week (MET-h/week). Results: The literature search identified 38 independent prospective studies published between 1987 and 2014 that included 116,304 breast cancer cases. Compared to the lowest level of physical activity, the highest level was associated with a summary relative risk (SRR) of 0.88 (95% CI (0.85, 0.90)) for all breast cancer, 0.89 (95%CI (0.83, 0.95)) for ER+/PR+ breast cancer and 0.80 (95%CI (0.69, 0.92)) for ER-/PR-breast cancer. Risk reductions were not influenced by the type of physical activity (occupational or non-occupational), adiposity, and menopausal status. Risk reductions increased with increasing amounts of physical activity, without threshold effect. In six studies, the SRR was 0.78 (95% CI (0.70, 0.87)) in women who never used HRT and 0.97 (95% CI (0.88, 1.07)) in women who ever used HRT, without heterogeneity in results. Findings indicate that a physically inactive women engaging in at least 150 minutes per week of vigorous physical activity would reduce their lifetime risk of breast cancer by 9%, a reduction that might be two times greater in women who never used HRT. Conclusion: Increasing physical activity is associated with meaningful reductions in the risk of breast cancer, but in women who ever used HRT, the preventative effect of physical activity seems to be cancelled out.

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Some observational studies have suggested an increased risk of breast cancer (BC) among diabetic patients. A meta-analysis was performed to assess the risk of BC in diabetic patients compared to nondiabetic patients. Studies were selected if they had a prospective design. Studies that compared BC incidence in women with diabetes to the incidence in the general population were excluded. Summary relative risks (SRR) were computed using a random-effect model. Eighteen studies were included in the meta-analysis, including 28,230,143 person-years of follow-up and 320,111 BC cases. A significantly increased risk of BC among diabetic patients compared to nondiabetic patients was found: SRR=1.13 (95% CI: 1.04, 1.24). There was a large amount of unexplained heterogeneity of results across studies (I²=95%), but no indication of publication bias. The SRR remained similar when the analysis was restricted to post-menopausal women (SRR=1.12 (95% CI: 0.99, 1.26)). Only two studies reported data in pre-menopausal women. In the 9 studies that adjusted for adiposity, both the SRR and the heterogeneity of results across studies substantially decreased (SRR=1.(95% CI: 0.97, 1.14), I²=21%). In contrast, in the 9 studies that did not adjust for adiposity, both the SRR and the heterogeneity increased (SRR=1.19 (95% CI: 1.01, 1.39), I²=98%). Only two studies included 1,723 and 14 BC cases among type 1 diabetic women. The RR for BC were 0.90 (95% CI: 0.85, 0.94) and RR=1.01 (95% CI: 0.60, 1.71), respectively. This analysis provides evidence for a moderately increased risk of BC in diabetic patients. The effect of the adjustment for BMI on the SRR and on the heterogeneity suggests that the increased BC risk appears to be linked to adiposity, and not to being diabetic. New studies should collect data allowing the assessment of Breast Cancer risk according to the duration of diabetes and treatments that favour weight loss. Disclosure M. Bota: None. P. Autier: Other Relationship; Self; Sanofi. P. Boyle: Other Relationship; Self; Sanofi.