The Medical Minute: A darker side of tanning

This year, like every year, more than one-third of Americans will get at least one sunburn. According to the Skin Cancer Foundation, the risk of melanoma -- the deadliest type of skin cancer -- more than doubles with just one severe sunburn in childhood or adolescence or from five such over exposures in a lifetime.

But the sun isn't the only culprit. Evidence that indoor tanning is associated with skin cancer is mounting. The use of tanning beds accelerates ultraviolet (UV) exposure. The International Agency for Research on Cancer Working Group on artificial UV light and skin cancer published a meta-analysis that reviewed numerous published studies on this topic. The study included information on the newest tanning technologies, finding that machines emitting both types of ultraviolet light (UVA and UVB), and clearly establishing that there is a 75 percent increased risk of melanoma in indoor tanning bed use before age 35, and a 225 percent increased risk of squamous cell carcinoma associated with every use of indoor tanning.

Evidence linking artificial UV exposure to both malignant melanoma and non-melanoma skin cancer is now certain. Although knowledge of these harmful effects has become more widespread over the past decade, the use of indoor tanning facilities is more popular than ever, especially among young adults.

The indoor tanning industry is a multibillion dollar enterprise. In addition to publishing advertisements in mainstream media publications, the industry also has published UV tanning advertisements in high school newspapers and websites as a safe method to tan. However, tanning is never safe, according to the International Agency for Research on Cancer. The intense UV rays in those beds can cause permanent skin damage, higher incidence of melanoma and other skin cancers, premature aging, weakened immune systems and eye damage.

The International Agency for Research on Cancer, part of the World Health Organization, listed UV radiation-emitting beds as "carcinogenic to humans," its highest category of cancer risks. Recently, Congress included a 10 percent tax on indoor tanning in the health reform bill to help pay for expanding medical costs and to make it harder for teens to afford indoor tanning. A tax on indoor tanning services serves as a reminder from the federal government to young people that indoor tanning is dangerous and should be avoided. The Food and Drug Administration is considering reclassifying tanning beds as a higher-class medical device subject to more stringent regulations.

More than 30 states have created regulations to limit teen use of indoor tanning. However, these rules aren't always enforced, and there are no restrictions for those 18 and older. In Pennsylvania, three bills were introduced in 2010 to limit exposure. The bills would require approval from a parent or legal guardian for anyone under age 18 to use indoor tanning, with penalties for tanning facilities that allow minors to use tanning devices without consent.

Also, the bills would require the facility to provide and require the use of protective goggles and limit exposure to the manufacturer's recommendation.

A second reason indoor tanning remains popular despite mounting evidence of the dangers, is that the tanning industry has argued that cutaneous production of vitamin D outweighs the risks of UV exposure to skin. This argument is deeply flawed because oral supplements of vitamin D produce identical (and more predictable) vitamin D supplementation without carcinogenic risk. The Federal Trade Commission recently warned the Indoor Tanning Association about making false claims about the health benefits of indoor tanning.

Third, and perhaps more important, is that indoor tanning could be addictive, as suggested by several studies measuring criteria of addiction. This year, a study published at Archives of Dermatology presented compelling evidence that, for a significant subset of young adults, indoor tanning may be more of an addiction than a choice. In fact, the authors found a greater proclivity to substance abuse, depression and anxiety, suggesting that habitual tanning may be a predictor of other addictive behaviors, such as alcoholism and cigarette smoking.

This new evidence points to habitual indoor tanning as a serious health issue that is potentially addictive. Teens, as well as adults, will most likely hear more than a few stern words of warning from doctors about the risks, the proven damage and the harmful effects of tannning.

Rogerio Izar Neves, M.D., Ph.D., is associate professor of Surgery, Dermatology and Pharmacology; director, Melanoma and Cutaneous Oncology Program; Clinical Science Leader, Melanoma and Skin Disease Area - Experimental Therapeutics Program, Penn State Hershey Cancer Institute; and medical director, Penn State Hershey Cosmetic Surgery.

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Last Updated July 22, 2010