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That Glorious Tan

Source: valley Advocate, By Stephanie Kraft, July 2014

Is that just-back-from-the-Caribbean look worth the risk of cancer down the road?

‘Tis the season that proves that the appeal of tanning salons is in no way limited to winter. Now that the beaches begin to lure vacationers, those looking for a toasty skin tone find their way to the salons to get a beginning layer.

But last month, just as it was about time to start checking out new beachwear and low-maintenance summer hair styles to go with that bronze skin tone, the federal Food and Drug Administration shook a warning finger at indoor tanning operations. It handed down a requirement that tanning beds and lamps carry warnings that they should not be used by people under 18, and raised their former designation as low-risk devices to moderate-risk.

It also ordered that instruction manuals and materials used to market the devices carry recommendations that users be monitored for skin cancer on a regular basis.

The FDA’s action is the latest in a long series of warnings by health agencies about connections between indoor tanning and cancer. In 2009 the International Agency for Research on Cancer (IARC), a branch of the World Health Organization, added UV exposure, including exposure from tanning beds, to its list of human carcinogens after reviewing studies from as far back as 25 years.

In January, a study entitled International Prevalence of Indoor Tanning, published in the American Medical Association’s JAMA Dermatology, found that globally, the number of skin cancer deaths caused by indoor tanning exceeded the number of lung cancer deaths caused by smoking. In the U.S., the study found, 419,254 cases of skin cancer a year—including 6,199 melanomas—“can be attributed” to indoor tanning.

Indoor tanning is especially hazardous, say experts, because the ultraviolet radiation from lamps may be up to three times as intense as that from the sun. And unlike lying on the beach, “When you go in some of those booths, you get it from front and back,” said Dr. Stanley Glazer of New England Dermatology and Lazer Center, a practice with offices in Northampton, Springfield, Longmeadow, Holyoke and Westfield.

Most at risk from tanning beds and lamps are teenagers, experts say, since using a tanning device when you’re under age 35 increases your chances of getting skin cancer later in life by as much as 75 percent. Yet an estimated 2.3 million teens visit tanning salons each year. The FDA’s announcement comes three years after the American Academy of Pediatrics called for tanning salons to refuse to serve minors.

Do physicians favor keeping people under 18 out of tanning salons? “Absolutely,” said Glazer. “We’ve had young patients in their teens and early twenties who said they had been tanning. What you can’t say is that it was the only cause, but it contributes.”

Dr. John McCann of the Baystate Regional Cancer Program at Baystate Medical Center agreed. “I believe most oncologists will agree that there is a clear link between the harmful ultraviolet rays tanning bed users are exposed to and the development of skin cancer,” he said. “We are now seeing younger women developing melanoma, the deadliest form of skin cancer, much earlier in their lives, and many of these women have a history of using tanning beds.”

Dr. Zubeena Mateen, an oncologist with Holyoke Medical Center, said the use of tanning beds “needs to be strongly discouraged. …Something with a high risk of significant morbidity and mortality related to a disease as deadly as melanoma should have a strict legislation against its use. It is not just melanoma; there is a 2.5 times higher risk of squamous cell carcinoma and a 1.5 times higher risk of basal cell carcinoma in tanning bed users.”

Though warnings about tanning salons have been circulating for years, and a growing range of self-tanning lotions and sprays is available, tanning salons are still popular. More than 28 million Americans visit them each year, most of them women, and not just to give their complexions a glow. Tanning can help clear up skin conditions such as psioriasis and eczema, and a dose of warm light improves people’s moods, especially in winter.

The tanning industry insists that tanning boosts clients’ vitamin D levels and is not hazardous as long as it is done properly. “Do they have any proof that tanning is not safe?” demands Debbie Teal, who has run The Tanning Zone in Westfield for 19 years. “Have I ever known anybody who died of skin cancer from it? No.”

However, said Teal, “There’s good and there’s bad in every business. There are tanning salons that will just constantly burn you. If my customers come in red, I send them home.”

And, she added, customers should avoid salons with inexperienced staff. Very young or uninformed staff “don’t have a clue, ” she explained: “They don’t know the amount of UVA or UVB [ultraviolet A or ultraviolet B] that’s coming out of the lamps.”

Teal pointed out that it’s important for tanning salon personnel to know their customers’ skin types. Customers should expect the staff to ask questions as a preliminary to tanning; as she put it, “If you went to a doctor and he didn’t ask you questions, how could he treat you properly? I talk to them about their skin type. I ask them what happens the second day on the beach: would they peel, blister, or would it subside? What happens on the third day? You educate them.”

The Tanning Zone, Teal said, does not serve people whose skin type is maximally vulnerable to burning.

In Britain, allowing minors to tan with ultraviolet devices can bring salon personnel a $30,000 fine. In the U.S., only a few states—including New York and Vermont, Massachusetts’ near neighbors—ban people under 18 from the salons.

Regulations are more relaxed in Massachusetts, where people as young as 14 can visit the salons if they are accompanied by parents or guardians, and 15- to 17-year-olds can tan there with written permission from parents or guardians. Legislation excluding people under 18 from tanning salons has been proposed here, but has never passed.

And though the FDA has given the tanning industry a smart slap on the wrist, it stopped short of dealing it a meaningful blow by doing what its own advisory committee recommended four years ago: moving for a national prohibition against salon tanning for people under 18.•

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