Professional Documents
Culture Documents
Sinnar Uv
Sinnar Uv
UV Radiation
& Skin Cancer
TheScience behind
Age Restrictions for
Tanning Beds
E
very year, millions of people climb in various states of undress
into warm, glowing tanning beds, where during a typical
2- to 15-minute session theyll absorb a controlled dose of
ultraviolet (UV) radiation at an intensity up to two to three
times stronger than the sunlight striking the equator at noon. The tan-
ning industry has grown rapidly since the 1980s,1 rising to an estimated
2012 Michael Drager/Shutterstock
28 million users in the United States.2 This rise has been accompanied
by an increase in diagnoses of skin cancer.
The reasons behind the rising skin cancer diagnoses remain open
to debate. Some experts attribute the rise to more frequent skin cancer
screening, whereas others blame environmental and behavioral risk factors,
particularly changes in UV exposure. In this latter context, UV-emitting
Focus
tanning bedsclassified as carcinogenic Although theyre not tracked by SEER, of the Journal of Clinical Oncology,12 says the
to humans by the International Agency for squamous cell carcinoma (SCC) and basal bans make sense. We legislate against smok-
Research on Cancer (IARC)3 have come cell carcinoma (BCC)the other two types ing in kids less than 18, and that sends a
under growing scrutiny. of skin canceralso appear to be on the strong message that theres something wrong
People tan to look healthy, but looks can rise, according to regional studies from the with it, she says. We need to send the same
be deceiving; UV radiation causes all three United States and Europe. A recent study message on indoor tanning.
types of skin cancer. Melanoma, a tumor by Anne Marie Skellett, a consulting derma- But the bans have drawn a backlash from
of the cells that produce the skin pigment tologist at Norfolk and Norwich University the tanning bed industry, whose representa-
melanin, is the rarest but deadliest type, Hospital, reveals that BCC diagnoses among tives say theyve been unfairly and incor-
accounting for 75% of skin cancer deaths people under age 30 in the United Kingdom rectly singled out. John Overstreet, executive
worldwide.4 According to the National Can- jumped 145% between 1981 and 2006.7 director at the Indoor Tanning Association
cer Institutes Surveillance, Epidemiology Statistics such as these have prompted in Washington, DC, describes the evidence
and End Results (SEER) program, melanoma 33 U.S. states and some municipalities to linking indoor tanning to skin cancer as
incidence among U.S. whites (who develop ban or restrict indoor tanning among chil- speculation and advocacy science reported
the disease more often than other races) rose dren under age 18.8 Californias ban, signed by the media as fact. He points out that UV
from 8.7 cases per 100,000 people in 1975 to into law in October 2011, was the first,9 light triggers skin cells to produce vitamin D,
28 cases per 100,000 in 2009.5 Most of that followed by Vermont in April 201210 and the which may have cancer-protective effects.
increase occurred in older men, who rarely city of Chicago the following June.11 Other Its frustrating, he says. Theres no doubt
tan indoors. But a closer look at the age-strat- states have introduced legislation to limit that repeated overexposure to UV or burn-
ified SEER data reveals that melanoma rates indoor tanning among minors.8 ing can cause skin problems, but you also
among white girls and women aged 1539 Mary Brady, an associate professor of have to look at the health benefits, and that
rose by 3.6% per year between 1992 and surgery at Weill Medical College in New issue always gets lost.
2006, compared with a 2% increase per year York and the author of an editorial on indoor
among boys and men of the same ages.6 tanning that appeared in the May 2012 issue Assessing the Weight of the
Evidence
Melanoma in the United States Artificial UV radiation made its public debut
in the 1940s, used for promoting vitamin D
From 2005 to 2009, the median age at diagnosis for melanoma of the skin was 61, and the synthesis in children. Early devices were heav-
ily weighted toward shorter-wave UVB radia-
median age at death was 68. The age-adjusted incidence rate was 21.0 per 100,000 men and
tion, which produces vitamin D but can
women per year. Based on melanoma rates reported from 2007 to 2009, 1.99% of men and
easily burn skin. By the time indoor tan-
women born today will be diagnosed with melanoma of the skin at some point in their life.
ning became popular in the 1980s, the trend
was toward longer-wave UVA rays that dont
Age at < 20 yrs 2034 3544 4554 5564 6574 7584 85+ burn skin so readily.13 IARC describes UVB
Diagnosis 0.60% 6.80% 10.70% 18.20% 21.60% 18.80% 16.70% 6.60% as a complete human carcinogen because
Death 0.10% 2.60% 5.60% 13.50% 19.90% 21.20% 24.10% 12.90% of its ability to cause direct DNA damage.
UVA, on the other hand, is carcinogenic by
Source: Howlander et al.5 an indirect mechanism: Its involved in the
production of DNA-damaging free radicals,
such as hydrogen peroxide.13 Overstreet says
most of the tanning beds used now in the
United States emit a ratio of 95% UVA to
5% UVB.
Scientists started investigating potential
links between artificial UV exposure and skin
cancer during the late 1970s. IARC reviewed
19 such studies during a meta-analysis pub-
lished in 2006.13 The results showed a 15%
increased risk for melanoma, 125% increased
risk for SCC, and 3% increased risk for BCC
among those who had ever tanned indoors
compared with those who had never done
so. In a subset analysis, IARC looked at
seven studies that homed in on melanoma
2012 Biophoto Associates/Photo Researchers, Inc
keratinocytes. Longer waves of UVA radiation penetrate more deeply into more sensitive to the carcinogenic effects of
the skin and reacts with melanin, turning it brown. UV radiation, or if tanning during youth
puts them at greater risk simply because they
accumulate more exposures over time. It also
customers may be permitted to administer who tan indoors versus those who dont in a 8. NCSL. Indoor Tanning Restrictions for MinorsA State-by-State
Comparison [website]. Washington, DC and Denver, CO:National
to themselves any amount of UV exposure study that goes forward in timewould go Conference of State Legislatures (updated May 2012). Available:
they want, [and] they will often keep the UV far in settling the debate, but such research http://www.ncsl.org/issues-research/health/indoor-tanning-
restrictions-for-minors.aspx [accessed 28 Jun 2012].
exposure going until they get some color in is hampered by the fact that melanoma is 9. OConnor A. California Bans Indoor Tanning for Minors. The
New York Times, Health section, Well subsection, online edition
their skin, at which point they have already so rare and by the complexity of potential (20 Oct 2011). Available: http://well.blogs.nytimes.com/2011/10/10/
burned themselves. confounding factors. And a controlled trial california-bans-indoor-tanning-for-minors/ [accessed 28 Jun 2012].
10. Vermont Becomes Second State to Ban Indoor Tanning for
Overstreet says this is avoided in states in which people are randomly assigned to Minors [press release]. New York, NY:The Skin Cancer Foundation
with effective enforcement, where trained tanning and nontanning exposure groups (2 May 2012). Available: http://www.skincancer.org/news/tanning/
vermont-tanning-ban [accessed 28 Jun 2012].
salon employees control the UV lamps, cut- simply isnt feasible for ethical reasons. 11. Chicago Bans Indoor Tanning for Minors [press release]. New York,
NY:The Skin Cancer Foundation (8 Jun 2012). Available: http://
ting them off when the proper exposure is Scientists and the public alike are there- www.skincancer.org/news/tanning/chicago-tanning-ban [accessed
obtained and enforcing 24- to 48-hour inter- fore left with retrospective evidence, and the 28 Jun 2012].
12. Brady MS. Public health and the tanning bed controversy. J Clin Oncol
vals between sessions. Overstreet adds that question now devolves to how or whether 30(14):15711573 (2012); http://dx.doi.org/10.1200/JCO.2011.40.9359.
restricting access to indoor tanning salons the government should use that evidence to 13. IARC. Exposure to Artificial UV Radiation and Skin Cancer.
Lyon, France:IARC Working Group on Risk of Skin Cancer and
could result in teenagers sunbathing or using protect public health. For now, the majority Exposure to Artificial Ultraviolet Light, International Agency for
Research on Cancer, World Health Organization (2005). Available:
home UV devices in search of a tan, poten- of states are taking a precautionary approach. http://www.iarc.fr/en/publications/pdfs-online/wrk/wrk1/
tially raising the likelihood of burns. Only time will tell if it makes a difference in ArtificialUVRad&SkinCancer.pdf [accessed 28 Jun 2012].
14. Vermont Department of Health. Youth Risk Behavior Survey.
The associations second argument is that melanoma diagnoses. Burlington, VT:Agency of Human Services, Vermont Department of
Health (2011). Available: http://healthvermont.gov/research/yrbs.aspx
the rise in melanoma rates might be artifac- [accessed 28 Jun 2012].
Charles W. Schmidt, MS, an award-winning science writer
tual and related more to changes in diag- from Portland, ME, has written for Discover Magazine,
15. Lazovich D, et al. Indoor tanning and risk of melanoma: a
casecontrol study in a highly exposed population. Cancer
nostics and screening than to environmental Science, and Nature Medicine. Epidemiol Biomark Prev 19(6):15571568 (2010); http://dx.doi.
org/10.1158/1055-9965.EPI-09-1249.
factors such as indoor tanning. A key source REFERENCES 16. Cust AE, et al. Sunbed use during adolescence and early adulthood is
behind that argument is Earl J. Glusac, a 1. Palmer RC, et al. Indoor tanning facility density in eighty U.S. cities. associated with increased risk of early-onset melanoma. Int J Cancer
J Community Health 27(3):191202 (2002); http://dx.doi.org/10.1023/ 128(10):24252435 (2011); http://dx.doi.org/10.1002/ijc.25576.
dermatopathologist at the Yale University A:1015202023512. 17. Zhang M, et al. Use of tanning beds and incidence of skin cancer.
School of Medicine. Glusac agrees that tan- 2. Kwon HT, et al. Promotion of frequent tanning sessions by indoor
tanning facilities: two studies. J Am Acad Dermatol 46(5):700705
J Clin Oncol 30(14):15681593 (2012); http://dx.doi.org/10.1200/
JCO.2011.39.3652.
ning beds pose a risk for skin cancers. But (2003); http://dx.doi.org/10.1067/mjd.2002.119560. 18. Ferrucci LM, et al. Indoor tanning and risk of early-onset basal
3. El Ghissassi F, et al. A review of human carcinogenspart D: radiation.
hes skeptical that melanoma rates are actu- Lancet Oncol 10(8):751752 (2009); http://dx.doi.org/10.1016/S1470-
cell carcinoma. J Am Acad Dermatol; http://dx.doi.org/10.1016/j.
jaad.2011.11.940 [online 9 Dec 2011].
ally rising significantly in the population. 2045(09)70213-X. 19. Bradford PT, et al. Rising melanoma incidence rates of the
4. Jerant AF, et al. Early detection and treatment of skin cancer. trunk among younger women in the United States. Cancer
Glusac acknowledges that there could be an Am Fam Physician 62(2):357368 (2000); http://www.aafp.org/ Epidemiol Biomark Prev 19(9):24012406 (2010); http://dx.doi.
increased incidence of melanoma in small afp/2000/0715/p357.html.
5. Howlander N, et al., eds. SEER Cancer Statistics Review, 19752009
org/10.1158/1055-9965.EPI-10-0503.
20. Garland FC, Garland CF. Occupational sunlight exposure and
subsets of the population; however, he states (Vintage 2009 Populations). Bethesda, MD:Surveillance Research melanoma in the U.S. Navy. Arch Environ Health 45(5):261267
Program, National Cancer Institute (Apr 2012). Available: http:// (1990); http://dx.doi.org/10.1080/00039896.1990.10118743.
that a true rising incidence of melanoma in seer.cancer.gov/csr/1975_2009_pops09/index.html [accessed 21. Kennedy C, et al. The influence of painful sunburns and lifetime sun
the population as a whole would be accom- 28 Jun 2012]. exposure on the risk of actinic keratoses, seborrheic warts, melanocytic
6. Jemal A, et al. Recent trends in cutaneous melanoma incidence and nevi, atypical nevi, and skin cancer. J Invest Dermatol 120(6):10871093
panied by a corresponding rise in death rates death rates in the United States, 19922006. J Am Acad Dermatol (2003); http://dx.doi.org/10.1046/j.1523-1747.2003.12246.x.
from the disease, which is not the case.22 65(5 suppl 1):S17.e1S17.e11 (2011); http://dx.doi.org/10.1016/j.
jaad.2011.04.032.
22. Reed KB, et al. Increasing incidence of melanoma among young
adults: an epidemiological study in Olmsted County, Minnesota.
What has increased, Glusac saysciting 7. Skellett AM, et al. The incidence of basal cell carcinoma in the under- Mayo Clin Proc 87(4):328334 (2012); http://dx.doi.org/10.1016/j.
30s in the UK. Clin Exp Dermatol 37(3):227229 (2012); http://dx.doi. mayocp.2012.01.010.
greater awareness of melanoma and a public org/10.1111/j.1365-2230.2011.04246.x.
drive toward screeningis the biopsy rate
ehp
for pigmented skin lesions, many of which
will never spread and thus are unlikely to
harm health. There may be lesions that look
7.04 Published monthly by the National Institute of Environmental Health Sciences (NIEHS)