A Dangerous Combination for Youths – Indoor Tanning and Skin Cancer

November 9, 2017

By Lynn Cornelius, Winfred A. and Emma R. Showman Professor in Dermatology, Washington University

Skin cancer is the most commonly diagnosed cancer in the United States, and rates have been rising for the past 30 years.1 Melanoma, the most serious and deadliest form of skin cancer, is one of the most common cancers diagnosed among young adults.2 In Missouri, our melanoma incidence rate has doubled in the last nine years.3

Skin Cancer Risks With Ultraviolet Radiation Exposure

Ultraviolet (UV) radiation exposure from the sun is a known cause of skin cancer, and UV radiation exposure during childhood and adolescence increases the risk of being diagnosed with skin cancer as an adult. Indoor tanning increases the risk of a skin cancer diagnosis even further. A more recent study found that tanning is associated with a six-fold increase in melanoma risk among women younger than 30 years.4 A meta-analysis of 27 informative studies published in the British Medical Journal in 2012 found that tanning before the age of 35 increases the risk of melanoma by 59 percent, squamous cell carcinoma by 67 percent, and basal cell carcinoma by 29 percent.5,6 Rates increase even more when they are used before age 25.6

The greatest avoidable known risk factor for skin cancer is avoiding the use of indoor tanning devices.

The damage of UV radiation is cumulative over an individual’s lifetime, with repeated exposure resulting in long-term effects such as premature aging of the skin, wrinkles, solar keratosis, permanent eye damage, and skin and ocular cancers.7

Despite the known dangers, misconceptions about the risks and benefits of indoor tanning persist partly due to misleading advertising and health claims by the tanning industry.8,9 A base tan is not a “safe” tan, and tanning beds aren’t not a good way to get vitamin D.

Children, susceptible to media and the prowess of marketing, are peppered with well-timed ad campaigns encouraging them to get their “glow” on for prom or back-to-school while flashing images of tanned and toned models.

Youth Tanning In Missouri

We’ve got a big problem with youth tanning here in Missouri. Twenty-one percent of Missouri girls in 11th grade and 30 percent of Missouri girls in 12th grade have used an indoor tanning device. Compare that to the nationwide rate of 16 percent of girls in the 12th grade.10,11

One of my patients, Heather, started indoor tanning in her teens with her group of friends. Their parents had to drive them to the salon, because they weren’t even old enough to have their licenses. During her freshman year of college, instead of worrying about classes or making new friends, she was diagnosed with melanoma. She was just 18 years old. Heather went home to endure treatments and surgeries that forever scarred her body – three procedures in just nine months. She’s been cancer-free for 12 years, but Heather says that not a day goes by when she doesn’t think about her cancer. And now she shares her story to try and stop teens from tanning.

Age Restriction Laws For Indoor Tanning Devices

With everything we know about the deadly side effects of indoor tanning, why aren’t we doing more to keep our children out of tanning salons?

If properly enforced, age restriction laws that prohibit the use of indoor tanning devices for individuals under the age of 18 are effective in deterring minors from using tanning devices and could help to reduce skin cancer incidence and mortality rates across the country.12,13,14,15

A recent Minnesota Department of Health survey found that, since the state’s law to prohibit minors under the age of 18 from using indoor tanning devices was passed, the number of 11th grade white females that used indoor tanning devices decreased over 70 percent – from 33 percent in 2013 to 9 percent in 2016.16

Additionally, a recent CDC cohort study following a group of 61.2 million youth aged 14 years or younger in the U.S. found that restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6,725 melanoma deaths, and save the U.S. $342.9 million in treatment costs over the group’s lifetime.17

Missouri’s current law, passed in 2014, allows those under 17 to tan with a permission slip signed by their parents. Parental consent laws like Missouri’s are not associated with reduced indoor tanning among youth.12 We need a law that outright prohibits minors from using tanning beds.

Restricting access to indoor tanning devices is consistent with other policies that protect youth from harmful products and substances such as tobacco. The U.S. Food and Drug Administration now requires manufacturers to include a visible black box warning stating that people younger than 18 shouldn’t use the devices.18

What are we waiting for? Already, our state is woefully behind states such as Oklahoma, Kansas, Illinois, Texas, Louisiana, and West Virginia when it comes to keeping kids out of tanning beds. These states passed and implemented comprehensive laws to protect their children, and the laws are working: States that have indoor tanning laws have a lower youth tanning rate than states with no laws.

We see the scars and suffering from skin cancer on our patients. We know that more than 1,600 Missourians will be diagnosed with melanoma this year.1 We must act to keep minors, who may be the most vulnerable to disease development, from using tanning beds when they don’t fully understand the risks – the real, and possibly deadly risk of developing melanoma.  As with smoking and lung cancer, the facts are strong, why aren’t we? Missouri’s kids deserve a strong law that will protect them from a known carcinogen.

References

1American Cancer Society. Cancer Facts & Figures 2017. Atlanta, GA: American Cancer Society; 2017.

2NAACCR Fast Stats: An interactive tool for quick access to key NAACCR cancer statistics. North American Association of Central Cancer Registries. http://www.naaccr.org/. (Accessed on 2-24-2016).

3American Cancer Society. Cancer Facts & Figures, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016. Atlanta, GA: American Cancer Society

4Lazovich D, Vogel RI, Weinstock MA, Nelson HH, Ahmed RL, Berwick M. Association between indoor tanning and melanoma in younger men and women. JAMA Dermatol. 2016; doi: 10.1001/jamadermatol.2015.2938.

5The 59% increased risk is cited here: Boniol B., Autier P., Boyle P., Gandini S. Corrections: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012; 345:e8503. Published December 2012; which is a correction of the original article cited here: Boniol B., Autier P., Boyle P., Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. British Medical Journal. 2012; 345:e4757. Correction published December 2012; 345:e8503.

6Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012, 345:35909. doi: http://dx.doi.org/10.1136/bmj.e5909.

7Guy GP, Watson M, Haileyesus T, Annest JL. Indoor tanning-related injuries treated in a national sample of US hospital emergency departments. JAMA Internal Medicine. 2015; 175(2): 309-311.

8U.S. House of Representatives Committee on Energy and Commerce Minority Staff. (2012, February 1). False and Misleading Information Provided to Teens by the Indoor Tanning Industry – Investigative Report.

9United States of America Federal Trade Commission. (2010, May 13). In the Matter of Indoor Tanning Association, a corporation – Docket Number C-4290 Decision and Order. Available at ftc.gov/os/caselist/0823159/100519tanningdo.pdf.

10Missouri Youth Risk Behavior Survey 2015 detailed tables by grade and gender

11Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Surveillance-United States, 2015. MMWR. 2016; 65(6).

12Guy GP, Berkowitz Z, Jones SE, Olsen E, Miyamoto JN, Michael SL, et al. State indoor tanning laws and adolescent indoor tanning. Am J Public Health. 2014; 104(4):e69-74.

13Mayer JA, Woodruff SI, Slymen DJ, et al. Adolescents’ use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates. Am J Public Health. 2011; 101(5):930-8.

14Watson M, Holman DM, Fox KA, et al. Preventing skin cancer through reduction of indoor tanning: current evidence. Am J Prev Med. 2013;44: 682-689.

15Sinclair C, Makin JK. Implications of lessons learned from tobacco control for tanning bed reform. Pre Chronic Dis. 2013; 10:120186. doi: http://dx.doi.org/10.5888/pcd10.120186.

16Minnesota Department of Health. Teens, indoor tanning and melanoma. Published December 1, 2016. Accessed on December 2016.
http://www.health.state.mn.us/divs/chs/mss/MDHIndoorTanningFactSheetw_ref.pdf.

17Guy GP, Zhang Y, Ekwueme DU, Rim SH, Watson M. The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis. J Am Acad Dermatol. 2016; 1-8.

18Federal Register. General and plastic surgery devices: reclassification of ultraviolet lamps for tanning, henceforth to be known as sunlamp products and ultraviolet lamps intended for use in sunlamp products. Published June 2, 2014. Accessed March 10, 2016. https://www.federalregister.gov/articles/2014/06/02/2014-12546/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to.


This post is part of the “High-Risk Health Behaviors” series of the Institute for Public Health’s blog. Subscribe to email updates or follow us on Twitter and Facebook to receive notifications about our latest blog posts.

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