A KILLER TAN Posted Saturday, April 17, 2004 by arjuna
Prevention magazine, May 2004

A Killer Tan Burning issue: Are UV rays in tanning beds really safe?

by Hallie Levine

Michele Hoard has stayed away from tanning beds and out of the sun
since she was diagnosed with malignant melanoma, a deadly form of skin
cancer, in January 2003. But when she heard that a tanning salon near
her home in Minneapolis was offering a sunless, spray-on self-tanner,
she decided that it was worth finding out more about the tanning
alternative.

"I walked in and asked the guy at the front desk about it, and he
recommended instead that I go into one of the tanning beds for 10
minutes before trying the spray," recalls Hoard, 35. "I said, 'I can't
tan; I'm a melanoma survivor.'"

His response floored her.

"He just waved his hand and said, 'No worries--the tanning beds are
good for you because they contain mostly UVA rays, which reduce your
risk of cancer.' I couldn't believe he was advocating tanning to
someone who'd had skin cancer."

Lisa Whitehead, now 42, bought an indoor-tanning membership and started
going every other day because "the manager told me that the beds were
FDA-approved and that the indoor rays were safer than the sun because
all the bad, cancer-causing agents were filtered out," she says. Four
years later, she noticed a black spot on her upper arm and decided it
had to be a beauty mark. "I didn't really think about it until a few
months later, when I went to see my dermatologist and she told me I
needed to have it biopsied," Whitehead recalls. Two days later, she
learned that she had stage 1 melanoma--at age 27. "I went back into the
tanning salon and screamed at them," says Whitehead, now married with
two children. "I told them that they had lied and that their beds had
given me cancer."

Hoard and Whitehead are not alone. In an investigation into the $5
billion tanning salon industry, Prevention has found that hard-sell
tactics and false assurances of safety are luring women into putting
themselves at risk for cancer, disfigurement, and worse. Not only do
some industry representatives claim that tanning is safe; they also
insist that soaking up ultraviolet radiation from sunlamps is actually
good for you. Read on for what you must know to protect yourself--or
your teenage daughter--from this dangerous misinformation.

Booming Business There's no doubt that the tanning business is booming.
Sales figures for Hollywood Tans, the largest tanning salon chain in
the country, have surged more than 450% since 2000, and industry
numbers are up overall: 29 million people visited a tanning salon in
2003, compared with 27 million in 2000, reports the National Tanning
Training Institute, an industry education group based in Phoenix. The
group claims that of the 1 million-plus people who spend time and money
in tanning salons each day, 70% are women, and 53% are between the ages
of 20 and 39. And, reports the industry, the two fastest-growing
categories of indoor-tanning-bed users are female teens between 16 and
19 and women between 40 and 49.

What may be drawing them, in part, are the tanning industry's
unprecedented and aggressive new marketing tactics, which have confused
consumers about the real risks of tanning beds. These started last
fall, on the heels of a 2-day October summit in Washington, DC, where
public health officials from the National Institutes of Health (NIH)
reviewed evidence suggesting that certain groups of Americans don't get
enough vitamin D in their diets. As remedies, experts recommended
supplements, vitamin-fortified dairy products, and brief exposure to
sunlight, because UV radiation helps the body manufacture vitamin D.

Indoor-tanning businesses took that baton and ran with it, boldly
offering their services as a solution to what they've dubbed "a
life-threatening epidemic of vitamin D deficiency."

"My wife uses tanning beds because she's concerned about vitamin D
deficiency," says Michael Stepp, CEO of Wolff System Technologies, a
major manufacturer of tanning lamps in Marietta, GA. "Sure, she's
Norwegian with a lot of moles, but she knows that the health benefits
of a small amount of sun exposure far outweigh the risks."

Such carefully crafted messages and testimonials extolling the benefits
of tanning "are convincing women that tanning salons are safe," says
Mark Naylor, MD, a dermatologist at the Oklahoma Medical Research
Foundation, an independent biomedical research organization in Oklahoma
City. The industry spin also has dermatologists scrambling to head off
the public's misplaced concerns regarding the need for vitamin D.
"These claims are ludicrous," says James Spencer, MD, professor of
dermatology at New York's Mount Sinai School of Medicine and a
spokesman for the American Academy of Dermatology. "The great majority
of Americans get adequate amounts of vitamin D." In addition, the
amount of sunlight a fair-skinned person needs to make a whole month's
supply of vitamin D is about 5 to 10 minutes three times a week--just
on the face. "The same UVB rays that create vitamin D can destroy it in
your skin," warns Robert Heaney, MD, John A. Creighton professor of
medicine at Creighton University and a speaker at the NIH conference
last fall. So with UVB, more exposure isn't better--even for
synthesizing vitamin D. Indoor-tanning packages, however, are often
sold in monthly units of unlimited tanning.

Tanning and Cancer Murky science and controversial claims are nothing
new for the indoor-tanning industry, which used to advertise its
tanning devices as safer than the sun. Now, it employs marketing
practices that are even more aggressive than the tobacco industry's
methods prior to the antismoking backlash of the 1970s. "When the first
research came out showing that smoking was dangerous, the tobacco
industry's response was always, 'We don't know. There's just not enough
science,'" says Spencer. "But here, the tanning industry is not just
saying it's not dangerous; it's saying tanning is actually good for
you. The tobacco industry never said that, to my recollection."

Even more worrisome than the tanning camp's assertions regarding
vitamin D is its position on cancer, which it says can be caused by sun
deprivation and prevented by tanning lamps. The claims--that brief
exposure to tanning devices can ward off cancers of the colon,
prostate, and breast, as well as a host of other debilitating diseases,
including osteoporosis, arthritis, and depression--do contain a tiny
kernel of truth. They're based on research conducted largely by Michael
Holick, MD, director of the Vitamin D, Skin, and Bone Research
Laboratory at Boston University, with partial funding from the tanning
industry. But Holick concedes that the amount of sunshine you need is
minimal, "and you don't need to go to tanning salons to get it."

Other experts are even more skeptical, pointing out that scientific
evidence suggests only that vitamin D may help protect against colon
cancer. "Even there, we're not sure if it's due to the vitamin alone or
in combination with calcium," says dermatologist Martin Weinstock, MD,
PhD, chair of the American Cancer Society's Skin Advisory Group.

The tanning industry's other major point--that avoiding the sun (or
sunlamps) may put you at increased risk of prostate, lung, breast,
colon, ovarian, and pancreatic cancers--is based on research conducted
by William Grant, PhD, a NASA scientist whose work is partially funded
by the Indoor Tanning Association. These claims, detailed in an October
2003 industry press release, have been dismissed by the dermatology
community. "It is dangerous to mislead the public into thinking
sunlight is a safe and effective 'cure' for other health conditions,"
says Raymond L. Cornelison Jr., MD, president of the American Academy
of Dermatology.

For all the urgency the tanning salon industry places on cancer
prevention and health, the one disease it downplays is skin
cancer--especially melanoma.

"One of the more common beliefs offered as 'fact' by some members of
the medical community and people opposed to tanning is the idea that
natural or artificial sunlight can trigger melanoma," says Wolff
System's Stepp. "The truth is, melanoma is believed to be genetically
triggered." Weinstock vehemently disagrees, noting that although
"genetic background plays a role, the biggest factor in melanoma is UV
exposure." What's more, scientific evidence supports a link between
tanning-bed use and skin cancer. A review study published last October
in the Journal of the National Cancer Institute strengthened the
evidence that tanning beds are helping drive up rates of melanoma, a
cancer that kills one American every hour. (The lifetime risk of
developing invasive melanoma has increased a whopping 2,000% since
1930.) The JNCI review noted that indoor tanning can increase a
fair-skinned individual's risk of developing melanoma by 55%. And it
can take a mere 10 indoor-tanning sessions to cause precancerous DNA
damage, reports a recent review study by a Kings College London
researcher.

Indoor tanning contributes to nonmelanoma skin cancers as well. A 2002
study in the JNCI found that tanning-bed enthusiasts have up to 2 1/2
times the risk of squamous cell carcinoma and 1 1/2 times the risk of
basal cell carcinoma compared with nonusers.

Naylor, the Oklahoma dermatologist, has no doubt that indoor tanning is
responsible for many new cases of skin cancer. "In the past few years,
I've seen an increase in the number of tanning-bed users with skin
cancers on parts of their bodies that don't get exposed to sunlight,
such as their breasts and buttocks," he says. Kristi Hiltz, 24, of
Baltimore, tanned topless 5 days a week for 4 years but stopped in 1999
when her dermatologist diagnosed melanoma in a mole on her left breast.
"My doctor is convinced that my cancer is from indoor tanning, since
the spot was always covered by a bikini top whenever I was outdoors,"
Hiltz says.

Questionable Assurances That UVB and UVA radiation--whether from
tanning bulbs or sunlight--can cause skin damage that can lead to
cancer is as close to a hard-and-fast medical certainty as science can
offer. Yet when Prevention sent a reporter to a tanning salon in the
New York area with a question about skin cancer, the sales
representative downplayed any link. When the reporter asked the rep
what she should do if she had had a squamous cell carcinoma removed
from her back, the rep handed her a tube of zinc oxide and said, "If
you're worried, just put this on; it'll block any suspicious areas."
Medical experts counter that if you've had one squamous cell carcinoma,
you're at increased risk for others anywhere on your body--for the rest
of your life. At a different tanning salon, a salesperson told our
reporter that squamous cell carcinoma had nothing to do with prior sun
exposure. "Not true," says Rex Amonette, MD, past president of the
American Dermatological Association and clinical professor of
dermatology at the University of Tennessee in Memphis. "We know for
sure that exposure to UV light contributes to all types of skin
cancer."

Here are two more tanning-industry claims and the facts behind them:

Unlike the sun, tanning bulbs don't burn your skin The industry did
dial down the rays in the 1980s, after it was revealed that the first
tanning beds, which emitted mostly UVB light, could cause serious burns
and eye damage after less than 1 minute of exposure. In response, many
tanning-bed manufacturers greatly reduced the amount of UVB light. That
proved not as efficient at tanning, so they developed beds that contain
about 94% UVA and 6% UVB rays--about the same ratio as what's in
sunlight. The one crucial difference: Studies show that UVA energy
levels in tanning beds are up to 15 times stronger than the sun's UVA
rays--and therefore increase the risk of burning.

A "base tan" protects you against sunburn Not likely. A 2002 study from
the Technical University, Munich, Germany, found that tanning for at
least 6 weeks in UVA beds did not offer any more UV protection than not
tanning at all. Shannon Carlino, 32, of Bear, DE, learned the hard way
what mounting evidence suggests: Tanning salon tans are probably
useless for protecting you against future sun damage. Five years ago,
she went to tanning salons three times a week for 2 months
because--ironically--she didn't want to burn on her Cancun honeymoon.
The move backfired. "I was so fried that I looked like I had raccoon
eyes and had to cover them with makeup in all my wedding photos," says
Carlino, who was diagnosed with a melanoma on her lower leg in August
2003.

Still, the flattering effects of deeply bronzed skin make tanning-bed
use very tempting for millions of women like Melanie Mahaffey, a
23-year-old publicist in Houston who's been tanning indoors twice a
week since age 15. "My mom, who also tans all the time, had a small
skin cancer taken off her arm last year, so sometimes I worry. But I
figure I'm still so young that my skin will automatically rejuvenate
itself," she says. Not so, say dermatologists, who warn that the aging
effects of tanning beds are irreversible and that indoor tanning ages
skin faster than the sun because of the concentrated levels of UVA.
"People wrinkle a lot faster from UVA light because it penetrates more
deeply and thins out skin's collagen, thus thinning out skin," says
Bruce Katz, MD, director of the JUVA Skin and Laser Center in New York
City. "When I see patients, I can tell right away if they've been to a
tanning parlor; they've got this crepey look to their skin like they've
baked in the sun all their lives. They will look old before their
time."

Limited Government Protection When asked about the industry's claims
and assurances, Dan Humiston, president of the Indoor Tanning
Association, replied that tanning beds are perfectly safe because the
government regulates them. "The FDA has strict guidelines on equipment
and on maximum exposure time in each bed, and we follow them," he says.
Indeed, the FDA does regulate the amount of UV light that tanning lamps
can emit. It also requires that each user wear goggles and that tanning
beds carry a warning label stating that UV light may cause skin cancer.
However, on visits to several tanning salons, Prevention found that
many of these warnings are on top of the machines and thus out of view.
Nonetheless, say salon owners such as David Kim, whose Hollywood Tans
franchise is in New York City, if customers get burned, it's because
they stay in the beds too long.

At best, consumers are getting mixed messages about the dangers of
indoor tanning. Who will help keep them from becoming future cancer
victims? The American Academy of Dermatology opposes indoor tanning and
supports a ban on the production and sale of indoor-tanning equipment
for nonmedical purposes. But "as much as we don't like to admit it,
doctors are losing the battle with our public anti-tanning messages,"
says Amonette. So far, federal agencies seem concerned only in
principle with the tanning industry's false claims and have no plans to
step up regulation. "Our role is to prevent burns to the skin and
eyes," says Howard Cyr, MD, PhD, chief of radiation biology at the FDA.
"We regulate warning labels on the machines. We don't have the
resources to inspect 25,000 salons, so we only crack down on tanning
salons if we've had a complaint. We don't have any jurisdiction over
claims the tanning salons may make."

The Federal Trade Commission, which has jurisdiction over these claims,
says it's been a number of years since the tanning industry has been
the target of an investigation. "In 1998, the FTC took action against
tanning-bed manufacturers for falsely claiming that indoor tanning did
not pose skin cancer and other risks," says Mamie Kresses, a senior
attorney in advertising practices at the FTC. When Prevention filled
her in on the industry's new pro-health campaign, she told us that the
agency is particularly concerned with health-related claims and asked
us to send more information.

Meanwhile, women who've been burned by tanning salons are furious
enough to go public in the hope that their experiences will serve as a
warning to others. Roxanne Smith, 44, of Hanover, PA, stopped using
tanning salons in 1999 after a severe burn on her back and buttocks
made sitting painful. Then she learned she had melanoma on her lower
back. "I know why women go to tanning salons. You go in there and
you're lulled into this false sense of security," she says. "The salons
say, 'Don't worry, you're safe, you won't burn,' even as they get you
to sign a release absolving them of all responsibility. Well, I've had
four biopsies and 12 moles removed since I was diagnosed with melanoma
in 2002. My 4 years of tanning in a salon mean a lifetime of
disfigurement for me."

The ABCs of UV Rays
UVA: Relatively weak but long rays that penetrate deep into the skin.
Considered a contributing factor in skin aging, wrinkling, brown spots,
and blotching. Both the sun and sunlamps contain a mixture of UVA and
UVB.

UVB: Shorter, more intense rays that cause burning, tanning, damage,
and skin cancer.

UVC: Superintense rays that you don't have to worry about because they
are absorbed by the earth's atmosphere and aren't used in sunlamps.

WHAT'S YOUR REAL TANNING RISK? Some skin types burn more easily than
others when exposed to UV rays from the sun or tanning lamps. Skin
burns are a sign of cell damage that can lead to premature aging and
cancer. If your skin type is 1, 2, or 3, dermatologists say you should
never attempt to tan.

1. Porcelain (pale skin) Always burns within minutes of UV exposure; never tans

2. White Burns easily; tans minimally

3. Medium white Burns moderately; tans gradually to a light brown

4. Beige or lightly tanned Burns minimally; tans easily to a moderate brown

5. Moderate brown or tanned Rarely burns; tans to a dark brown

6. Dark brown or black Never burns; deeply pigmented

Source
American Academy of Dermatology