© Oxford University Press 2006.
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Legislators Combat Melanoma, Restrict Teen Tanning
Young teens would be banned from indoor tanning beds and older teens would need their parents' permission, under a law proposed in Massachusetts.
The state is just one of many that have banned or restricted indoor tanning for teenagers. California, Texas, New Jersey, North Carolina, and New Hampshire have recently passed bills, bringing to 25 the number of states that have placed some restriction on minors' access to tanning beds. Legislators, with the support of local and national cancer advocacy groups, have passed the bills seeking to limit skin cancer risk. But opponents in the industry say that parents should be able to decide whether their children can visit tanning beds and that restricting tanning may limit teens' exposure to vitamin D, which has been associated with lower risk of some cancers.
"What we're seeing is a grassroots effort in many states to bring to the fore the problem of UV as a carcinogen," says Allan C. Halpern, M.D., of Memorial Sloan-Kettering Cancer Center in New York. "In so doing, we're targeting an important subset, the teen population where tanning is very common and a significant concern because of its potential for raising cancer rates in these children at a later age."
The Massachusetts proposal would make using an indoor tanning bed illegal for anyone under 16 and require those over 16 but under 18 to get a parent or guardian's permission. This law and others come at a time when melanoma rates are on the rise, from 8 per 100,000 in 1975 to nearly 23 per 100,000 in 2003. The American Cancer Society estimates that more than 62,000 people will be diagnosed and almost 8,000 people will die of melanoma in 2006. Studies have shown that younger people are more susceptible to melanoma; for example, melanoma is the number one cancer in women aged 25–29 years.
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How UV Causes Cancer
Melanoma and other skin cancers, such as squamous cell carcinoma, are often a result of sun exposure. Both the sun and indoor tanning bulbs create the ultraviolet rays, UVA and UVB. UVB burns the skin, and both UVA and UVB have been linked to DNA damage and mutations.
A 2005 review in Cancer Epidemiology Biomarkers and Prevention found that tanning bed use was associated with an increased risk of cutaneous melanoma. The risk increased the younger people were when exposed to UV in tanning beds and the more frequently they used a tanning bed. William Blot, Ph.D., of the International Epidemiology Institute in Rockville, Md., says UV poses a similar exposure-related risk to that of other carcinogens: "For most cancers caused by toxins, the higher the dose, the higher the risk."
Tanning beds may also carry a higher risk than tanning in the sun. A survey of 50 North Carolina tanning facilities, published in the Journal of the American Academy of Dermatology in 2003, showed that 95% of customers received more than the recommended dose of UV radiation. Tanning beds can expose a person to 4 times the amount of UVA and 2 times the amount of UVB as a similar period of sun exposure in the Washington, D.C., area.
Despite the link between UV radiation and skin cancer, new legislation has its opponents, primarily in the tanning industry. John Overstreet, executive director of the Indoor Tanning Association in Washington, D.C., agrees that minors' access to tanning beds should be restricted, but he says it should be a matter of parental consent.
Opponents Turn to Vitamin D
The industry also argues that UV from tanning beds can combat vitamin D deficiency. Around 40% of adults in the United States don't get adequate daily amounts of vitamin D, according to The UV Advantage, a book by Michael Holick, M.D., Ph.D., of Boston University. The deficiency has been associated with certain cancers—like breast and colon—and other health problems. "Lots of people can't afford to take supplements and don't pay attention to their diets. UV light from a tanning bed is a natural and noncostly way to get vitamin D," says Overstreet.
But Halpern says that tanning beds are not a solution. "I wouldn't advocate the use of tanning booths. Not at all."
However, the balance between vitamin D and melanoma risk remains under debate. Marie-France Demierre, M.D., of Boston University, advocates using a daily vitamin D supplement and limiting sun exposure.
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"We're starting to see so many melanomas in young people, it's unbelievable. It's already an epidemic," Demierre said.
Blot, on the other hand, thinks a small amount of sun exposure may not be so bad. "The risk associated with sunlight exposure most likely comes from heavy exposure. You may be able to have your cake and eat it too. You probably can have a brief exposure that would be low enough that you may not increase the risk of melanoma."
Will Laws Make a Difference?
Demierre says the new laws don't go far enough.
"The tanning industry is not well controlled and not regulated very well. We have considerable literature that has shown there's a lack of compliance with state laws. Minors may have access to indoor tanning, use facilities longer than indicated, or be misinformed about its benefits," she says.
But she acknowledges that legislation alone cannot combat rising melanoma rates. Researchers think rising skin cancer rates can also be addressed through government regulation and a general shift in what skin tone is considered fashionable. "I think the problem has to be addressed at this juncture primarily through prevention ... which means limiting UV exposure," says Halpern.
For now, though, industry regulation plays an important role in melanoma prevention. "I'd like to see that the industry is regulated, that there's law enforcement, so not any 15-year-old can walk into an indoor tanning session every day of the week and get burned," Demierre says. "Young adolescents might not be able to weigh all the risks."
Such state regulations can include an active inspection program to make sure beds are up to standards and enforcement of rules against minors' tanning. In North Carolina, which has banned teen tanning since October 2004, a tanning facility that is in violation receives a warning and time to comply with the law. If the salon does not comply, the state can impose penalties or, in extreme cases, shut the salon down.
North Carolina's teen tanning laws were a response to the public-health problems faced by people overexposed to UV radiation, says Amy Sawyer, who oversees enforcement of tanning facilities for the state's radiation protection section in the Department of Environmental Health. "Absolutely, [the laws] are a benefit to public health," she says. "And we hope policies will help educate the public about the risks of tanning and force industry compliance with regulations." Sawyer says most facilities have some violations at an inspection, though they are often minor and fixed in the allowed time.
Despite recommended bans on teen tanning from the World Health Organization and American Academy of Dermatology, 25 states haven't followed North Carolina's lead regulating the tanning industry. The bill proposed in Massachusetts and passed in other states may be only a first step.
"The problem is not only the use of tanning beds but also tanning with natural sunlight. I don't think legislation will affect fashion," says Halpern, "I do think that as we've seen with cigarette smoking and other hazards, changing behavior without legislation is often very difficult."
Demierre hopes the bill in Massachusetts will pass and that the remaining states will follow.
"It's such an important measure. It's an issue that is very close to my heart."
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