Health warning: That tan could be hazardous

By Sabrina Tavernise, New York Times News Service

Tuesday, Jan. 13, 2015 | 2 a.m.

TEQUESTA, Fla. — On their way home from an SAT tutoring session, the Van Dresser twins, Alexandra and Samantha, 17, popped into Tan Fever & Spa, a small family-owned salon tucked into a strip mall between a bar and a supermarket.

They wanted to get tan before the prom, and the salon was the perfect combination of fast and cheap: Twenty minutes in a tanning bed cost just $7.

“It’s the quickness of the tanning bed,” Alexandra explained one afternoon last year. “We don’t have time to lay out on a beach.”

Indoor tanning might seem like a fashion that faded with the ‘80s, but it remains a persistent part of American adolescence, popular spring, summer and fall but especially in winter, when bodies are palest. Salons with names like Eternal Summer and Tan City dot strip malls across the country, promising prettiness and, in some cases, better health, despite a growing body of evidence that links indoor tanning to skin cancer.

Here in the Sunshine State, there are more tanning salons than McDonald’s restaurants, CVS stores or Bank of America branches, according to a 2014 study by University of Miami researchers.

For decades, researchers saw indoor tanning as little more than a curiosity. But a review of the scientific evidence published last year estimated that tanning beds account for as many as 400,000 cases of skin cancer in the United States each year, including 6,000 cases of melanoma, the deadliest form.

And clinicians are concerned about the incidence rate of melanoma in women younger than 40, which has risen by a third since the early 1990s, according to data from the National Cancer Institute. (Death rates have not gone up, however, a testament to earlier detection and better treatment.)

“We’re seeing younger and younger patients coming to us with skin cancer,” said Dr. Eleni Linos, assistant professor of dermatology at the University of California, San Francisco. “That is a new phenomenon.”

As such worrying signs have accumulated, tanning has emerged as a serious public health concern. Last year, the surgeon general called on Americans to reduce their exposure to the sun and tanning beds to prevent skin cancer, and the Food and Drug Administration invoked its most serious risk warning, lifting tanning beds from a category that included Band-Aids to that of potentially harmful medical devices. The Obama administration’s 2010 health care law imposed a little-noticed 10 percent tax on tanning salons.

And more than 40 states, including Nevada, now have some sort of restriction on the use of tanning salons by minors, according to AIM at Melanoma, an advocacy and research group based in California, the first state to adopt a ban on minors in 2011. At least nine states plus the District of Columbia (pending congressional approval) have passed such bans.

For the first time, new federal data has documented a decline in the use of indoor tanning among teenage girls, dropping to about a fifth of them in 2013, from a quarter in 2009. Gery P. Guy Jr., a researcher with the Centers for Disease Control and Prevention who analyzed the data, which was released in December, attributed the decline to greater awareness and tougher laws.

Even so, public health experts say tanning remains a persistent problem, especially among white teenage girls, a full third of whom say they have tanned indoors, more than the share who smoke cigarettes.

There were about 14,000 salons across the country as of early 2014, according to John Overstreet, executive director of the Indoor Tanning Association. That does not count tanning beds in gyms and beauty parlors. The number is down about a fifth in recent years, he said, as the recession eroded young women’s disposable income and the tax imposed under the new health care law squeezed salons’ profits.

Overstreet argues there is no science that conclusively links moderate, nonburning ultraviolet ray exposure to melanoma. His organization’s mission, according to its website, is “to protect the freedom of individuals to acquire a suntan.”

“The folks who don’t like this industry are exaggerating the risks,” he said, adding: “It’s just like anything in life. If you get too much of it, it’s bad for you.”

Cancer link

Evidence of the link between melanoma and ultraviolet exposure may have been inconclusive a decade ago, but recent research, including fresh data from the Cancer Genome Atlas, a federally funded program that is cataloging genetic mutations responsible for cancer, bolsters the case for the link.

Dr. Jeffrey E. Gershenwald, a leader of the melanoma Atlas project, said studies to date showed a majority of melanomas initially arising on the skin contains mutations associated with ultraviolet exposure. As for burning, one recent study controlled for that, and still found an increased risk from indoor tanning.

“There’s no longer a question of whether UV is important,” said Gershenwald, medical director of the Melanoma and Skin Center at the University of Texas MD Anderson Cancer Center. “Genomics has been transformative in our understanding of melanoma.”

The problem with indoor tanning, researchers say, is many of those who do it, do it a lot. The federal government has collected data on tanning among high school students only since 2009, but researchers were surprised at the findings: Among those who used tanning beds, more than half had used them 10 times or more in the past year, according to Guy.

There is strong peer pressure to be tan, particularly in small-town high schools.

Sarah Hughes started tanning at 16, during beauty pageant season in her hometown, Dothan, Ala. She often tanned five days a week.

Over time, she came to crave it.

“People did drugs. People had eating disorders. I tanned,” said Hughes, who is now 30.

Hughes stopped tanning at 25 when a doctor diagnosed advanced melanoma. A tumor on her left leg had grown down into her muscle and, eventually, her lymph nodes. In all, she had 33 spots removed, including eight melanomas over two years, a searing experience.

She survived.

Craving for confidence

Many young women said in interviews that tanning fed a craving to be pretty, at a time in life when it is most acute. Madison, 21, a student at the University of Rhode Island who asked that her last name not be used because she felt self-conscious about the issue, said tanning made her feel “more confident and more comfortable when I walk around.”

“Sometimes it makes me feel thinner,” she continued. “It has all these weird effects that just make me feel better about myself.”

Some experts say combating the problem is a matter of raising awareness about the dangers of tanning. But many women said in interviews they were aware of health risks but cared more about how they looked now.

“If I get skin cancer I’ll deal with it then,” said Elizabeth LaBak, 22, a student at Westfield State University in Massachusetts. “I can’t think about that now. I’m going to die of something.”

LaBak said fewer women on campus tan now.

“All the Victoria Secret models are pale now,” she said.

Even so, salons persist. About half the country’s top 125 colleges have tanning beds on campus or in off-campus housing, University of Massachusetts medical school researchers reported in October. But LaBak’s favorite spot, Beach Club Tanning, which offered $2 tans, has closed, and “now there’s no place that’s cheap enough,” she said.