Burning issue: Are UV rays in
tanning beds really safe?
by Hallie Levine
Intro 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 percent 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 percent are women, and 53 percent
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. 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 percent since 1930.)
The
JNCI review noted that indoor tanning can increase a
fair-skinned individual's risk of developing melanoma by 55
percent. 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 percent UVA and 6
percent 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
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