The Skin Cancer Foundation Journal

MAY 2014

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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Page 28 of 103

The World Health Organization's International Agency for Research on Cancer has classifed UVR from the sun and artifcial UV tanning devices as carcinogenic to humans. 2 Both old and newer tanning lamps have been shown to increase risk of skin cancer. 3,4 The im- pact of indoor tanning on someone's total UV exposure can be substantial: For example, one minute in the average in- door tanning bed in England is twice as cancer-causing as one minute in the midday Mediterranean sun. 5 Young People in Peril T hose who start tanning when young obviously accumulate more skin damage over time. Their skin also appears to be more vulnerable. In the past few years, a wave of studies has given us horrifying details on what tanning is doing to young people. Their sky- rocketing increases in mela- noma incidence coincide perfectly with the increased popularity of tanning. The U.S. Food and Drug Administration estimates that nearly 30 million Americans now use tan- ning devices annually, and two to three million are teens. 6,7 Two major surveys since 2008 have found that tanning rates are highest among young white women, especially those between 18 and 29 years of age 8,9 – and lo and be- hold, melanoma incidence has risen preferentially among young women in that time, especially on body sites such as the trunk that are naturally sun-protected by clothing. 10 Purdue and colleagues reported that the annu- al incidence of melanoma at all stages among young women increased from the 1990s on; 11 again, these increases paralleled the rise in young women's tanning bed use. 12 There is no evidence that young women are spending more time in the sun or using sun protection less; thus, it would appear that the sharp melanoma increases among young women is owing to their epidemic use of tanning beds. Unfortunately, even adolescents have caught the fever: 13 percent of high school students engage in indoor tan- ning, including 29 percent of white high school girls, and 32 percent of girls in the 12 th grade. 9 Trending even younger, a 2011 study of over 6,000 14-17-year olds in the 100 most popu- lated American cities found that in the preceding year, over 17 percent of girls and over 3 percent of boys had used indoor tanning. 13 Making matters worse, several ma- jor studies in the past three years have shown that the earlier young people start to tan, the greater their odds of developing skin cancer while young, and that the more they tan, the greater their lifetime chances of developing all three major skin cancers. 14-16 Old Before Your Time S kin cancer isn't the only thing tanners have to worry about. We know that more than 90 percent of the visible changes commonly attrib- uted to skin aging are caused by the sun's UV rays. Logically, indoor tanning must be an even greater ager, since tan- ning beds produce such concentrated amounts of UVA, the prime aging ray. What isn't logical is that people use indoor tanning in the quest to become more attractive. In the 2011 second edition of their book, Cancer of the Skin, Rigel, et al say it well: " Since the point of indoor tanning is cosmetic enhancement, it is ironic that the long-term efect may be photoaging, which leads to wrinkled, leathery, discolored skin." 17 The authors point to a study by Lavker, et al 18 showing that human skin exposed to low, non- reddening doses of UVA daily for only one month demonstrated many tissue changes characteristic of photoaging, including swelling, infammation and deposits of lysozyme, an enzyme that attempts to repair UV damage. Hooked T he truth is, many people get it – they're aware enough of the science to know that tanning puts their skin at risk – but they keep tanning. Part of it, especially for many young people, is that they simply don't care: they think they look better tan now, and don't want to worry about what hap- pens down the road. 19 But a more insidious factor is at work as well: addiction. Tanning is both psycho- logically and physically addictive. In 2005, Warthan, et al adapted classic substance abuse questionnaires (the CAGE questionnaire, normally used for alcoholism screening, and the American Psychiatric Association's DSM-IV-TR for substance abuse) to survey beach tanners in Galveston, TX. Of 145 participants, 26 percent met the modifed CAGE criteria and 53 percent the DMS-IV-TR criteria for a substance-related disorder. 20 In 2011, Harrington, et al adapted the same two questionnaires, proving that this addiction held true for indoor tanners: of 100 frequent tanners in- terviewed, 41 percent met the criteria for a "tanning addictive disorder." 21 Several studies have now shown the physiological basis for this addiction. In 2004, Feldman, et al had frequent tanners unknowingly spend one ses- sion in a tanning bed that emitted 27 "Since the point of indoor tanning is cosmetic enhancement, it is ironic that the long-term effect may be photoaging, which leads to wrinkled, leathery, discolored skin."

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