Indoor tanning drives increase in skin cancer - study, Part 2

Growing popularity

As indoor tanning has grown more common, so too has skin cancer. Between 1998 and 2008, the incidence of melanoma rose 2.1% per year in Caucasian men and 2.4% per year in Caucasian women. Increases in men were seen only in those over 55, while increases were seen in women of all ages. Nonmelanoma skin cancers (NMSCs), including BCC and squamous cell carcinoma, are also on the rise. One study found a 77% rise in NMSC treatments for Medicare beneficiaries between 1992 and 2006.

Unfortunately, many indoor tanners feel pressured to engage in the activity. For some young people, the norms of their sport or activity demand bronzed skin. These include beauty pageant contestants, dancers, synchronized swimmers, wrestlers, gymnasts and bodybuilders. "If they're not tan, they're viewed as not competitive," says Mayne. "These people shouldn't have to feel that they have to engage in these carcinogenic behaviors just to be competitive at what they love to do."

Simply being a teenager can also suffice to get a person in the door. Lauren Hurd, 26, knows this firsthand. A blond, blue-eyed former lifeguard, she began tanning with friends at age 17 to prepare for her prom. "I was hesitant at first and knew it probably wasn't a healthy choice, but it was a social activity and we all know at that age how heavily this can impact a decision," she recalls. On arriving at college in upstate New York, she discovered that tanning was equally popular among her new friends, and when a spa-like salon opened up across from campus, she joined them in purchasing its $20 unlimited monthly packages. Soon Hurd was going in for 20-minute sessions several times a week; she found tanning a reprieve from the daily pressures of college.

"Just like when you're addicted to anything else you know is bad for you, you try to rationalize. You say to yourself, 'It won't happen to me. Even if I do get skin cancer, it will be way down the road.'" For Hurd, that road took only about five years. She was diagnosed at age 22 with early-stage malignant melanoma on her leg.

Mayne says she was shocked to learn of the sheer popularity of indoor tanning among the young people in her study. "Amongst our females who had these early-onset skin cancers, 81% of them had used a tanning bed," she says. "That's a mind-boggling number." In her study, more than 50% of indoor tanners had started this practice before the age of 17. According to national data from the 2011 Youth Risk Behavior Surveillance System, 21% of high school girls report having engaged in indoor tanning in the past 12 months; this figure rises to 29% among non-Hispanic, Caucasian high school girls.

The pressure may be internal as well. Evidence is mounting that indoor tanning may be addictive. Many frequent tanners claim they are hooked, and the problem may be compounded by the youthfulness of the indoor tanning set - evidence from other behaviors such as drinking indicates that beginning such behaviors at early ages raises the likelihood of addiction. The phenomenon, says co-author Brenda Cartmel, research scientist and lecturer in the Department of Chronic Disease Epidemiology, may relate to endorphins, which are produced in the skin in response to UV exposure. One blinded study found that people could tell with near-perfect accuracy whether their tanning bed had a UV filter. Participants reported feeling more relaxed and less tense after UV exposure than they did after non-UV exposure.

Dangerous though it may be, indoor tanning as a risk factor is readily modifiable - unlike, say, a genetic predisposition. That makes it a tempting target for public health initiatives aimed at preventing skin cancer. Mayne and Ferrucci calculated that 43% of early-onset BCCs in women could be avoided if the women never tanned indoors, while an October study in BMJ suggested that indoor tanning could account for about 170,000 skin cancers each year in the United States alone.

Many states have enacted age-related restrictions on indoor tanning, most of which require parental permission for minors. Two states - California and Vermont - ban indoor tanning outright for people under 18, while New York bans it for those under 17. Supporters of such laws point out that children are barred from legally purchasing another known carcinogen, tobacco. In addition, says Mayne, the laws can ease peer pressure.

"If you talk to skin cancer survivors, they will tell you, 'I started tanning because everybody was tanning,'" says Mayne. "If we're able to restrict it, that eliminates them having to make those difficult decisions. And then when they're 18, hopefully they're in a little bit better position to be able to make informed choices."