Australia Joins Other Governments in Banning Indoor Tanning Salons

Health officials in Australia’s Legislative Assembly – the Australian Capital Territory (ACT) have announced a complete ban on commercial indoor tanning in Australia beginning January 1, 2015.

The ban follows rulings by the states of New South Wales, South Australia, Victoria and two other states to ban the salons – after cumulative research connects increased skin cancer risk to indoor tanning, and 80% of all Australian cancers are skin cancer.

Since 2003, several countries have created regulations on indoor tanning. Brazil, France, Spain, Germany, Austria, England, Wales, Ireland, Scotland and Portugal have restricted indoor tanning to adults. Brazil later moved to a complete ban.

Some 33 U.S. states have established restrictions for those under the age of 18 – including California and Vermont, which were the first states. This summer the U.S. FDA proposed new regulations on tanning salons as well.

How strong is the evidence that indoor tanning causes cancer?

Pretty strong. In 2006, the International Agency for Research on Cancer (IARC) reviewed 19 large studies and calculated that indoor tanning increases the risk of squamous cell cancer by 125% and melanoma by 15%.

The research also found that those who have tanned indoors before 35 years old have a 75% increased risk of skin cancer when compared with those who have never done indoor tanning.

These numbers in addition to new research has prompted the American Cancer Society to take a position on the subject. Kelly Stoddard, American Cancer Society vice president of health and advocacy initiatives reflects on the Vermon restrictions in the case of young people:

“We have data showing that 21% of young women in Vermont use tanning beds. And melanoma rates in the 25- to 29-year age group here are growing, which leads us to think it has something to do with UV damage during the teen years.”

Recent research confirms this notion. A 2010 study compared 1,167 patients with invasive cutaneous melanoma in Minnesota with 1,101 matched control subjects. This study found that indoor tanning increased the risk of melanoma by 74%.

This also had a dose-dependent response – the gold standard in establishing risk: Those who had tanned indoors under 10 times only had a 34% increased risk. And those who tanned more than 100 times had a 272% increased risk of melanoma.

This finding was confirmed by another study from Australia’s Sydney School of Public Health. Here 604 patients with invasive cutaneous melanoma were studied with matched controls. Those who used indoor tanning 10 or more times before the age of 29 had a 600% increased risk of melanoma. Of those who tanned between 30 and 39 years old, the increased risk was 60%.

And more recently, a study from Harvard conducted a long-term study of 73,494 women as part of the Nurses’ Health Study II. This found that indoor tanning during high school and college increased the incidence of basal cell carcinoma (BCC) by 83%, while indoor tanning between 25 years old and 35 years old increased BCC risk by 30%.

Furthermore, a study from Yale that followed 376 basal cell cancer patients together with 390 matched controls found that indoor tanning increased basal cell cancer risk by 69%.

What about Vitamin D and Cancer?

To balance this, there is significant evidence that vitamin D produced from safe exposure to UVB reduces the risk of all cancers. (See Healthy Sun for more information). And vitamin D deficiencies have also been linked with numerous other health conditions.

But there are also nutritional considerations as well.

Advocates of safe indoor tanning also suggest that sunburns can be better prevented in indoor tanning booths because the conditions are more controlled.

And there is clear evidence that sunburns are significantly related to the mutation of DNA that occurs in skin cancers. This was confirmed in a recent University of Manchester study of 43,794 Australians.

The hypothesis that indoor tanning reduces sunburn frequency was in fact studied by researchers from the New Jersey University of Medicine and Dentistry. After screening 853 participants, the researchers followed 198 female college studies from two universities. They tested to what degree the students experienced sunburn (skin erythema) when using indoor tanning. The research found that 66% of those who used indoor tanning had sunburns from indoor tanning, and an astounding one in five tanning sessions resulted in a sunburn.

The researchers stated:

“The findings of our study contradict assertions from IT proponents that the so-called controlled exposure provided by IT devices results in minimal risk of burn.”

Some advocates – many who also sell tanning beds – suggest the increased cancer risk relates to the ballast of the tanning bulbs. The older, larger ballast bulbs produce quite a bit of voltage, which when placed near the skin, can conduct increased electromagnetic frequencies. This in addition to the lack of full spectrum light may account for the increased risk of cancer.

Newer tanning beds may be equipped with low ballast bulbs that conduct far less voltage and thus less EMFs – which have been implicated in other research as cancer-causing.

Some tanning salons also utilize red light therapy in their tanning beds – which has been shown to slightly increase skin healing. This was confirmed in a study of 65 women with facial skin photodamage. Those treated with the red light therapy showed slightly greater dermal thickness, as well as improvements in collagen, estastic tissue and fibrosis.

Synthetic versus Sunlight

As humans have been exposed to the sun for millions of years, the question boils down to whether the exposure to UVB within an indoor tanning bed is a natural form of sun exposure. Certainly, UVB treatment and red light therapy has been shown to be beneficial as a medical therapy as supervised by health professionals – in the treatment of seasonal affective disorder (SAD) and vitamin D deficiency.

But unrestricted use of an artificial means of the healing rays of the sun are often licenses for abuse by those who simply want to have that “healthy glow” without understanding the risks. For these reasons many governments have stepped in to regulate tanning salons.

In other words, these artificial versions of the sun’s rays are very similar to pharmaceuticals – which are synthetic isolated chemicals attempting to mimic the full-spectrum healing effects of medicinal herbs. Restricting and regulating synthetic versions of nature appear to be par for the course.

Certainly, a tanning bed can be effective in cases of SAD or severe vitamin D deficiency for those who otherwise have no access to the sun. But  given the ease of indoor tanning misuse as indicated by the research, many are pushing to prescriptively use them under professional supervision as a public health concern.

REFERENCES:

FDA wants tighter rules for indoor tanning. Cancer Discov. 2013 Jul;3(7):OF12. doi: 10.1158/2159-8290.CD-NB2013-078.

Watson M, Holman DM, Fox KA, Guy GP Jr, Seidenberg AB, Sampson BP, Sinclair C, Lazovich D. Preventing skin cancer through reduction of indoor tanning: current evidence. Am J Prev Med. 2013 Jun;44(6):682-9. doi: 10.1016/j.amepre.2013.02.015.

Schmidt CW. UV radiation and skin cancer: the science behind age restrictions for tanning beds. Environ Health Perspect. 2012 Aug;120(8):a308-13. doi: 10.1289/ehp.120-a308.

Olsen CM, Green AC, Neale RE, Webb PM, Cicero RA, Jackman LM, O’Brien SM, Perry SL, Ranieri BA, Whiteman DC; QSkin Study. Cohort profile: the QSkin Sun and Health Study. Int J Epidemiol. 2012 Aug;41(4):929-929i.

Gold MH, Sensing W, Biron J. Fractional Q-Switched 1,064-nm laser for the treatment of photoaged-photodamaged skin. J Cosmet Laser Ther. 2013 Dec 14.

Sinclair CA, Makin JK, Tang A, Brozek I, Rock V. The Role of Public Health Advocacy in Achieving an Outright Ban on Commercial Tanning Beds in Australia. Am J Public Health. 2013 Dec 12.

Stapleton JL, Hillhouse J, Turrisi R, Robinson JK, Baker K, Manne SL, Coups EJ. Erythema and ultraviolet indoor tanning: findings from a diary study. Transl Behav Med. 2013 Mar;3(1):10-6. doi: 10.1007/s13142-012-0155-2.