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Stuart Fox
livescience.com Sun Jun 20, 11:21 am ET
For years and years now, millions of sun worshippers across the country would
hit the beaches during summer to work on the perfect, golden tan. However, the
advent of indoor tanning salons now allows Americans to sport a sun-kissed look
year-round. And as more and more people pursue a perpetual summer-style tan,
dermatologists have begun noticing a significant rise in skin cancer incidents,
especially among young women.
Melanoma, the deadliest form of skin cancer, still makes up just 3 percent of
all skin cancers, and results in about 8,000 deaths a year, according to the
National Cancer Institute. But three factors have doctors alarmed: The rates of
this cancer are rising; it has become the most common cancer for young people;
and many of the cases result from the preventable, but addictive, behavior of
indoor suntanning.
"In the last few decades, it's certainly been on the rise. And some people
think that may be a result of behavior, and UV exposure," said Jennifer Stein,
an assistant professor of dermatology at New York University's Langone Medical
Center. "This is a very serious cancer, and this is a behavior that's
preventable."
Tanning and cancer go hand-in-hand
Without tanning beds, soaking up the rays was limited to clear days in the
summer. The invention of the tanning bed changed that, and throughout the
1990s, the rapid proliferation of tanning salons provided venues for millions
of people to sunbathe regardless of weather, season, or time of day.
Since 1992, the indoor tanning industry has grown five-fold, with 28 million
indoor tanners in the United States supporting a billion-dollar-a-year
business, said Maria Tsoukas, an assistant professor of dermatology at the
University of Chicago Medical Center.
During that same period, melanoma rates have increased by 2 percent in the
general population, Stein said. Amongst young women, who make up 71 percent of
tanning salon customers, incidents of melanoma have increased by 2.2 percent,
Stein said. Over that time, skin cancer also became the most common form of
cancer for Americans ages 25-29, a group that traditionally shows very low
cancer rates, Stein said.
"We see a surprising number of young women coming in with melanoma, and a lot
of them say they've used tanning beds," Stein told LiveScience.com. "By far, by
far, the majority of users of indoor tanning beds are young women."
While some dermatologists believe that other factors, such as increased UV
exposure resulting from the hole in the ozone layer, contribute to the rise in
melanoma rates over the last 18 years, the irrefutable link between indoor
tanning and melanoma makes tanning beds the prime suspect, Tsoukas said.
In a recent study conducted by researchers at the University of Michigan,
frequent tanning bed users proved three times more likely to develop melanoma
than non-users, and subjects that used tanning beds for any amount of time
showed a 74-percent higher rate of melanoma than non-users, according to
research published online May 27 in the journal Cancer Epidemiology, Biomarkers
and Prevention.
That study did not investigate the percentage of indoor tanners who developed
melanoma, rather showing the difference between users and non-users.
How tanning causes cancer
Indoor and outdoor tanning can be dangerous, because the same ultraviolet
radiation that provokes a tan also damages DNA. In fact, exposure to the
mid-day sun can produce as many as 40,000 DNA errors an hour, said Regina
Santella, a professor of environmental health sciences at Columbia University's
Mailman School of Public Health in New York.
The UV light causes the DNA molecule thymine to bind to adjacent thymine
molecules in a manner that renders both molecules unreadable during
transcriptions, Santella said. Transcription is a step in which the body reads
the DNA instructions the cell will later follow. When those thymine errors
occur in areas of DNA that regulate cell growth, skin cancers like melanoma can
begin to develop, Santella said.
Most times, skin cells rapidly repair most of those 40,000 errors, but over
time repeated errors can cause cancer or other problems.
Tanning is actually the body's response to that damage, with the darker color
produced by skin adding an additional layer of protection for the DNA, Stein
said. However, when the body produces the hormone that initiates tanning, it
also produces a secondary molecule in the endorphin family, said Scott Feldman,
a professor of dermatology at the Wake Forest University Baptist Medical
Center.
Endorphins are chemicals that transmit feelings of pleasure and happiness. In
effect, exposure to UV radiation gets tanning bed users high, Feldman said. And
like any high, tanning can become addictive.
In 2005, Feldman conducted a study where he gave volunteers endorphin-blocking
chemicals before they used a tanning bed. The study aimed to test whether
frequent tanning salon customers would enjoy the experience as much if their
bodies didn't produce endorphins. They didn't. And even before the frequent
tanners used the tanning bed, they showed signs of physical addiction to
tanning.
"When we started doing the experiments, the first couple volunteers got sick,
and we said 'Hey, that's unexpected,'" Feldman told LiveScience. "We were
putting them into withdrawal."
Tan responsibly
With studies proving that tanning bed use causes both addiction and cancer,
many dermatologists have begun comparing the practice to other forms of drug
abuse like drinking and cigarette smoking, Feldman said. And much like with
smoking and drug abuse, doctors have told their tan-loving patients to "just
say no."
"There is no point to it. Someone wants to look darker? Gimme a break. For
cosmetic reasons, people risk getting a fatal cancer. To me, it's a public
health hazard because it has no upside," Santella said. "Don't go to skin
tanning salons. Simple as that."
Others advocate that tanning salon patrons take an approach more like drinking
alcohol, with moderation and responsibility mitigating the long-term health
effects, Feldman said.
"We see the cancer patients, but there are millions of people tanning, and
considering the number of people doing it and not getting cancer, it's probably
not the first problem we need to solve in America," Feldman said. "If a woman
comes in, and I see cigarettes in her bag, I'll tell her to stop smoking before
I tell her to stop tanning. Lung cancer is considerably worse."
But those approaches only tackle the physical side of tanning without getting
to the root problem that drives millions of Americans, young women in
particular, to engage in a behavior they often know raises their risk of a
deadly disease, Stein said. To fix the social pressures behind the rise in this
largely preventable cancer, America might need to refine its idea of beauty.
"I've met people who said they couldn't stop tanning. They wanted to stop, but
couldn't. They liked the way it felt and they felt pressure from their
friends," Stein said. "I think we really need to change that notion in this
country that looking tan means looking healthy, because we know that tans are
not healthy."