Indoor tanning increases the risk of developing melanoma skin cancer, researchers reported in the BMJ (British Medical Journal) today. Tanning bed users who are exposed before they are twenty-five years old are especially vulnerable to developing basal cell carcinoma and squamous cell carcinoma, the authors added.

Tanning salons are very popular in Western Europe and North America. A report published in Archives of Dermatology in December 2010 estimated that 18.1% of women and 6.3% of men in America use tanning beds regularly.

In July, 2012, the BMJ published another study which revealed that 5.4% of all new melanoma diagnoses in Western Europe are linked to indoor tanning, particularly among young adults. European dermatologists and other health care professionals are calling on European governments to introduce a “tan tax” on tanning salons, as is done in the USA.

In the USA, State authorities have started introducing their own laws to protect young people’s skin. On July 16th, 2012, Andrew Cuomo, Governor of New York, signed a bill banning children under 16 from using indoor tanning salons. The bill also requires that 17-year olds can only use tanning beds if they have written parental consent.

In October, 2011, California Governor Jerry Brown signed a new bill into law, which raised the minimum age for using tanning beds to 18 years, from 14. Fourteen to eighteen year-olds used to be able to use indoor tanning salons if they obtained parental consent. The new law banned the use of tanning beds for anybody under the age of 18, even those with parental consent.

Professor Eleni Linos at the University of California San Francisco, who led this research, and team have estimated that over 170,000 cases of non-melanoma skin cancer in America alone are caused by indoor tanning.

Over the last thirty years, the number of reported cases of non-melanoma skin cancer has risen considerably. Non-melanoma skin cancer is not as deadly as melanoma, but it affects a considerable number of people globally and places a heavy financial burden on health systems.

Professor Linos and colleagues set out to determine whether indoor tanning affected skin cancer rates, and if it did so by how much. They gathered and examined data from 12 studies involving 7,645 patients with basal cell carcinomas and 1,683 with squamous cell carcinomas.

The researchers found that:

  • The risk of developing squamous cell carcinoma was 67% higher from ever using indoor tanning, compared to never having used it
  • Ever using indoor tanning increased the risk of developing basal cell carcinoma by 29%, compared to never using it
  • Indoor tanning is probably the cause of 3.7% of all basal cell carcinomas in the USA each year – a total of 98,408 cases
  • Indoor tanning probably causes 8.2% of all squamous cell carcinomas in the USA each year – a total of 72,244

People younger than 25 years of age who are exposed to indoor tanning are particularly prone to developing basal cell carcinoma. The authors wrote, “This suggests a critical period for exposure during early life and a potential dose-response effect.”

Even after making adjustments for several factors which may have impacted on the results, the authors wrote that their findings still stood.

The researchers say their study suggests a causal link between non-melanoma skin cancers and indoor tanning. They believe that indoor tanning is probably responsible for hundreds of thousands of skin cancer cases in America alone.

The authors concluded:

“We hope that these findings can support public health campaigns and motivate increased regulation to reduce exposure to this carcinogen, especially during early life.”

Scientists from the Queensland Institute of Medical Research, Australia, wrote that the latest and last July’s reviews “provide more convincing evidence that exposure to artificial ultraviolet radiation is a cause of the three main skin cancers.”

Regarding regulations aimed at the indoor tanning industry, the authors wrote:

“(regulations) ..must be tethered to warnings by health professionals and educators about the risks of indoor tanning” and suggest that “young people in particular should be made aware that the use of sunbeds for short term cosmetic tanning carries the long term price of an increased risk of skin cancer.”

Simon Williams, from Northwestern University, Chicago, said in a personal view article “The EU needs to follow the example of the United States by introducing a so called tan tax on indoor tanning services.”

Williams estimates that adding 10% tax (excise duty) on indoor tanning prices could raise between £95m and £113m ($145m and $165m) for the UK government. From a public health point of view, a 10% tax is probably nowhere near enough; but it is a starting point, he added. The excise duty would also show general acknowledgment regarding indoor tanning’s potential health risks, as is the case with tobacco. Williams referred to indoor tanning as “a primary tier carcinogen that warrants its own sin tax.”

In February, 2012, the US House Energy and Commerce Committee, a Congressional Panel, slated tanning salons for failing to make the risks clear to their clients. In what they described as a “sting operation”, committee investigators inquired at 300 salons around the country, posing as fair-skinned 16-year old females. Over 90% of the indoor tanning salons said they used special tanning beds which have no significant health risks. Over half of them said tanning beds do not increase skin cancer risk at all.

Over three-quarters of the salons told the undercover “young girl” that regular use of their tanning beds would be good for her health. They added that media stories about increased cancer risk were “rumor” and hype”.

An addictive neurological reward-and-reinforcement process may be triggered by frequent tanning bed use, researchers at UT Southwestern Medical Center reported in August 2011. Very frequent tanning bed users often have similar brain activity and blood flow to those observed in people who are dependent on alcohol or drugs.

The researchers believe that their findings could explain why some people continue using tanning beds excessively even after finding out about the skin cancer risk.

The researchers explained that “Using tanning beds has rewarding effects in the brain so people may feel compelled to persist in the behavior even though it’s bad for them. The implication is, ‘If it’s rewarding, then could it also be addictive?’ It’s an important question in the field.”

Written by Christian Nordvist