SMOKINCHOICES (and other musings)

January 17, 2015

Tanning beds? be aware

Public health

Too many ignoring tanning-bed danger

By Sabrina Tavernise • THE NEW YORK TIMES

TEQUESTA, Fla. — On their way home from an SAT tutoring session, the Van Dresser twins, Alexandra and Samantha, 17, popped into Tan Fever & Spa, a small, family-owned salon tucked into a strip mall between a bar and a supermarket. • They wanted to get tan before the prom, and the salon was the perfect combination of fast and cheap: Twenty minutes in a tanning bed cost only $7.

“It’s the quickness of the tanning bed,” Alexandra explained one afternoon last year. “We don’t have time to lay out on a beach.”

Indoor tanning might seem like a fashion that faded with the ’80s, but it remains a persistent part of American adolescence, popular in spring, summer and fall but especially in winter, when bodies are palest. Salons dot strip malls across the country, promising prettiness and, in some cases, better health, despite a growing body of evidence that links indoor tanning to skin cancer.

In Florida, there are more tanning salons than McDonald’s restaurants, CVS stores or Bank of America branches, according to a 2014 study by University of Miami researchers.

For decades, researchers saw indoor tanning as little more than a curiosity. But a review of the scientific evidence published last year estimated that tanning beds account for as many as 400,000 cases of skin cancer in the United States each year, including 6,000 cases of melanoma, the deadliest form. And clinicians are concerned about the incidence rate of melanoma in women younger than 40, which has risen by a third since the early 1990s, according to data from the National Cancer Institute. Death rates have not gone up, however, a testament to earlier detection and better treatment.

“We’re seeing younger and younger patients coming to us with skin cancer,” said Dr. Eleni Linos, assistant professor of dermatology at the University of California-San Francisco. “That is a new phenomenon.”
Last year, the surgeon general called on Americans to reduce their exposure to the sun and tanning beds to prevent skin cancer, and the Food and Drug Administration invoked its most serious risk warning, lifting tanning beds from a category that included Band-Aids to that of potentially harmful medical devices. The Obama administration’s 2010 health-care law imposed a little-noticed 10 percent tax on tanning salons.

And more than 40 states now have some sort of restriction on the use of tanning salons by minors, according to AIM at Melanoma, an advocacy and research group based in California, the first state to adopt a ban on minors in 2011. At least nine states plus the District of Columbia (pending congressional approval) have passed such bans, even Republican-controlled Texas, where antipathy to government regulation runs deep.
“The tide is turning,” said Samantha Guild, director of public policy at AIM. “States are saying: ‘We don’t have to go out on a limb on our own. There’s broad support for this issue.’”

For the first time, new federal data have documented a decline in the use of indoor tanning among teenage girls, dropping to about a fifth of them in 2013 from a quarter in 2009. Gery P. Guy Jr., a researcher with the Centers for Disease Control and Prevention who analyzed the data, which was released in December, attributed the decline to greater awareness and tougher laws.

Even so, public-health experts say tanning remains a persistent problem, especially among white teenage girls, a full third of whom say they have tanned indoors, more than the share who smoke cigarettes.

There were about 14,000 salons across the country as of early 2014, said John Overstreet, executive director of the Indoor Tanning Association. That does not count tanning beds in gyms and beauty parlors. The number is down about a fifth in recent years, he said, as the recession eroded young women’s disposable income and the tax imposed under the new health-care law squeezed salons’ profits.

Overstreet argues that there is no science that conclusively links moderate, nonburning ultraviolet-ray exposure to melanoma. His organization’s mission, according to its website, is “to protect the freedom of individuals to acquire a suntan.”   “The folks who don’t like this industry are exaggerating the risks,” he said, adding: “It’s just like anything in life. If you get too much of it, it’s bad for you.”

Evidence of the link between melanoma and ultraviolet exposure might have been inconclusive a decade ago, but recent research, including fresh data from the Cancer Genome Atlas, a federally funded program that is cataloging genetic mutations responsible for cancer, bolsters the case for the link.
Dr. Jeffrey E. Gershenwald, a leader of the melanoma Atlas project, said studies to date showed that a majority of melanomas initially arising on the skin contain mutations associated with ultraviolet exposure. As for burning, one recent study controlled for that, and still found an increased risk from indoor tanning.

“There’s no longer a question of whether UV is important,” said Gershenwald, medical director of the Melanoma and Skin Center at the University of Texas MD Anderson Cancer Center. “Genomics has been transformative in our understanding of melanoma.”

The problem with indoor tanning, researchers say, is that many of those who do it do it a lot.

There is strong peer pressure to be tan, particularly in small-town high schools.

Sarah Hughes started tanning at 16, during beauty-pageant season in her hometown, Dothan, Ala. She often tanned five days a week, paying with money earned working at Pier 1 Imports. In her senior year, she got a job at a tanning salon so she could tan for free.

“Living in a small town in southern Alabama, you don’t want to be the oddball out,” said Hughes, who is now 30 and works as a loan processor in a bank.
Over time, she came to crave it.   “People did drugs. People had eating disorders. I tanned,” she said.

Hughes stopped tanning at 25 when a doctor diagnosed advanced melanoma. A tumor on her left leg had grown down into her muscle and, eventually, her lymph nodes. In all, she had 33 spots removed, including eight melanomas over two years, a searing experience.     She survived.

Brandi Dickey of Fort Worth, Texas, did not. Her mother, Paula Pittsinger, blames the near constant tanning from the age of 14 to 28, when she was found to have a particularly aggressive form of cancer that eventually spread to her brain. She died in October at 33 after 18 surgical procedures, including six on her brain. There was no history of melanoma in her family.

“When you see the impact, the brain surgeries, the scars, when you see what tanning has done, it has got to hit home that it’s just not worth it,” Pittsinger said.

Many young women said in interviews that tanning fed a craving to be pretty, at a time in life when it is most acute. Madison, 21, a student at the University of Rhode Island, said tanning made her feel “more confident and more comfortable when I walk around.”   “Sometimes, it makes me feel thinner,” she continued. “It has all these weird effects that just make me feel better about myself.”

She recently reduced her use to a few times a month, down from almost daily, honoring a request from her mother.
“I’d love to stop tanning but I can’t,” said Madison, who asked that her last name not be used. “Confidence is such a touchy aspect of a girl’s life. It takes a lot of time and practice. I’m just not there yet.”

  • The CDC’s national youth survey found that indoor tanning often goes along with binge drinking and unhealthy weight-control practices.

(Know anybody like that?    I do, . . .  tho I’m no one to judge — there are times in our lives that we all need a bit of help and maybe some, a little more.  It’s hard growing up and discovering who we really are.  And realizing that with every choice, there is a cost or consequence. . .just the way stuff works.   Sometimes, . .  so sad.     Jan)

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