Please click links in each section for more information.

Ultraviolet (UV) Radiation and Skin Cancer

• The Surgeon General calls skin cancer a major public health problem. While fair skin and family history of skin cancer contribute to risk, the most common types of skin cancer are strongly associated with exposure to ultraviolet (UV) radiation¹.
• Two of the world’s most trusted voices on the causes of cancer, the World Health Organization and the National Toxicology Program, agree that UV radiation is carcinogenic to skin. (Wikipedia defines “carcinogen” as “directly involved in causing cancer.”)

• Tanning beds and UV radiation from the sun are ranked “Group-1 carcinogens” by the World Health Organization, based on broad science³. The National Toxicology Program also rates tanning bed exposure as “known to be a human carcinogen.” Other carcinogens in this highest risk category include radon, tobacco and asbestos.

• Indoor tanning is linked to more skin cancers than cigarettes to lung cancers. A University of California San Francisco study⁵ attributed over 388,000 new cases of skin cancer in the United States to indoor tanning each year, compared to just over 203,500 cases of lung cancer attributed to cigarettes. Lung cancer and tobacco-related illnesses cause many times more deaths than skin cancer. However, because of 1) the tremendous rise in new skin cancer cases in the U.S.,  2) the link of indoor tanning to skin cancer, and 3) the popularity of indoor tanning despite risk, indoor tanning is associated with a far higher number of cancers. 

• Tanning bed use is linked to higher rates of all three major forms of skin cancer. These include deadly melanoma⁶ and the less deadly but often disfiguring non-melanoma⁷ skin cancers (basal cell and squamous cell carcinoma).

• The number of non-melanoma skin cancers in the U.S. is estimated to be higher than that of all other cancers combined^8.

• Young people who tan indoors have higher rates at younger ages of basal cell carcinoma, the most common skin cancer⁹.
• Both burns and gradual accumulation of UV damage¹⁰ in skin cells are associated with skin cancers, according to the Skin Cancer Foundation. Burns, however, are worse.
• UVB and UVA are carcinogenic to skin cells in different ways³. UVB directly damages skin cell DNA. UVA causes indirect damage.
• There is no such thing as a “SAFE TAN.” Any color the skin develops is a direct result of DNA damage to the skin cells¹¹. This DNA damage accumulates and increases the risk of skin cancer.
• Spray tanning and self-tanning lotions have not been shown to be carcinogenic.

Malignant Melanoma

• Tanning indoors before age 35 increases your risk of melanoma by nearly 60%. An international study¹² found that indoor tanning before age 35 raised the risk of getting melanoma by 59%¹³. Not only that, the risk was 1.8% higher with EACH additional tanning session¹² in a given year.
• One person dies of melanoma every hour in the U.S. The American Cancer Society Facts and Figures¹⁴ predicts one person will die about every 54 minutes in the United States from malignant melanoma in 2014. 
• New cases of melanoma continue to climb in the U.S., even while most other serious cancers are leveling off or declining.  According to the American Cancer Society¹⁵, the annual percent increase for melanoma between 1992 and 2009 exceeded that of breast, lung, and colorectal cancers. 

• Malignant melanoma is the single most common cancer of young adults, and one of the most common cancers in teenagers. A recent National Cancer Institute report¹⁶ ranked melanoma the number one cancer of adults aged 25-29 years, and the second highest in adolescents and young adults aged 15-25 years.

• Nebraska had the highest mortality from melanoma in the nation per capita in women in 2007-2008, and the second highest in men ¹⁷.

• Melanomas are developing earlier and more often in young women than in young men¹⁸. Is it a coincidence that 70% of the one million people who tan in the U.S. each day are young women¹⁹?
• A Minnesota study²⁰ showed an astounding 24-fold melanoma increase in women aged 40-60, compared to only a 4.5-fold increase in men of the same age.
• The most common location of melanomas on young women has changed from the legs to the trunk. This may be related to exposure trends, including exposure in tanning beds²¹.
• Invasive melanoma in young people is linked to indoor tanning at earlier ages, and to repeated tanning. A 2010 multi-center study²² of young adults found that, in persons aged 18-29 years with invasive melanoma who had ever used a tanning bed, “76 percent of melanomas were attributable to sunbed use.” 
• In addition, they reported that “the association was stronger for those who [started tanning] at an earlier age²².” Finally, they concluded that “those who reported more than 10 lifetime sessions appeared some six times more likely to be diagnosed with melanoma before 30 years of age compared with never-users²².”
• The stronger the tanning bed, the higher the risk. Another Minnesota study²³ showed that so-called “high speed” or “high intensity” machines (that boost UVB) led to nearly a 3-fold rise in melanoma. “High pressure” devices that intensify UVA caused over a 4-fold increase.

Teenage Girls and Young Women

• The large majority (70%) of the 1 million people who tan in the US each day are young women¹⁹.
• 30% of Nebraska teen girls report using tanning beds in the last year²⁴.
• 2.3 million teenagers tan indoors in the US each year¹⁹.
• Tanning frequency increases with each year of high school²⁵.

• Is tanning addictive? It appears to be²⁶. Health and beauty expert Dr. Susan Evans says, “studies indicate that people who suffer from tanorexia display the same addictive behavior as smokers or people with other addictive habits.”

• One study²⁸ actually produced withdrawal symptoms in frequent tanners with medicine used to treat heroin overdose.

• Another analysis²⁹ of high school teenagers also found higher rates of alcohol, tobacco, and drug use in indoor tanners.

UV Radiation and Skin Aging

• As if higher cancer risk wasn’t bad enough, there is more bad news.  Tanning makes your skin age faster³⁰. Professional models know this and use self-tanners or spray tans.  And more and more they embrace their own natural skin tone.
• You can’t see or feel UV. UV radiation from the sun and tanning beds is emitted in waves longer than X-rays and shorter than visible light. UV is invisible and you can’t feel it (until later!)  So your senses can’t tell you how large a dose of UV your skin is getting.
• UVA (think A for Aging) penetrates deeply into both layers of skin and damages collagen and elastin. This is how UVA exposure leads to premature aging, including sags, bags, wrinkles and lines where you don’t want them.
• UVB (think B for Burning) is higher energy but only penetrates into the top layer of skin. Besides burns, UVB causes blotches and pigment irregularities.
• Sunscreen decreases aging changes³¹ caused by UV radiation exposure.

UV Radiation and Seasonal Affective Disorder

• Seasonal Affective Disorder (SAD) may drive sufferers to tanning beds on short gloomy winter days. However, did you know that SAD responds best to visible light, not to harmful UV radiation³²?
• Tanning indoors causes “feel-good” endorphin release, but it comes at the price of UV damage to skin cells. The endorphins appear, ironically, to be part of the skin’s attempt to avoid further damage¹¹.

Indoor Tanning Devices

• The U.S. Food and Drug Administration in 2014 strengthened warnings for sunlamp products³⁶. Starting in 2015, all tanning bed labels must state:

  The product is contraindicated for use on persons under the age of 18 years;

  The product must not be used if skin lesions or open wounds are present;

  The product should not be used on people who have had skin cancer or a family history of skin cancer;

  People repeatedly exposed to UV radiation should be regularly evaluated for skin cancer.

• Before UV lamps were developed, the skin of humans was exposed only to natural UV in sunlight.  We are only beginning to see the fallout from skin exposure to brief, large doses of UV radiation.
• Intermittent, intense UV exposure is thought to have a major association with heightened melanoma risk³⁵. This is exactly the type of exposure from that comes from much-stronger-than-nature UV lamps.
• High-pressure units have been shown to have up to 14 times the UVA of mid-day natural sunlight. One cancer scientist believes we are raising the stakes on Mother Nature: “Modern sunbeds are powerful sources of UV radiations that do not exist in nature, and repeated exposures to high doses of UVA constitute a new phenomenon³⁴ in humans.”
• Tanning beds are much more intense than natural sun exposure. The amount of UV averages double the UVB and four times the UVA, according to a North Carolina study³³. The same study found a four-fold variability in potency among tanning beds³⁴. There is no federal or state standardization of either UV amounts or the ratio of UVB to UVA in a given unit.
• One of the five strategic goals of the U.S. Surgeon General in his 2014 call to action to prevent skin cancer is to “reduce harms from indoor tanning¹.”

• Still, tanning beds are minimally regulated.  A warning sign on the device is the only FDA requirement that is enforced.  The FDA publishes upper limits of exposure, but does not enforce them, so the limits are often ignored³³.
• Tanning units account for over 1,800 Emergency Room visits a year for BURNS³⁷. This underestimates the true number of burns handled in doctor’s offices, urgent care facilities, or treated at home. Nearly 60% of patrons of tanning facilities report having been burned³⁸.
• Your skin remembers EACH tanning session. Just one indoor tanning session before age 35 increases risk of melanoma by 59%, and each additional use during the same year boosts risk⁶ by another 1.8%.
• The beds in most facilities appear to be sanitary, but what you can’t see may amaze you. A medical team in New York City swabbed the center of 10 upscale “Best of New York” Manhattan tanning beds, where skin contact typically occurs.  All 10 beds harbored bacteria³⁹ (including staphylococcus, enterococcus, klebsiella, enterobacter, pseudomonas, and bacillus).  All of these bacteria can cause skin infections.
• Warts⁴⁰, even genital warts⁴¹ have also been linked to tanning beds.

Indoor Tanning Facilities

• Tanning facilities do not require a license to operate in Nebraska.
• In 2010, the U.S. Federal Trade Commission ordered the Indoor Tanning Association to cease false advertising claims: 1) that tanning is safe or healthy, 2) that tanning poses no danger, and 3) that tanning does not increase risk of skin cancer⁴².
• Yet, a congressional investigative report⁴³ two years later found:
  • Tanning Salons market their product to teenagers.
  • Nine out of ten salons DENIED KNOWN RISKS of indoor tanning.  Salons claimed:
    • Young people are not at risk for developing skin cancer,
    • Skin cancers are caused by sunscreen,
    • Government regulators had certified the safety of indoor tanning.
  • Four out of five salons FALSELY claimed:
    • Indoor tanning is beneficial to a young person’s health
    • Indoor tanning would prevent cancer.
    • Tanning would treat depression and low self-esteem,
    • Tanning would prevent and treat arthritis, osteoporosis, cellulite, lupus, and fibromyalgia
    • Tanning would boost the immune system and aid weight loss.

Remember: The tanning industry’s business is selling tanning sessions.

Vitamin D

• Vitamin D advertisements don’t tell you the whole story. What they don’t tell you is that only a few minutes of UVB in natural summer midday sun, on a fair-skinned person (less than it takes to get pink or tan,) maxes out your pre-vitamin D production.  After that, pre-vitamin D begins to degrade as fast as it is generated⁴⁴.

• UVA has no effect on vitamin D production, but does age skin and increase cancer risk.
• Is it worth it? Compared to natural summer sunlight, the artificially high UVB in tanning beds adds risk without adding benefit³³. Together, excessive UVB and UVA in tanning beds are a one-two punch to your skin. Let your skin breathe a sigh of relief and make the healthy choice to get your Vitamin D in a supplement.
• Supplementation is as natural as diet, as an alternative to exposing yourself to UV.

References

1. The Surgeon General’s Call to Action to Prevent Skin Cancer Executive Summary

2. El Ghissassi, F. et al., Special report: policy. A review of human carcinogens—part D: radiation. The Lancet 2009; 10(8):751-752

3. International agency for Research on Cancer Working Group on Artificial Ultraviolet (UV) Light and Skin Cancer.  The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers:  a systematic review.  Int J cancer 2006;120(5):1116-1122

4. Ultraviolet-Radiation-Related Exposures. National Toxicology Program, Department of Health and Human Services. Report on Carcinogens, Twelfth Edition (2011).

5. Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International Prevalence of Indoor Tanning: A Systematic Review and Meta-Analysis. JAMA Dermatol. doi:10.1001/jamadermatol.2013.6896 Note: the numbers in this study pertain only to UNITED STATES statistics.  

6. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345:e4757. doi: 10.1136/bmj.e4757

7. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012; 345:e5909 doi: 10.1136/bmj.e5909

8. Stern RS. Prevalence of a history of skin cancer in 2007:  results of an incidence-based model. Arch Dermatol. 2010;146(3):279-282

9. Nelson HH, Spencer SK, Gilbert-Diamond D, Sayarath V, Stephenson RS, Barton D, Karagas MR, Zens MS, Li Z, Stukel TA, Perry AE  Early-Onset Basal Cell Carcinoma and Indoor Tanning: A Population-Based StudyDOI: 10.1542/peds.2013-3559

10. Facts about Sunburn and Skin Cancer, Skin Cancer Foundation

11. Cui R, Widlund HR, Feige E, Lin JY, Wilensky DL, Igras VE, D’Orazio J, Fung CY, Schanbacher DF, Granter SR, Fisher DE.  Central Role of p53 in the Suntan Response and Pathologic Hyperpigmentation. Cell 128, 853–864, March 9, 2007

12.  Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345:e4757. doi: 10.1136

13. Boniol, M et al. Correction: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis BMJ 2012;345:e8503 doi: 10.1136/bmj.e8503

14. Cancer Facts & Figures 2014, American Cancer Society

15. Siegel R, Naishadham, MA, Jemal A.  Cancer Statistics, 2013. Ca Cancer J Clin 2013;63:11-31

16. Herzog C, et al. (eds): Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000. National Cancer Institute, NIH Pub. No. 06-5767. Bethesda, MD 2006.

17. Cancer Incidence and Mortality in Nebraska: 2008. Nebraska Department of Health and Human Services. (Dec. 2011).

18. Reed KB, Brewer JD, Lohse CM, Bringe KE, Pruit CN, Gibson LE. Increasing Incidence of Melanoma Among Young Adults: An Epidemiological Study in Olmsted County, Minnesota. Mayo Clinic Proceedings 2012; 87(4):328-334.

19. Indoor Tanning Facts and Statistics, American Academy of Dermatology

20. Lowe GC, Saavedra A, Reed KB, Velazquez AI, Dronca RS, Markovic SN, Lohse CM, Brewer JD. Increasing Incidence of Melanoma Among Middle-Aged Adults: An Epidemiologic Study in Olmsted County, Minnesota Mayo Clin Proc. January 2014;89(1):52-59

21. Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. Bethesda, MD: National Cancer Institute; 2006.

22. Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2010.

23. Lazovich D, Isaksson Vogel R, Berwick M, Weinstock MA, Anderson KE, Warshaw EM.  Indoor tanning and risk of melanoma: a case-control study in a highly exposed population.  Cancer Epidemiol BiomarkersPrev. 2010 June; 19(6): 1557–1568.

24. Nebraska 2013 YRBS Report Preliminary January 2014

25. City 100: Our Findings,  Controlling Indoor Tanning in Youth

26. Mosher CE, Danoff-Burg S. Addiction to indoor tanning: relation to anxiety, depression, and substance use. Arch Dermatol 2010;146:412-7.

27. “Tanorexia: Are You Obsessed With Your Tan?” – Susan Evans, MD

28. Kaur M, Liguori A , Lang W, Rapp SR, Fleischer AB, Feldman SR , Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. J Am Acad Dermatol 2006;54:709-11

29. Guy GP Jr, Berkowitz Z, Tai E, Holman DM, Everett Jones S, Richardson LC, Indoor Tanning Among High School Students in the United States, 2009 and 2011. JAMA Dermatol. doi:10.1001/jamadermatol.2013.7124

30. Yaar M, Gilchrest BA. Aging of skin. In: Freedberg IM, et al, eds. Fitzpatrick’s Dermatology in General Medicine. 5th ed. New York: McGraw Hill; 1999:1697-706.

31. Hughes MCB et al. Sunscreen and prevention of aging.  Annals of Int Med 2013;158(11):I-28.

32. Seasonal Affective Disorder Sufferers Have More Than Just Winter Blues by SAD expert Kelly Rohan, PhD, American Psychological Association

33. Hornung RL et al. Tanning facility use: are we exceeding Food and Drug Administration limits? J Am Acad Dermatol 2003; 49:655-61.

34. Autier P. Perspectives in Melanoma Prevention: The case of sunbeds. European Journal of Cancer 2004; 40:2367-2376

35. Elwood JM and Jopson J. Melanoma and Sun Exposure: An Overview of Published Studies. Int. J. Cancer 1997; 73:198–203

36. Indoor Tanning Raises Risk of Melanoma: FDA Strengthens Warnings for Sunlamp Products, U.S. Food and Drug Administration

37. National Electronic Injury Surveillance System, CDC. Reported on U.S. Food and Drug Administration website

38. Stapleton JL, Hillhouse J, Turrisi R, Robinson JK, Baker K, Manne SL, Coups EJ. Erythema and ultraviolet indoor tanning: findings from a diary study.  TBM 2012. doi: 10.1007/s13142-012-0155-2

39. Russak JE, Rigel DS.  Tanning bed hygiene: Microbes found on tanning beds present a potential health risk.  Journal Amer Acad Derm 2010; 62(1):155-157.

40. Perniciario C, Dicken CH.  Tanning bed warts.  Journal Amer Acad Derm 1988;18(3):586-587

41. The Truth About Tanning, Infographic from the Centers for Disease Control and Prevention

42.  Indoor Tanning Assocaition Case by the U.S. Federal Trade Commission

43. False and misleading health information provided to teens by the indoor tanning industry.

44. Tang JY, Fu T, Lau C, Oh DH, Bickle DD, Asgari MM. Vitamin D in Cutaneous Carcinogenesis: Part 1. J Am Acad Dermatol. 2012 November ; 67(5): 803

World Health Organization. Sunbeds. World Health Organization. 2010.

American Cancer Society. Cancer Facts & Figures 2013. Accessed January 31, 2013.

The Bed is Dead Facts page was last updated on 9/23/2014.