The Lancet Oncology, Volume 10, Issue 9, Page 835, September 2009
On July 6, 2009, the British Association of Dermatologists (BAD) reported a disturbing lack of customer screening and generally unsafe equipment use in a survey of 332 tanning salons in Northern Ireland, prompting even the UK sunbed industry to agree that “there may be a case” for better standards. A few weeks after this announcement, on July 29, the International Agency for Research on Cancer (IARC) raised the classification of ultraviolet-emitting tanning devices from “probably carcinogenic to humans” to “carcinogenic to humans”—the highest risk category—based on evidence of a substantially higher risk of cutaneous melanoma in those who regularly used sunbeds. IARC’s assessment leaves no doubt about the carcinogenic potential of sunbeds, and with the reported lax operating procedures of tanning salons, is it not time to ban this practice altogether?
The UK government has been uncharacteristically reticent to involve itself in the regulation of the tanning industry, especially considering sunbeds have long been assumed to have a role in skin cancer. Nevertheless, some local authorities have followed the advice of health activists and prohibited tanning beds in leisure centres, but the sunbed industry itself is only under voluntary regulation. Any individual, seemingly without qualifications or experience, can set up a tanning salon and there are no regulatory restrictions on the type of equipment that can be purchased. In fact, around 25% of the salons surveyed by BAD had sunbeds with radiation levels intended for medical use only, and most did not know what level of ultraviolet radiation their beds emitted. The Department of Health publishes guidance for salon owners, but with only half of the facilities in the BAD survey checking their customers’ age, any advice clearly is not being followed.The Department of Health is considering banning children under 18 years of age from using sunbeds in England—following Scotland’s lead—but this is far short of what is needed to protect public health.
The incidence of skin cancer is increasing worldwide, and the number of melanoma cases in the UK is around four times that seen 30 years ago. A quantitative association between sunbed use and skin cancer is difficult to prove, not least because of confounding by sun exposure and under-reporting of tanning habits. But what is certain is that sunbed use is increasing and that available tanning devices are more powerful than even a decade ago. A ban on sunbeds for under-18s recognises that burns early in life are particularly dangerous and that young people might not understand or might ignore the risks; but these concerns are equally applicable to adults. IARC’s meta-analysis found a 75% increase in the risk of cutaneous melanoma when people began tanning regularly before the age of 30 years.So is there any benefit from tanning? The inclusion of sunbeds in gyms and health facilities, and the public misconception about possible benefits of tanning hinder an appropriate understanding of the risks. Some proponents suggest that vitamin D deficiency from sun avoidance is an issue, especially for those living in northern climates, and that this deficiency can be treated with “safe” tanning. But this claim is irresponsible: vitamin D can be easily and more safely acquired in the diet. A further misconception is that previous exposure to sunlight, via a sunbed, provides protection against sunburn from intensive vacational exposure. This is not true since overexposure during tanning is likely, with individuals being less likely to take preventive measures.
Of note, guidelines for skin-cancer prevention recommend avoidance of direct exposure to mid-day sun as a first priority—regardless of skin type—with sunscreen only a secondary preventive measure. A practice whereby a source of intense ultraviolet radiation is brought within 6 inches of a person’s skin must therefore be questioned.Most of the 100 000 new cases of skin cancer diagnosed in the UK each year are preventable, so why attempt expensive industry regulation and ineffective consumer education programmes? Sunbeds for cosmetic tanning clearly increase the risk of skin melanoma, and probably the risk of ocular melanoma; they should be banned for all ages. WHO, the British Medical Association, and Cancer Research UK already advise against sunbed use completely. In the name of skin-deep beauty, a beast has been unleashed—in face of the recognised health risks, the industry’s continued existence can in no way be justified.
