Growing up, indoor tanning was considered part and parcel of one's beauty regimen. Male or female it was no matter, having a great off-season tan was an absolute must-have. Little thought, if any, was given to the fact that people might be walking into a cancer den. Or at least an increased risk of it.
Indoor tanning provides concentrated, potent ultraviolet radiation (UVR) emitted by sources such as tanning beds, lamps, bulbs and booths. The ultraviolet portion of the solar radiation spectrum, comprised mainly of UVA and UVB, is the most mutagenic – causing changes in a cell's genetic material – and the most harmful. It is associated with an increase incidence of melanoma and non-melanoma (basal and squamous cell) skin cancer, as well as premature skin aging and eye damage, including cataracts and ocular melanoma. Additionally, UVR has been shown to cause immune suppression and incite an increased inflammatory response in the skin as has been evidenced by a surge in cellular inflammatory markers such as cytokines, prostaglandins and interleukins.
At the American Council on Science and Health, we began warning about overuse of this in the 1980s. Society has long since caught on, so much so that a prominent indoor tanning trade group, the Indoor Tanning Agency (ITA), has gone out of business. The World Health Organization's International Agency of Research on Cancer (IARC) agreed with us in 2009 and declared indoor tanning devices as Group 1, Carcinogenic to Humans, like plutonium and cigarettes. (1) Thought it took decades, widespread dissemination of information on the harmful effects of UVR is a major public health victory and the recent dissolution of the ITA, founded in 1999 to protect companies in that business, is a sign the battle may be won. Like Blockbuster, their day is done. In some cities, the number of tanning salons once exceeded the number of McDonald's and Starbucks.
Warnings by the Food and Drug Administration (FDA), United States Department of Health and Human Services and even the Federal Trade Commission have resulted in a significant drop in consumer acceptance of the risks. Sadly, despite the mounting evidence of significant harm caused by indoor tanning, the ITA's executive director, John Overstreet, insists that ITA's ultimate demise is a result of an "unrelenting misinformation campaign waged against this industry in the media."
ITA had, as expected, made claims touting the potential benefits of indoor tanning, ranging from somewhat truthful, such as improved appearance, enhancement of mood and increased Vitamin D levels, to "alt-truths" such as lengthening life and that a base tan can act as the body's natural protection against a sunburn (it does not).
On numerous occasions the Federal Trade Commission called out ITA for propagating misinformation on their website. Just a few months ago, they sent a letter to the attorney representing the group, for falsely maintaining that indoor tanning does not cause skin cancer and that indoor tanning is somehow less dangerous than outdoor tanning because, according to them, indoor tanning is a "more monitored and controlled" exposure to UVR. They additionally claimed that there was no association between melanoma and UVR from tanning beds. The FTC blasted them again, one of numerous times since 2010, because their claims were in turn copied by others for use on their websites.
Rapidly increasing rates of melanoma in the United States were reasonable cause for alarm by us and government bodies. There was a 2.2 and 2.1 percent increase in the incidence of melanoma in Caucasian males and females, respectively, between the years 1997 and 2006. Frequent indoor tanning was correlated with increased melanoma risk, irrespective of age and when tanning was initiated. In a meta-analysis published in the British Medical Journal (BMJ), 12 studies that included a total of 9,328 cases of non-melanoma skin cancer revealed indoor tanning was associated with a significantly increased risk of squamous cell and basal cell skin cancer.
We often caution that anecdotes are not evidence but we had people engaging in self-experimentation, and that was a lot more powerful than epidemiology. Much of the data utilized to draft and enforce regulations restricting indoor tanning was provided by the misfortune of real people who suffered death and disability from potentially preventable cancers. Like with smoking, we knew that if we prevented it from being a pediatric disease, it was far less likely to occur and we can now say with confidence that the dismantling of the indoor tanning business was founded on sound, evidence-based data.
NOTE:
(1) That classification may be a little exaggerated but that is due to weakness in their classification scheme. Still, they were not as controversial then so a Group 1 classification was meaningful. Today they think bacon is as dangerous as mustard gas so no one outside California takes them seriously.
