Promoting Public Health

A YSPH Professor and Others Testify on the Health Risks Posed by Indoor Tanning

Connecticut is considering a law that would prohibit minors from using indoor tanning devices, a measure, advocates say, that would protect young people from a carcinogen in much the same way as tobacco laws.

Senate Bill 872 would ban people under 18 years of age from indoor tanning salons. Currently, people as young as 16 are allowed to tan indoors without parental consent. Supporters and opponents of the bill testified before the state legislature’s Public Health Committee Friday night (March 15) during a public hearing in the Legislative Office Building in Hartford.

Susan T. Mayne, a cancer epidemiologist at the Yale School of Public Health, told the committee that the ultraviolent rays produced by indoor tanning devices are scientifically linked to elevated risks for several types of skin cancer, including the potentially deadly form of skin cancer, melanoma, and the less lethal, but potentially disfiguring forms of skin cancer, basal cell carcinoma (BCC) and squamous cell carcinoma.

“There is no doubt in my mind that indoor tanning causes both melanoma and non-melanoma skin cancers,” said Mayne, the C.-E. A. Winslow Professor of Epidemiology.

She cited a Connecticut-based study that she and others published in 2012. It surveyed almost 800 people and found that indoor tanning was associated with a 69 percent increased risk of BCC compared with those who had never tanned indoors. More than 80 percent of the females under age 40 who had skin cancer had also used indoor, commercial tanning facilities. Furthermore, the study concluded that 43 percent of early-onset BCCs in women could be avoided if they never tanned indoors.

Mayne compared the current tactics used by the tanning industry to those used previously by the tobacco industry. They seek to get people hooked at a young age so that they become lifelong customers.

“The industry continues to promulgate falsehoods, while credible scientific organizations have reviewed all of the data and have classified indoor tanning devices as carcinogenic,” she said.

The International Agency for Research on Cancer (IARC), for instance, evaluated the data on indoor tanning and skin cancer and found what it called “convincing evidence” of a link for several types of skin cancers. More recently, in 2009, IARC classified tanning devices that emit ultraviolent (UV) light as Group 1 carcinogens, in the same category as tobacco smoke, asbestos and X-rays. Then, in 2012, an updated review of the epidemiology studies on BCC and indoor tanning published in BMJ concluded that indoor tanning was associated with an increased risk of BCC. Many health and medical organizations, including the American Cancer Society, the American Academy of Dermatology and the U.S. Food and Drug Administration, have recommended that people avoid indoor tanning altogether.

Lauren Hurd, a melanoma survivor who works at Yale, learned about the dangers of skin cancer at a young age. She told the public health committee that almost 30 million people in the United States tan indoors, of which 2.3 million are teenagers. She was one of them.

“Young people maintain the notion that they are somehow invincible. I discovered the hard way how wrong I was,” she said.

Hurd began visiting indoor tanning salons when she was 17 years old, and by college she was going several times a week. At age 22 she was diagnosed with malignant melanoma on her leg. Hurd is now cancer-free, but she will have to undergo surveillance for the rest of her life. “Please strongly consider helping to protect the youth of Connecticut,” she said.

Testimony on the bill started late Friday night and stretched into early Saturday morning. People on both sides of the issue waited in the Legislative Office Building for hours (in some cases more than 12 hours) for the opportunity to speak. The committee did not take up tanning until late Friday because a host of unrelated public health measures (including the use of genetically modified organisms in food) drew large numbers of people to testify.

By 11:30 p.m., the committee began consideration of the indoor tanning ban for minors and the public testimony stretched past midnight and into the early hours of Saturday morning. The committee is expected to vote on the measure in the coming weeks. If approved, the bill would move to the state’s General Assembly for further consideration.

While a number of states have enacted age-related restrictions on indoor tanning, most of which require parental permission for minors, only two states—California and Vermont—have so far banned indoor tanning outright for people under 18, while New York bans it for those under 17.

A similar bill to restrict minor’s access to indoor tanning salons was proposed in Connecticut last year, but it failed to win approval, noted David Boomer, who represents a number of tanning salons in Connecticut. During Friday’s hearing, he offered a compromise proposal that, he said, “could bring legislators from both sides together and pass.”

Boomer said that the state’s salon community, some 100 outlets, has voluntarily implemented its own measures, which, among other things, allow 16 and 17 years olds to tan, but only with a parent’s written consent. “They [the tanning industry] are meeting you more than half of the way. We encourage you to consider this and substitute this for the bill,” Boomer said.

Joseph Levy, executive director of Smart Tan Network, an advocacy and educational organization for the tanning industry, maintained that there is a “lot of confusion” surrounding the issue of indoor tanning and cancer. He said that the risk for melanoma is driven by factors such as heredity, red hair and the number of moles one has on his or her body and does not have a “straightforward” or “clear cut” relationship with UV exposure.

Avery LaChance, a medical student at the University of Connecticut, explained to the committee that two different wavelengths of ultraviolet light, known as UVA and UVB, are used in tanning salon lamps and both pose potential cancer hazards. In contrast, phototherapy devices that are used by dermatologists to treat certain skin conditions can hone in on very specific wavelengths or combine UV light with certain medications to maximize treatment success while minimizing overall UV exposure, resulting in a better risk-benefit ratio to patients.

Mayne noted that the testimony of the indoor tanning industry does not address the issue of non-melanoma skin cancers, even though they are the most common types.

Peter Spain, a YSPH alumnus, told the Public Health Committee that banning minors from indoor tanning salons could prevent disease and potentially save lives.

“Please support a complete ban to protect minors from the dangers of tanning booths,” he said. “Let’s do what is right today for our kids to prevent cancers tomorrow. Who doesn’t want that?”