Good afternoon Representative Ritter, Senator Gerratana, and other distinguished members of the Public Health Committee. My name is Dr. Leah Ferrucci and I am a cancer epidemiologist at the Yale School of Public Health. I am here representing not only members of our skin cancer research team, but also Yale Cancer Center in strongly supporting Senate Bill 54 – An Act Concerning the Use of Indoor Tanning Devices by Persons under Eighteen Years of Age.
Skin cancer is increasing in incidence, especially in young people. The causal association between indoor tanning and melanoma, the most lethal type of skin cancer, has been confirmed, with the most harmful effects in individuals who used tanning beds under the age of 35 (1). More recently, work done by our research team at the Yale School of Public Health and Yale Cancer Center has extended this finding to now link indoor tanning with basal cell carcinoma in people under age 40. Basal cell carcinoma is not only the most common form of skin cancer, but also the most common cancer in humans; surpassing all other cancer types combined.
We found that young people who had tanned indoors had a 69 percent increased risk of early-onset basal cell carcinoma compared to those who never used tanning beds (2). Based on our study of young people in Connecticut, approximately a quarter of the overall cases of early-onset basal cell carcinoma—including 43 percent of cases in young women—could be prevented if individuals never tanned indoors. Indoor tanning in our study was done almost exclusively in commercial facilities and there was an increased risk of basal cell carcinoma even for individuals who never experienced a burn while using tanning beds.
Tanning beds are used primarily by older adolescents and young adults (3); in our study, half of those who had tanned indoors started using tanning beds by age 17 (2). While the science about the health risks of indoor tanning is clear, the risks of this behavior are not well understood by the general public. Much of this confusion may stem from the indoor tanning industry’s marketing practices and conveyance of false and misleading health information. A recent investigative report prepared by the Minority Staff of Committee on Energy and Commerce in the United States House of Representatives, found that the indoor tanning industry targeted teenage girls with advertising, denied known health risks, provided false information on health benefits, and did not follow recommendations by the Food and Drug Administration on tanning frequency (4).
In 2009, based on the research for melanoma the World Health Organization’s International Agency for Research on Cancer classified ultraviolet-emitting tanning devices as carcinogenic to humans, akin to cigarettes and asbestos (5). Our new research, reflecting what is happening to the young people in our state, adds to a compelling body of evidence showing that indoor tanning is carcinogenic.
This is a public health issue that demands action. Current public health policies protect children from other known carcinogens such as tobacco. It is inconceivable that we should allow children to engage in indoor tanning, a behavior that is a known human carcinogen and will adversely impact their health in a predictable fashion.
Since many indoor tanning businesses offer spray-on tanning services, which are not associated with an increased risk of skin cancer, there is a viable and safe alternative for tanning facilities to remain in business.
In addition to restrictions for minors described in S.B. 54, the health risks of indoor tanning should be communicated clearly to the public by State agencies. Tanning salons should be required to post clear, unambiguous warnings about the risk of melanoma and basal cell carcinoma, allowing adult tanners to make informed choices.
As stated in a perspective piece in the New England Journal of Medicine (6), "Regulation of this [the indoor tanning] industry may offer one of the most profound cancer prevention opportunities of our time." Scientific evidence is clear that indoor tanning salons are a serious risk to public health and we urge you to take this opportunity to more closely regulate this industry and protect the young people of Connecticut.
References
1. 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. 2007;120(5):1116-22.
2. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol. 2011. Dec 8 [Epub ahead of print]
3. Coups E, Phillips L. A more systematic review of correlates of indoor tanning. J Eur Acad Dermatol Venereol.2011;25(5):610-616.
4. U.S. House of Representative Committee on Energy and Commerce - Minority Staff. False and Misleading Health Information Provided to Teens by the Indoor Tanning Industry, Investigative Report. February 2012.
5. El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens--part D: radiation. Lancet Oncol. 2009;10(8):751-2.
6. Fisher DE, James WD. Indoor tanning--science, behavior, and policy. N Engl J Med. 2010;363(10):901-3.