Tanning Beds and Cancer
by Victor Limjoco and Joyce Gramza published online August 15, 2006
Lawmakers around the country are turning up the heat on the tanning bed industry, blaming the popularity of
indoor tanning among young people for rising skin cancer rates. But new scientific research on the benefits of vitamin D
has clouded the debate.
"We know the cause of skin cancer—too much ultraviolet light," says James Spencer, vice-chair and director of
dermatologic surgery at Mount Sinai School of Medicine. "We could prevent that, and yet, the incidence of skin cancer is
rising, letting us know that we're still getting too much ultraviolet light."
Indoor tanning is especially popular among teenage girls, which worries dermatologists like Spencer. "When you
look at the population and who's going to indoor tanning, it's young people, teenagers, most often young women," he
says. "And this is the peak of their sensitivity, this is the time when they should be avoiding this the most."
A study of the tanning behavior of white American teens, using data from the National Longitudinal Study of Adolescent
Health ("Add Health") confirmed those concerns. "Fully 24 percent of the teens in our study ... used an indoor tanning
facility at least once," says Catherine Demko of the Comprehensive Cancer Center at Case Western Reserve University
School of Medicine and University Hospitals of Cleveland. "Females were far more likely to use it than males, and by the
time girls were 18 or 19 years old, about 47 percent reported that they had used an indoor tanning facility three or more
times." The study, published in the journal of Archives of Pediatrics and Adolescent Medicine, suggests that teenagers
don't see tanning as potentially dangerous behavior.
While the Indoor Tanning Association warns consumers to avoid burning, "I am not satisfied with the message
that burning is bad, but tanning is good," says Kevin Cooper, professor and chair of the department of dermatology at
Case Western Reserve University. "There's no way you can get a tan without damaging the skin, That's what the tan is."
Cooper says the message should be "that whatever color you are is OK, that's it's not necessary for you to be dark in
order to be accepted."
But some researchers think if we avoid the sun, we are preventing our bodies from getting vitamin D, which our
skin needs sunlight to produce. "Vitamin D has always been recognized as being very important for child bone health,
and vitamin D deficiency of course causes rickets in children," says Michael Holick, professor of dermatology, medicine
physiology and biophysics at Boston University Medical Center. "But we also know that vitamin D is really clinically
important throughout our entire lives, not only for bone health, but for a wide variety of physiological processes."
Vitamin D together with calcium is known to protect against bone diseases including osteoporosis and osteomalacia in
adults. And a growing body of evidence shows that vitamin D may also protect against diseases such as multiple
sclerosis, hypertension, depression, and colon, breast and prostate cancers.
The Institute of Medicine has set 200 international units of vitamin D as the adequate allowance for adults under
fifty—that's two glasses of milk a day. But research by Holick and others suggests we need five times that amount. "We
think that you need 1000 international units of vitamin D a day," says Holick. " So even if you drank one or two glasses of
milk a day and one or two glasses of orange juice each day, you're getting no more than 20 to 40 percent of the vitamin
D requirement that truly satisfies your body's needs."
Holick and others say the best way to get that amount is moderate exposure to sunlight—"typically for a white
person say in New York or in Boston that would be no more than probably 5 to 10 minutes on your arms and legs, or
your face, hands and arms, two to three times a week," he says. "I then recommend that you put sunscreen on with a
sun protection factor of at least 15."
The tanning industry has embraced Holick's research, leading the American Academy of Dermatology to issued a
statement saying that "reports linking the health benefits of Vitamin D to unprotected sun exposure mislead the public."
"You do not need to go to the beach or the tanning parlor to raise your vitamin D—and get wrinkles and skin cancer—
when you can just simply eat a balanced diet and take vitamin supplements if you want," says Spencer. "We don't really
know that vitamin D prevents cancer. To say that vitamin D prevents cancer is a wild speculation. To say that ultraviolet
light causes skin cancer is a fact."
According to MedicalNewsToday.com, a study published in the March 2007 issue of the "Journal of the
American Academy of Dermatology" indicates that users of indoor tanning devices are more likely to become addicted
to tanning. Exposure to ultraviolet light can be addictive, due to the production of endorphins that can cause
dependency. Tanning still remains popular, even though people may be well aware of the skin cancer and other risks
associated with tanning either by sun or salon. There are alternatives, such as spray-on tanning lotions, that can help
you achieve that attractive golden bronze look without risking your health.
Tanning Beds & Cancer Risks
Since the early 1990s, the total revenues of the indoor tanning industry have quintupled, according to the Skin
Cancer Foundation. The annual take for tanning salons is now a staggering $5 billion. The perceived healthy look and sex
appeal of an artificially induced tan has overridden well-publicized concerns about the dangers of indoor tanning.
Nevertheless, those concerns have steadily increased over the years, leading some states to ban teens from using
artificial tanning equipment at all. The continuing boom in the tanning industry indicates that the message about health
risks has not sufficiently penetrated the public consciousness.
Who Is Tanning?
White women 16 to 49 years of age have flocked to tanning salons, making up nearly three-quarters of the
industry's clientele. Teens are turning out for artificial tans in record numbers, with an annual tally of well over 2 million.
This has occurred, despite warnings from medical researchers that starting to tan at a younger age increases the risk for
skin cancer by as much as 75 percent.
Types of UV Light
There are three wavelength classifications of ultraviolet light---UVA, UVB and UVC. UVC coming from the sun is
contained by the ozone layer in Earth's atmosphere and generally does not reach the ground. According to NASA, UVB
radiation destroys DNA in human skin and, if the body is unable to repair it, skin cancer can develop. The remaining type
of ultraviolet light, UVA, was once believed to be generally harmless (although long-term exposure to UVA was known to
make skin overly dark and leathery).
New UVA Concerns
According to the Skin Cancer Foundation, scientists now know that UVA light, the main radiation emitted in
tanning beds, penetrates deeply into the skin and can be hazardous. In addition to causing immune system damage and
cataracts, it may be more likely than UVB to cause skin cancers.
Tanning Salon Claims
The attractive brownish cast of Caucasian skin after exposure to UVA radiation comes from a pigment called
melanin, produced by skin cells known as melanocytes to darken the epidermis, as a defense against further damage
from UV radiation. However, it is now known that only people with naturally darker skin have any built-in defense.
Tanning salon owners' claims that the UVA radiation of their tanning beds is safer than exposure to sunlight are out of
date, yet many clients who are unaware of recent research are still willing to believe the industry. The Department of
Health & Human Services specifically names artificial tanning as a cause of cancer.
Facts & Figures
The risk for developing malignant melanoma increases sevenfold in people who use tanning beds more than 10
times per year, according to the Skin Cancer Foundation. The melanoma risk for anyone who has ever used a tanning
bed even once goes up by 15 percent. According to U.S. Food & Drug Administration estimates, approximately 7,300
people per year die from melanoma.
Artificial vs. Natural
Tanning, whether by artificial means or the sun's rays, presents a risk. According to SkinCancer.org, there is no
such thing as a safe tan. Repeated sun exposure damages the DNA, causing genetic defects that can result in skin cancer.
Sun exposure can also cause premature aging effects such as wrinkles and sagging skin. The ultraviolet rays used in
tanning beds are not safe either and increase the risk of skin cancer. The National Cancer Institute states that "exposure
to tanning-salon rays increase damage caused by sunlight because ultraviolet light thins the skin and makes it less able
UVA vs. UVB
Tanning beds primarily emit long-wave ultraviolet A (UVA) rays, whereas sunlight contains both UVA and
medium-wave ultraviolet B (UVB) rays. The sunlamps used in tanning salons emit UVA that is 12 times that of the sun,
according to the Skin Cancer Foundation. At one time, UVA rays were thought to be harmless, but now the National
Institutes of Health and the World Health Organization now deem both UVA and UVB to be causes of cancer. Although
UVA is less capable of causing sunburn than UVB, UVA is present during the day year round and accounts for 95 percent
of ultraviolet rays reaching earth. UVA damages skin cells in the dermal layer of the skin and contributes to the
development of skin cancer. People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma
and 1.5 times more likely to develop basal cell carcinoma.
The Risks of Tanning
UV radiation, whether from natural or artificial sources, damages the skin. Below are some of the short and long term
side effects of UV exposure.
What it is:
Sunburn, also called erythema, is one of the most obvious signs of UV exposure and skin damage. Often marked
by redness and peeling (usually after a few days), sunburn is a form of short-term skin damage.
Why it happens:
When UV rays reach your skin, they damage cells in the epidermis. In response, your immune system increases
blood flow to the affected areas. The increased blood flow is what gives sunburn its characteristic redness and makes
the skin feel warm to the touch. At the same time, the damaged skin cells release chemicals that send messages through
the body until they are translated as a painful burning sensation by the brain.
White blood cells, which help protect you from infection and disease, attack and remove the damaged skin cells. It is this
process of removing damaged cells that can cause sunburned skin to itch and peel.
The Bottom Line:
Sunburn can be a very painful effect of UV exposure. Studies have shown a link between severe sunburn and
melanoma, the deadliest form of skin cancer. Pay careful attention to protecting yourself from UV rays.
What it is:
There is no such thing as a safe tan. The increase in skin pigment, called melanin, which causes the tan color
change in your skin is a sign of damage.
The Bottom Line:
Evidence suggests that tanning greatly increases your risk of developing skin cancer. And, contrary to popular
belief, getting a tan will not protect your skin from sunburn or other skin damage. The extra melanin in tanned skin
provides a Sun Protection Factor (SPF) of about 2 to 4; far below the minimum recommended SPF of 15.
What it is:
Sometimes referred to as “photoaging,” premature aging is the result of unprotected UV exposure. It takes the
form of leathery, wrinkled skin, and dark spots.
Why it happens:
Although the causes of premature aging are not always clear, unprotected exposure to harmful UV rays break
down the collagen and elastin fibers in healthy young skin, and cause wrinkles and loosened folds. Frequent sunburns or
hours spent tanning can result in a permanent darkening of the skin, dark spots, and a leathery texture.
What it is:
There are two main types of skin cancer: Melanoma , Non-melanoma
Melanoma is the less common, but more dangerous form of skin cancer, and accounts for most of the deaths
due to skin cancer each year. Melanoma is cancer that begins in the epidermal cells that produce melanin
(melanocytes). According to the American Cancer Society (ACS) melanoma is almost always curable when detected in its
Non-melanomas (basal cell and squamous cell carcinomas) occur in the basal or squamous cells located at the
base of the epidermis, both inside and outside the body. Non-melanomas often develop in sun-exposed areas of the
body, including the face, ears, neck, lips, and the backs of the hands.
Why it happens:
Predisposition to skin cancer can be hereditary, meaning it is passed through the generations of a family through
genes. There is also strong evidence suggesting that exposure to UV rays, both UVA and UVB, can cause skin cancer.
UV radiation may promote skin cancer in two different ways: By damaging the DNA in skin cells, causing the skin to grow
abnormally and develop benign or malignant growths and By weakening the immune system and compromising the
body’s natural defenses against aggressive cancer cells.
The Bottom Line:
According to the American Cancer Society, most of the more than one million skin cancers diagnosed each year in the
U.S. are considered sun-related. Skin cancer occurs in people of all skin tones, though it is less common in those with
darker skin tones.
Actinic or Solar Keratoses
What it is:
A fourth type of growth, actinic or solar keratoses, is a concern because it can progress into cancer. Actinic
keratoses are considered the earliest stage in the development of skin cancer, and are caused by long-term exposure to
sunlight. They are the most common pre-malignant skin condition, occurring in more than 5 million Americans each
Actinic or solar keratoses share some of the symptoms of skin cancer. Look for raised, rough-textured, or scaly
bumps that occur in areas that have been sunburned or tanned.
Eye Damage - Photokeratitis
What it is:
Photokeratitis can be thought of as a sunburn of the cornea. It is caused by intense UVC/UVB exposure of the
eye. Photokeratitis is also called “snow blindness” because many people develop this condition at high altitudes in a
snowy environment where the reflections of UVB are high. This condition can also be produced by exposure to intense
artificial sources of UVC/UVB, like broken mercury vapor lamps, or certain types of tanning lamps.
Symptoms: Tearing, Pain, Swollen eyelids, A feeling of sand in the eye, Hazy or decreased vision
Immune System Suppression
According to the World Health Organization (WHO), all people, regardless of skin color, are vulnerable to the
effects of immune suppression. Overexposure to UV radiation may suppress proper functioning of the body’s immune
system and the skin’s natural defenses, increasing sensitivity to sunlight, diminishing the effects of immunizations or
causing reactions to certain medications.
In people who have been treated for an infection of the Herpes simplex virus, sun exposure can weaken the
immune system so that it can no longer keep the virus under control. This results in reactivation of the infection and
recurring cold sores.
The best way to protect your skin from the dangerous effects of UV radiation is to make sun protection part of
your daily routine.
Remember that certain oral and topical medicines, including antibiotics, birth control, and benzoyl peroxide
products can increase the sensitivity of your skin and eyes to UV rays. Check the label on your medicines and discuss the
risks with your doctor.
Cosmetics that contain alpha hydroxy acids (AHAs) also may increase sun sensitivity and susceptibility to
sunburn. Look for FDA’s recommended sun alert statement on products that contain AHAs.
Sun Protection Tips
Avoid overexposure to UV rays from both natural and artificial sources.
Plan your outdoor activities to avoid the sun's strongest rays. As a rule, seek shade and remember that the sun’s
UV rays are the strongest between 10am and 4pm. You can also use the “shadow rule”; the sun’s UV rays are
strongest when the shadow you cast on the ground is shorter than you are.
Use extra caution near water, snow, and sand because they reflect damaging UV rays and increase your chance
of sunburn and other damage to the skin and eyes.
Wear protective clothing such as wide-brimmed hats, and long pants and long-sleeved shirts made of tightly-
woven fabric to reduce sun exposure.
Wear sunglasses that provide 100% UV ray protection (look for models that advertise both UVB and UVA
Use a broad-spectrum (protecting from both UVA and UVB) sunscreen with a sun protection factor (SPF) of 15 or
greater to protect uncovered skin. For best results, apply the sunscreen 30 minutes before sun exposure and
reapply every 1-1/2 to 2 hours even on cloudy days and after swimming or sweating. Both selection of the
sunscreen and re-applications are important.
Carefully examine all of your skin once a month. Early detection of melanoma can save your life. A new or
changing skin lesion should be evaluated by a dermatologist.
See a dermatologist if you notice an unusual mole, a scaly patch, or a sore with local persistent bleeding or that
does not heal. This may be a pre-cancer or a skin cancer. If you develop severe itching or rashes in the sun, this
may be an allergic reaction.
BENEFITS: POSITIVE EFFECTS OF UV EXPOSURE
Heliotherapy... The Positive Effects of the Sun
We all know that the sun can make us feel happier and more relaxed. Vitamin D sufficiency, along with diet and
exercise, has emerged as one of the most important preventive factors in human health. Hundreds of studies now link
vitamin D deficiency with significantly higher rates of many forms of cancer‚ as well as heart disease‚ osteoporosis‚
multiple sclerosis and many other conditions and diseases.
Vitamin D Comes From the Sun
Sunlight is the best and only natural source of vitamin D. Unlike dietary or supplementary vitamin D, when you get your
‘D’ from sunshine your body takes what it needs, and de-metabolizes any extra. That’s critical – as vitamin D experts and
many health groups now advocate 1,000 to 2,000 IU of vitamin D daily – five to ten times the old recommendations.
Because too much ‘D’ from dietary supplements may cause the body to over-process calcium, nobody really knows for
sure how much supplementary vitamin D is safe. On the other hand, sunlight-induced vitamin D doesn’t have that
problem – it’s the way your body is intended to make it!
Nature's Skin Protection
It is commonly known that our natural tanning process provides protection against burning. Unlike some sunscreens, a
tan provides reliable, full-spectrum (UVA & UVB) protection from burning. Your natural tan offers protection that
doesn't rub, sweat or wear off the way sun screen lotion can.
Prevention of Some Cancers
People who live in regions with more sunlight have been found to have a lower incidence of death from ovarian, breast
and colon cancers than those who live in places with less sunlight.
Vitamin D, Osteoporosis Prevention
Sunlight and sun-tanning beds that emit UVB are reliable sources of vitamin D. Vitamin D is necessary for our bodies to
use the calcium we get in our diet. This vitamin is found in few foods. One study showed that vitamin D was largely
lacking in the fortified milk supply in the U.S. Your skin produces vitamin D naturally when exposed to sunlight. A
sunscreen of SPF 8 or higher has been found to disable and halt the skin's ability to produce vitamin D.
Seasonal Depression Therapy
Sunlight and simulated sunlight "doses" are a successful treatment for Seasonal Affective Disorder, known as the "winter
blues." Sunlight and simulated sunlight exposure has been found to improve low winter moods. Indoor lighting, on the
other hand, is generally perceived by the brain as near darkness.
Reduce Symptoms of PMS
Exposure to bright light has been found to help alleviate some symptoms of Pre Menstrual Syndrome, such as mild
depression and mood swings, irritability, physical discomfort, and social withdrawal.
A Strong Biological Clock for Optimal Health
Having well-synchronized circadian rhythms, or biological clock, results in a better quality sleep, daytime alertness, and
optimal health in general. The more sunlight exposure you get during the day, the more in-sync with your environment
your circadian rhythms will be.
Exposure to UV-light is commonly prescribed by doctors to alleviate the unsightly appearance and discomfort of
psoriasis. Drugs such as psoralens have been developed to work in conjunction with UV-light treatments. Those with
psoriasis should consult their doctor before proceeding with any treatment program.
Jet Lag Prevention
"Doses" of sunlight or simulated sunlight timed carefully upon arrival in a new time zone, can re-set your body's
biological clock resulting in less day time drowsiness and better quality nighttime sleep.
Light Therapy May Combat Fungal Infections, New Evidence Suggests
The discovery in the human pathogen Cryptococcus neoformans further suggests that UV light therapy, in combination
with anti-fungal drug treatments, might offer an effective method to combat a variety of fungal infections, particularly
those of the skin or nails, said HHMI investigator Joseph Heitman, M.D., James B. Duke professor of molecular genetics
and microbiology and medicine at Duke.