PITTSBURGH - Ciana and Katrina Cahill started tanning at age 15.
Twice a month, the Wexford, Pennsylvania natives, who are now 21 and 26, respectively, would go to the salon, undress, rub on some lotion, strap on protective goggles, and lie back surrounded by the tanning bed's bluish glow. But as relaxed as the sisters may have felt, each minute they spent under the tanning bulbs increased their risk of cancer-causing mutations in their skin. And according to recent studies, that risk was even higher because of their young age.
The Food and Drug Administration is now trying to prevent Americans like the Cahills from tanning before the age of 18. In late May, the organization announced a reclassification of sunlamp products such as tanning beds from low to moderate risk, and ordered that these machines have a black-box warning against their use by children under 18. Yet the response from cancer researchers, tanning professionals and indoor tanners has been anything but unanimous.
If you think that indoor tanning is not widespread, think again. A 2009 study found that, on average, there were more tanning salons than Starbucks or McDonald's in American cities. The Indoor Tanning Association estimates that roughly 30 million Americans go to these salons every year.
And those numbers have been increasing, especially among adolescent girls, said dermatologist Laura Ferris, who runs a high-risk skin cancer clinic at UPMC. "Like using drugs, tanning can actually be addictive," she said. "It releases the same endorphins, the feel-good hormones."
Studies have shown that the UV rays emitted by tanning beds increases the risk of melanoma, the deadliest form of skin cancer, by about 60 percent. "We see melanoma increasing at a high rate among the exact people who use tanning beds," said Dr. Ferris. She finds it shocking to see how many of the Pittsburghers she treats are indoor tanners, and just how many of them began tanning as teens.
Dr. Ferris explained why the FDA is especially worried about tanning among minors. Within our cells, we have an anti-cancer police force made up of tumor suppressor genes. Their job is to repair damaged DNA which could lead to cancer. If these genes are themselves damaged by UV rays, they are unable to do their job, and the cancer-causing mutations can have a field day, making cells proliferate to form a malignant tumor.
"The earlier you start having those mutations form, the higher the risk that you will have enough of them to develop cancer," Dr. Ferris said. Which means that the earlier you start tanning, the likelier you are to get melanoma.
Dr. Ferris would like to see a nationwide ban on indoor tanning for minors, but she is glad that the FDA is taking this first step. She also pointed out that in May Pennsylvania Gov. Tom Corbett signed legislation that bans those 16 and under from using tanning beds and requires parental consent for 17-year-olds. This takes effect in July.
DeAnn Lazovich takes a harder line. The University of Minnesota epidemiologist, who has been researching skin cancer and tanning since 2000, is frustrated about the FDA advancing in half measures. "I think it is very problematic," she said. "It leaves it up to the minor to see the warning. There is no onus on the salon operator."
In a study released May 29, Ms. Lazovich found that the risk of melanoma was nearly four times higher for those who had tanned indoors than for those who had not. This study countered the common belief that tanning indoors can be a healthy way to prevent outdoor sunburns and the cancers they might cause: Even those participants who had been severely sunburned a number of times had a much lower risk of melanoma than indoor tanners who had never been burned.
In spite of clear evidence that tanning increases the risk of cancer, tanners and tanning salon operators have mixed feelings about the recent FDA warning.
Some did not know about the change. "No one told us this. Nobody will enforce it," said a tanning salon manager in Oakland, Pennsylvania who did not want her name or workplace published. When asked about enforcement, an FDA spokesperson wrote that the organization can refuse to approve devices that do not meet national standards. They can also "take various enforcement actions" based on inspections or complaints.
Most tanning salons require parental authorization for minors already, and employees said that the transition would not have much effect on business. Lisa Masley, 35, co-owner of Hollywood Tanning in Ross and Monroeville, feels that it will even out the competition with those salons that have looser policies.
But the Cahill sisters feel that the FDA has overstepped its bounds. "If your parents say you're allowed, you should be allowed," said Ciana. "They're your guardians."
Eric Boodman: firstname.lastname@example.org or 412-263-3772.
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