Indoor tanning, melanoma on the rise in young, white women
By Andy Koopmans
A new study published online Aug. 19 in JAMA Internal Medicine confirms that indoor tanning is associated with an increased risk of skin cancer, particularly among frequent users and those starting use at a young age.
Both the World Health Organization and the U.S. Food and Drug Administration have warned against the use of tanning beds for years, indicating that they pose a serious health risk. Several U.S. states restrict their usage, particularly for minors, and several countries have either restricted or outlawed their use entirely.
However, the study by Dr. Gery P. Guy and colleagues at the U.S. Centers for Disease Control and Prevention in Atlanta confirms that despite these restrictions and warnings, usage is on the rise amongst young, non-Hispanic white women. It found widespread tanning-bed use among female high school students and adults aged 18 to 34, reporting that 30 percent had used tanning beds in the previous year and 17 percent reported doing so at least 10 times.
According to the study, indoor tanning before the age of 35 increases risk of melanoma skin cancer by 59 to 79 percent while use before the age of 25 increases non-melanoma skin cancer risk 40 to 102 percent, with a nearly 2 percent increase with each additional tanning session per year.
The study indicated that melanoma incidence is increasing steadily among young women, a fact the researchers associate with the increase in indoor tanning. “This widespread use is of great concern given the elevated risk of skin cancer among younger users and frequent users,” the authors wrote.
Melanoma is the deadliest form of skin cancer, although it is also the least common. If untreated, it can spread to other organs and be lethal. It starts in melanocytes, the cells that give skin its color. Malignant melanoma usually begins with an abnormal mole but can also start in other pigmented tissues, such as the eyes or intestines.
According to Dr. Margaret M. Madeleine of the Public Health Sciences Division at Fred Hutchinson Cancer Research Center, risk factors for melanoma and other skin cancers include:
- a history of severe sunburn
- having light eyes, hair and skin
- a personal or family history of skin cancer
- having a large number of moles
- being older or immunosuppressed
- having undergone an organ or bone marrow transplant
- taking antibiotics or other photosensitizing drugs
A key to survival of skin cancer is early detection, but according to Madeleine, efficacy of screening for skin cancer, either self-practiced or by a physician, is still under scrutiny and not widely practiced, even among those at high risk, such as transplant recipients. Patients who undergo organ transplantation are at higher risk for skin cancer because they must take immunosuppressant drugs long-term to prevent organ rejection, which can make them more vulnerable to cancer.
“My experience with transplant patients, a high-risk group for skin cancer, suggests that even after being advised by their primary care doctor to see a dermatologist, only about 50 percent of them have seen a dermatologist for a skin exam,” Madeleine said.
While the American Cancer society recommends monthly self-exams and yearly physician skin exams at routine physicals, the U.S. Preventive Services Task Force, which published clinical guidelines for skin cancer screening in 2009, found there was limited (but insufficient) evidence to support self-exams or physician exams.
“There is still lots of research to be done before we know the comparative efficacy of self-exam, exam by a non-dermatologist clinician, or exam by a dermatologist,” Madeleine said. “It may be more important in the short term for people who are at high risk to seek screening.”