Cancer prevention efforts target tanning salons
■ The AAP, AMA and others call for doctors to encourage patients to take precautions and support state laws banning minors from indoor tanning facilities.
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Ultraviolet radiation is a known carcinogen, and physicians should advise patients to take precautions against harmful exposure and support state-level legislation to ban minors from indoor tanning salons, says the American Academy of Pediatrics.
Rising skin cancer rates among young people have prompted the AAP and other organizations, including the American Medical Association and the American Academy of Dermatology, to issue policies warning against tanning and excessive UVR exposure.
Too many people don't realize skin cancer can kill, said Maribeth B. Chitkara, MD, assistant professor of pediatrics at Stony Brook Long Island Children's Hospital.
"The majority of the public thinks that skin cancer is no big deal -- that if you get a skin cancer, you just cut it off," said Dr. Chitkara, whose sister died of skin cancer three years after being diagnosed at age 26. "The real public health danger of this is really a lack of understanding."
Several factors have contributed to a rise in melanoma during the past 30 years, including more skin-revealing clothing, depletion of the ozone layer and the rise of tanning salons, said Sophie J. Balk, MD, a pediatrician at The Children's Hospital at Montefiore in New York and lead author of the AAP's revised policy statement on UVR exposure in children and teens in the March Pediatrics.
"A lot of kids think that being tanned is healthy when it's not," Dr. Balk said.
The debate over indoor tanning
In 2007, 58,094 U.S. residents were diagnosed with melanomas, and 8,461 died of skin cancer, according to the latest Centers for Disease Control and Prevention statistics.
Melanoma is the second most common cancer among women in their 20s and the third most common cancer among men in their 20s. Incidence of melanoma in white females between age 15 and 39 has been rising 3% annually since 1992, the AAP report said.
Indoor tanning is particularly dangerous, because tanning beds can emit 10 to 15 times more UVR radiation than the midday sun, said Dr. Balk, also a professor of clinical pediatrics at Albert Einstein College of Medicine of Yeshiva University in New York. "If we protect kids from smoking, why shouldn't we protect them from this other carcinogen?" Dr. Balk asked.
Surveys have found that about a quarter of white teenagers have used a tanning facility, the AAP report said.
"There are over 50,000 tanning salons in the United States, more than there are McDonalds and Starbucks combined, and it's an industry that's completely unregulated," Dr. Chitkara said.
But indoor tanning advocates say there isn't consensus among researchers about UVRexposure and melanoma skin cancer, and that government intervention isn't warranted until consensus is reached.
Barring minors from tanning salons wouldn't stop teenagers from tanning, said an Indoor Tanning Assn. statement issued in response to the AAP report. "It will only send them outdoors into an uncontrolled environment, with no supervision, no trained staff, no parental consent required, where they are more likely to be overexposed or sunburned," the statement said.
The AMA issued policy in 2006 to develop model legislation prohibiting minors from indoor tanning facilities. Sixty percent of states have laws that place some limitations on minors from using tanning salons, but no states ban them completely, Dr. Balk said.
One of the most restrictive laws is in Texas, which prohibits anyone younger than 16½ years old from going to a tanning salon and requires parental consent through age 18, said Samantha Guild, a patient advocate with AIM at Melanoma, a nonprofit working to increase skin cancer research support. Wisconsin bans such facilities for anyone younger than 16. California, New York, Delaware, New Jersey and Illinois ban anyone younger than 14.
Physicians should make a habit of discussing the dangers of UVR exposure with patients, said Guild, who lost her 26-year-old sister to skin cancer.
"Prevention is key. Educate your patients about the need for sun screen and the need to do skin checks, so we never even get to the point where you're dealing with a suspicious mole," she said.