NEJM Perspective: Indoor Tanning — Science, Behavior, and Policy
David E. Fisher, M.D., Ph.D., and William D. James, M.D.
An estimated 1 million times per day, someone in the United States uses ultraviolet (UV) radiation for skin tanning. According to the indoor tanning industry, tanning beds are used by 30 million Americans, or about 10% of the US population, each year (www.theita.com/indoor). These users include minors, who often have ready access to tanning beds. In response to considerable grassroots and political opposition to indoor tanning, in late March the Food and Drug Administration (FDA) convened an advisory panel to review the safety of the procedure. The FDA is expected to announce a decision soon on whether and how to reclassify tanning lamps and possibly to address minors’ access to them.
Abundant epidemiologic data have been examined to assess potential connections between indoor tanning and both melanoma and non-melanoma cutaneous cancers. According to a 2006 meta-analysis by the International Agency for Research on Cancer (IARC), among people who first used indoor tanning before 35 years of age, the relative risk of melanoma was 1.75 — a finding that prompted the World Health Organization to classify tanning beds as a group I carcinogen. Similarly, a recent case–control study in Minnesota showed an adjusted odds ratio of 1.74; the risk of melanoma increased as the number of years of tanning and hours of tanning sessions increased.
An even more dramatic association has been found between exposure to UV radiation and non-melanoma skin cancers. In the IARC study, history of any indoor tanning was associated with a relative risk of 2.25 for squamous-cell carcinoma. Although most of these lesions are successfully treated at an early stage, metastasis persistently occurs in a small minority of such lesions, at which point cure is rare. Although the overall rate of death from squamous-cell carcinoma is low, the high incidence of this form of cancer means that it accounts for 25 to 35% of skin-cancer–related deaths.
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