Exposure To Sunbeds/Sunlamps
Listed As Known Carcinogen By NIEHS
WASHINGTON--On May 15, 2000 ,the Department of Health and Human Services released its Report on Carcinogens 9th Edition. The report, which is published every two years, is prepared by the National Toxicology Program and identifies substances that are "known" or are "reasonably anticipated" to cause cancer.
Exposure to solar ultraviolet radiation, sunlamps or sunbeds was added to the list of "known human carcinogens." The report cited questionable data that indicates a "casual relationship between exposure to solar radiation and melanoma and other skin cancers in humans, and that exposure to sunlamps or sunbeds is associated with melanoma."
This listing was initiated without full consideration of scientific data. In January 1998, Dr. Anthony J. Swerdlow and Dr. Martin A. Weinstock presented a paper, "Do Tanning Lamps Cause Melanoma; An Epidemiological Assess-ment," indicating that "published data is insufficient to determine whether tanning lamps cause melanoma."
Swerdlow's and Weinstock's study included the review of 19 articles attempting to show a link between sunlamp use and melanoma. The report stated "there is little support for an association of exposure to sunlamps or sunbeds with non-melanocytic skin cancer.
In addition, a March 2000 editorial review in Archives of Dermatology (Vol. 136, No. 3) re-examins a 1998 study asking the question "Does Sunlamp Use Increase The Risk Of Cutaneous Malignant Melanoma?" Marie Sofia Cattaruzza came to a surprising conclusion after reviewing the 1998 Connecticut study.
The objective of the study was to evaluate whether recreational exposure to artificial UVR could increase the risk of cutaneous melanoma. Up until this study, UVR was considered the most important risk factor for cutaneous melanoma by some dermatologists.
In the case study, 624 patients who were diagnosed between Jan. 15, 1987 and May 15, 1989, with a first primary melanoma were matched with 512 control patients who randomly were selected from the general population. Both groups were evaluated for five years.
The results obtained from the study indicated that an association between the use of sunlamps and melanoma was not statically significant. No association between the use of sunlamps before age 25 vs. never having used a sunlamp. Also, among those who reported using only one type of sunlamp, the risk of melanoma was not statistically increased by the use of any particular type of sunlamp. Information within the study also did not show any relevant differences between men and women.
Commenting on the study, Dr. Cattaruzza stated that published articles on the risks of artificial tanning are still scant and results from previous studies are inconsistent. Cattaruzza suggests that further studies on this topic might help better define the role of UVR exposure and its effects. A point that NIEHS did not take into consideration when it made its listing.
Not A Good Track Record
Twenty years ago, the U.S. Food and Drug Administration acted on the findings of a Canadian study that supposedly proved that the artificial sweetener saccharin caused cancer. New studies recently have disclosed the original Canadian study was flawed. The evidence now points to saccharin only causing cancer in male rats when ingested in very high amounts--the human equivalent of 800 cans of diet soda per day.
On May 15, 2000, saccharin finally was removed from the Report on Carcinogens 9th Edition despite a 1998 National Toxicology Program recommendation recognizing that saccharin is not carcinogenic. The case of the artificial sweetener is a classic example of how federal regulators are quick to create health scares and slow to undo an unjustifiable labeling.
The government's reluctance to change its determination does not paint a flattering picture of the review process they use to determine product safety. In addition, it doesn't speak well of the government's ability to be a thorough agent of scientific information. It must leave the American public wondering about newly reported findings on things such as health concerns related to exposure to sunlamps and sunbeds.
"There are options available," says Don Smith, executive director of the North American Alliance of Tanning Salon Owners (NAATSO). "We can continue to keep our heads stuck in the sand, do nothing. Or, we can make the collective decision that from this point forward, we will utilize the legal system to protect the best interests of the indoor tanning industry."
According to Smith, the NIEHS used nine scientific papers as evidence to prove there was a link between exposure to sunlamps and sunbeds and melanoma. In addition, Smith notes that in his delisting petition filed in September 1999, he provided evidence that all nine of those articles (and 10 others) were invalid because of serious flaws in facts supporting their evidence.
"NIEHS has failed to conduct economic impact studies, health impact studies and failed to consider the importance of an individual's skin type," he notes. "NIEHS also failed to be consistent--for example, they provided the beneficial effects of Tamoxifen but not UVR. The ruling could have a significant financial impact on all sunshine-related industries."
Educating Your ClientsInevitably, due to the listing of sunbeds and sunlamps by NIEHS, and its exposure by the media (TIME magazine had a small article on the new list in its May 29 issue.) salon owners nationwide could be faced with some pretty tough questions from concerned tanning clients. How can you respond? One of the best ways to respond to a client's concern is to point out that all nine of the references used as "evidence" that there is a link between "Exposure to Sunlamps and Sunbeds" and melanoma were shown in studies to be epidemiologically invalid. Moreover, there is no known harm from "exposure" to UVR; rather it is "overexposure" to UVR that causes sunburn and, presumably, squamous cell carcinoma. Second, NIEHS failed to list the benefits of sensible, moderate and responsible exposure to UVR and they conducted no risk vs. benefit analysis. A good example to use would be the consumption of alcoholic beverages. NIEHS also did not consider the ¼benefits of sensible, moderate and responsible alcohol consumption. The "Dietary Guidelines for Americans" (compiled by the Departments of Agriculture and Health and Human Services) states that moderate drinking is associated with a lower risk of heart disease in some people. Another good example to use would be Tamoxifen which has been approved for treatment of breast cancer. There has been concern expressed that the listing of tamoxifen by NIEHS could raise concerns among patients regarding its use for cancer treatment or prevention. It is, therefore, important to again note that these listings do not address potential benefits of exposure to certain carcinogenic substances. Finally, LOOKING FIT will continue to print articles that promote the benefits of moderate exposure to UVR. These article are great pieces to set out in your waiting rooms for clients to read while they are waiting to tan. |
Industry Reactions
Roger Brown, President
puretan® International, Inc.
I feel short term, the listing by NIEHS will have an impact on the indoor tanning industry. However, I feel long term the affects will be minimal. In addition, I believe that it is important that the information leading up to listing be released through the Freedom of Information Act, since many of the studies cited by NIEHS have been proven invalid and the support data is not convincing, especially for melanoma. Finally, exposure to sunlamps and sunbeds should be delisted immediately.
Joe Schuster, Media Liaison
Suntanning Association for Education (S.A.E.)
The Ninth RoC claims that "Exposure to solar ultraviolet radiation, sunlamps or sunbeds is listed as a known human carcinogen." The RoC cites data that indicate a causal relationship between exposure to solar radiation and melanoma and other skin cancers in humans, and that exposure to sunlamps or sunbeds is associated with melanoma. The RoC references Swerdlow et al.1988, Walter et al. 1990, Autier et al. 1994, & Westerdahl et al. 1994 as epidemiological studies showing an association between sunlamps and the link to malignant melanoma.
This epidemiological support data is not convincing, especially for melanoma. It ignores high dose versus low dose (sub-erythemal doses) effect. There is no data to support that tanning without burning is conclusively linked to melanoma as well as no conclusive data on indoor tanning related cancer from suberythemal doses in humans.
Today, millions of people enjoy the aspects of obtaining a cosmetic tan in a controlled environment. We advocate indoor tanning with moderation and responsibility.
On behalf of the Suntanning Association for Education, the trade association for responsible indoor tanning and its members, we urge NIEHS to delist sunlamps and sunbeds as "known carcinogens" immediately.
The above statement was edited for length. Please check back in the August issue of LOOKING FIT to read S.A.E.'s full response to NIEHS.
Michael Stepp, President
Wolff System Technology Corp.
The studies used in support of listing sunbeds and sunlamps as known carcinogens seem to provide the best avenue to de-listing these same products. Each of the cited studies clearly was inconclusive regarding a link between suberythemal UV exposure and any cancer. Given the widely-recognized 20-30 year latency period for skin cancer, and with the indoor tanning industry just 20 years young today, studies conducted from 1988-1994 should not be relied upon to draw conclusions.
Further, epidemiological studies conducted with a population almost exclusively Parrish Skin Type I are inconsistent with the well-regulated indoor tanning industry in this country. Those who can't tan, Skin Type I, are not voluntary tanners whether indoors or out. Most definitely Skin Type I people are not good candidates for our controlled tanning services. This again points to the need for good controlled studies that do not begin with a bias.
Rick Mattoon, Technical Training Director
National Tanning Training Institute
I was very disappointed in the announcement made by NIEHS regarding the Ninth Report on Carcinogens. The addition of "Solar UV Radiation and Exposure to Sunlamps and Sunbeds" to the list was obviously done without regard to sound scientific observation.
It is extremely unfortunate that the NIEHS has chosen to create possible health concerns using insufficient scientific studies. Members of the Dermatology community are even rational enough to realize that results from previous studies are inconsistent regarding the relationship between moderate ultraviolet radiation exposure and cancer.
I am confident that the continued education our industry offers and our clients regarding moderate, sensible and responsible tanning will prevail over the government's inability to appropriately categorize carcinogens.
Ed Chaney, President
Sunchain Tanning Center, Phoenix
Realistically, how the study affects the indoor tanning industry depends on how the news media relates the information. For the last four years, at least, the industry has been educating clients on the direct affect ultraviolet radiation has on the body. We also have studies and articles alluding to the health benefits of sunshine and ultraviolet light.
I believe the study will just offer owners and employees more of an opportunity to educate clients. People have started to become immune to the list of what gives them cancer and what doesn't. I think the most questions will come from our mature clientele--a definite growth market in the next 10 years. Our younger clients, those under the age of 30, will probably remain unaffected by the listing, knowing that it could change within a couple of years, just as other items have been added and removed from the list.
Katie Burland, salon owner St. Louis Tan
St. Louis, Mo.
Although I feel the ruling paints a negative aspect on the indoor tanning industry, I don't think it will have a major impact on whether people decide to tan indoors.
The indoor tanning industry has been fighting negative press since its inception more than 20 years ago. Salon owners are going to have to be more aware of the beneficial aspects of moderate and controlled exposure to UVR so that they can explain them to their clients.
Additionally, educational groups, such as NTTI, will become increasingly more important to provide salon owners with the education and knowledge they need to be successful.
LOOKING FIT will continue to monitor and report on industry response to the NIEHS listing of sunbeds and sunlamps as a known carcinogen.
Tanning Industry Wounded By NIEHS Listing
Solar UV Radiation and Exposure to Sunlamps and Sunbeds--Exposure to solar ultraviolet radiation, sunlamps or sunbeds is listed as a "known human carcinogen." The Ninth Report on Carcinogens cites data that indicate a casual relationship between exposure to solar radiation and melanoma and other skin cancers in humans, and that exposure to sunlamps or sunbeds is associated with melanoma. The Report also indicates that skin cancers are observed with increasing duration of exposure, and the effects especially are pronounced in individuals under the age of 30 and for those who experience sunburn."This announcement, in my opinion, constitutes a serious threat to the future of the indoor tanning industry. The statement by NIEHS "that exposure to sunlamps or sunbeds is associated with melanoma" is disturbing to say the least, especially since the statement is categorically not true.
What does this listing mean to the indoor tanning industry?
First, it means that the enemies of indoor tanning can make sure the 9th Report On Carcinogens receives widespread media attention and they will use this listing as "proof" that sunlamps and sunbeds cause melanoma. The May 29, 2000 issue of Time magazine was just the first example. Time stated on page 69: "SOLAR RADIATION & SUNLAMPS: "A deep tan may look nice, but is it worth the melanoma and other skin cancers it leads to?"
Additionally, the Food and Drug Administration will, in my opinion, propose mandating melanoma warnings on sunbeds and they will cite this listing as their justification.
Potential new clients may be frightened away by this unwarranted and unjustified linking of sunlamps and sunbeds with melanoma and even some of our existing clients may decide to stop tanning.
This listing especially is painful to me since I spent a lot of time preparing the "delisting petition" that I submitted to NIEHS in September 1999. This document proved beyond a shadow of a doubt there are no facts linking sunlamps and sunbeds with cutaneous malignant melanoma. In fact, I provided data to prove their "evidence" was flawed and faulty. In addition, NIEHS doesn't seem to understand that the cause of a sunburn is overexposure to UVR, not exposure.
Where does the indoor tanning industry go from here? There are two options available: We can keep our heads stuck in the sand and watch our industry stagnate, or, we can make the collective decision that, from this point forward, we will utilize the legal system when necessary to protect our interests.
I don't know about you, but I believe it is a total waste of time trusting a bureaucracy to do the right thing. NIEHS, in my opinion, chose political expediency over scientific truth and they have lied to the American public about our industry.
By the time you read this article I will have invoked the Freedom of Information Act (FOI) to gather information we will need to determine whether or not there has been a concerted action involving multiple governmental agencies and the enemies of indoor tanning regarding this listing.
I have decided to dedicate whatever time and resources are necessary to reverse this unwarranted, unjustified and unfair listing. If you believe as I do, please e-mail me at naatso@aol.com and let me know that you are willing to help.
Working together, we can move to have NIEHS reverse this listing.
Donald L. Smith
Executive Director
North American Alliance of Tanning Salon Owners (TSO)
