Indoor Tanning

Why are Indoor Tanning Beds a Skin Cancer Risk?

Artificial tanning devices such as tanning beds and sunlamps emit ultraviolet (UV) radiation, primarily UVA rays. The International Agency of Research on Cancer, a division of the World Health Organization, has declared UV radiation from artificial sources such as tanning beds and sun lamps “carcinogenic to humans.” These devices were elevated to the highest cancer risk category, which includes other carcinogens such as radon, tobacco, and asbestos.1,2

Exposing the Truth About Risks

For many years, the tanning industry has promoted tanning devices as a safe alternative to the natural sun, which leads to a lot of misleading and incorrect information believed by the general public. Despite a large amount of data that connects indoor tanning to skin cancer, the most important misconception is that indoor tanning does not cause skin cancer. Indoor tanning is linked to melanoma, basal cell carcinoma (BCC), and squamous cell skin cancer (SCSC). Indoor tanning can increase users’ risk of developing SCSC by 58% and BCC by 24%.3 Using tanning beds before age 20 can increase your chances of developing melanoma by 47%, and the risk increases with each use.3

Researchers have estimated that 452,796 cases of BCC and SCSC, and 11,374 cases of melanoma each year are attributable to indoor tanning.4 The younger a person starts indoor tanning, the higher his/her risk becomes for skin cancer. Those who begin tanning before the age of 35 substantially increase their melanoma risk, and that risk continues to increase with each subsequent use.5 Women younger than 30 are six times more likely to develop melanoma if they tan indoors.6

Similarly, many people believe that indoor tanning is safer than outdoor tanning. It is not, and it appears to be even more dangerous. The amount of UV radiation produced during indoor tanning may sometimes emit up to 15 times the strength of the midday summer sun.7 Indoor tanning often involves prolonged and intense exposure to UV radiation unlike natural sunlight, which varies throughout the day and can be shielded by clouds or shade. Tanning beds continuously emit concentrated levels of UV rays. This constant bombardment of high-intensity radiation significantly increases the risk of developing skin cancer. Furthermore, frequent indoor tanners usually start at a young age when their skin is more vulnerable to damage. Adolescents and young adults who engage in indoor tanning are particularly susceptible to developing melanoma – the deadliest form of skin cancer.

A common myth is that using a tanning bed to get a “base tan” prevents later sunburns. A “base tan”—whether from a tanning bed or the sun—does not prevent sunburns. Research suggests that a base tan might offer a person an SPF rating of approximately 3—a nearly useless amount of SPF.8,9 More importantly, it’s critical to remember that a tan indicates DNA damage from UV rays, just like a sunburn. Damaged DNA—whether because of sunburn or tan, and whether resulting from the sun or a tanning bed—causes mutations in the skin cells that can result in skin cancer.

Finally, some people believe that indoor tanning is an excellent source of vitamin D. It is not. Tanning beds and other indoor tanning devices mainly emit UVA rays. It is UVB rays that interact with a protein in the skin to convert it into vitamin D. And most people get enough vitamin D from incidental sun exposure in just a few minutes a day. For those who are vitamin D deficient, the medical community recommends getting vitamin D from a healthy diet that includes foods and beverages naturally rich in vitamin D and/or vitamin D supplements.

The World Health Organization (WHO), the American Medical Association (AMA), the American Academy of Pediatrics (AAP), and the American Academy of Dermatologists (AAD) have all called for a ban on all indoor tanning by minors. The United States FDA also recommends that no one under the age of 18 use these devices.

Indoor Tanning Facts & Statistics

Who is using indoor tanning devices?

  • Approximately 7.8 million adult women and 1.9 million adult men in the United States tan indoors.10
  • Almost 36% of American adults, 55% of college students, and 19% of teens have reported using a tanning device in their lifetime.10
  • Nearly 74% of tanning salon customers are White females, primarily between the ages of 15 to 29.4
  • Research indicates that more than half of indoor tanners (52.5%) start tanning before the of age 21.
  • More than 44% of those who started tanning before age 16 reported they did so with a family member. Forty-nine percent of those who started tanning with a family member did so with their mother.11

What is the risk?

  • Those who begin tanning before the age of 35 substantially increase their melanoma risk and that risk increases with each subsequent use.5
  • Women younger than 30 are six times more likely to develop melanoma if they tan indoors. At all ages, the more women tan indoors, the higher their risk of developing melanoma.3
  • Any history of indoor tanning increases the risk of developing BCC before age 40 by 69%.12
  • The risk for early-onset skin cancer under 50 years of age increases 99% for SCSC and 79% for BCC among those who use indoor tanning devices.3

What are the costs, both literal and figurative?

  • More people develop skin cancer because of indoor tanning than develop lung cancer because of smoking.4
  • Researchers have estimated that 452,796 cases of BCC and SCSC, and 11,374 cases of melanoma each year are attributable to indoor tanning.4
  • The estimated cost of treating skin cancers attributable to indoor tanning is $343.1 million a year, leading to a total economic loss of $127.3 billion over the lifetime of those affected.13

Regulations Governing the Use of Tanning Devices

The World Health Organization, the U.S. Food & Drug Administration, National Cancer Institute, American Medical Association, and American Academy of Dermatology all recommend that no one under the age of 18 use a tanning device.

In the United States, only 20 states and the District of Columbia completely ban the use of tanning devices for those under the age of 18. Two states allow minors to use tanning devices with a doctor’s prescription. Many states have some form of restrictions for minors, which range from parental permission to a partial ban, or combination thereof.

Brazil and Australia have passed complete bans for all of their citizens on indoor tanning. France, Spain, Portugal, Germany, Austria, Belgium, the United Kingdom, Iceland, Italy, Finland, Norway, and parts of Canada prohibit indoor tanning for youth under age 18.


References

1. Lew RA, Sober AJ, Cook N, et al. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Onc. 1983; 12:981-6.

2. The International Agency for Research on Cancer (IARC) Monograph series. List of classifications by cancer sites with sufficient or limited evidence in humans. https://monographs.iarc.who.int/agents-classified-by-the-iarc/. Adapted from Table 4 in Cogliano VJ, Baan R, Straif K et al.  J Natl Cancer Inst. 2011;103(24):1827-39.

3. An S, Kim K, Moon S, et al. Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis. Cancers (Basel). Nov 25 2021;13(23)doi:10.3390/cancers13235940

4. Wehner MR, Chren M, Nameth D et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol. 2014;150(4):390-400.doi: 10.1001/jamadermatol.2013.6896.

5. Doré JF, Chignol MC. Tanning salons and skin cancer. Photochem Photobiol Sci. 2012;11(1):30-7. doi: 10.1039/c1pp05186e.

6. Lazovich D, Vogel RI, Weinstock MA et al. Association Between Indoor Tanning and Melanoma in Younger Men and Women. JAMA Dermatol. 2016;152(3):268-75.doi: 10.1001/jamadermatol.2015.2938.

7. The International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 1:Exposure to Artificial UV Radiation and Skin Cancer. Lyon, France: World Health Organization; 2005. Available at: www.iarc.fr/en/publications/pdfs-online/wrk/wrk1/ArtificialUVRad&SkinCancer.pdf

8. Dennis LK, Lowe JB. Does artificial UV use prior to spring break protect students from sunburns during spring break? Photodermatol Photoimmunol Photomed. 2013;29(3):140-8. doi: 10.1111/phpp.12040.

9. Sheehan JM Potten CS, Young AR. Tanning in human skin types II and III offers modest photoprotection against erythema. Photochem Photobiol. 1998;68(4):588-92.

10. Guy GP, Berkowitz Z, Holman D and Hartman A. Recent Changes in the Prevalence and Factors Associated With Frequency of Indoor Tanning Among U.S. Adults. JAMA Dermatol. 2015;151(11):1256-9.

doi: 10.1001/jamadermatol.2015.1568.

11. NAACCR Fast Stats: An interactive tool for quick access to key NAACCR cancer statistics. North American Association of Central Cancer Registries. http://www.naaccr.org/. (Accessed on 3-10-2016).

12. Ferrucci LM, Cartmel B, Molinaro AM et al. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol. 2012;67(4):552-62. doi: 10.1016/j.jaad.2011.11.940.

13. Guy GP, Zhang Y, Ekwueme DU et al. The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis.  J Am Acad Dermatol. 2017; 76(2): 226–233. doi: 10.1016/j.jaad.2016.09.029.