FDA Proposal and the Need for Continued Education on Melanoma Awareness

Today, December 18, 2015, the Federal Drug Administration announced a proposal of new rules that would ban anyone under 18 from using tanning beds or tanning booths.  In addition, they would require that tanning facilities obtain a client’s signature that he/she acknowledges the risk to one’s health when using such devices.  They also propose that all tanning devices be labeled with a warning that UV radiation can cause skin cancer, skin burns, premature skin aging, and eye damage (both short- and long-term).  This is an effort by the FDA to “improve consumers’ understanding of the risks related to UV radiation exposure.” ¹ 

The primary resource for the FDA’s decision is a 2012 publication by the British Medical Journal (“Cutaneous Melanoma Attributable to Sunbed Use: Systematic Review and Meta-analysis”) which concludes that “sunbed use is associated with a significant increase in risk of melanoma.  This risk increases with number of sunbed sessions and with initial usage at a young age (<35 years).  The cancerous damage associated with sunbed use is substantial and could be avoided by strict regulations.”²  The study cites well-documented statistics such as tanning beds may emit 10-15 times stronger UV radiation that the sun, UV radiation is classified as a carcinogen, and tanning bed use results in a 75% increase in risk of melanoma (from 40% to 228%) when indoor tanning starts during adolescence or young adulthood.   

The public (including up to 19,000 tanning salons) has 90 days to share comment on the proposal.

This is indeed a great day in the fight against skin cancer and melanoma.  For years, the FDA has been asked to take more action against the use of tanning beds.  Citing the administration’s bans and warnings on tobacco use, the argument was made that more cases of cancer were caused by tanning beds than cases of lung cancer caused by cigarettes.  Today’s action by the FDA is a long time coming.

But this does not close the book on skin cancer prevention.  While there will be harsher warning labels attached to the equipment, the age restrictions apply only to facilities that offer tanning services, such as tanning salons and “health” clubs.  The restrictions do not apply to personal tanning beds.  Additionally, once an individual reaches the age of 18, tanning bed use will be allowed, although the FDA proposal requires disclosure of health risks before allowing an individual to use such a device.  The only real weapon against such use will be in public education.

There are efforts and organizations that are devoted to educating the public on the risks of UV radiation, both from tanning devices and from the sun.  One such organization is the Melanoma Education Initiative.  Founded in 2011, the MEI has been raising awareness about the dangers of melanoma by visiting middle schools with an interactive presentation, visiting high schools and colleges with harder-hitting presentations including first-hand and graphic accounts of melanoma, distributing educational material at community health fairs, and participating in health and wellness events for companies and organizations.

When asked why founder Beth Mancini didn’t just join forces with existing organizations such as the Melanoma Research Foundation, AIM at Melanoma, or others, she responded that “many organizations out there raise money for research which will benefit patients down the road, but we wanted to save lives in a more immediate way by educating people about early detection and prevention. We couldn't find an organization … educating in the way we wanted to, thus, Melanoma Education Initiative was born.”  The MEI was founded and continues advocating near Akron, OH, however Beth. Mancini and her family now reside in North Carolina.  She hopes to expand the MEI efforts within the Tarheel State and beyond.

Much like the aggressive anti-tobacco “truth” campaign to curb youth smoking in the US, the MEI and other organizations hope to equally educate teens and young adults about the dangers of UV radiation.  I encourage you to offer your support to the MEI, or any such educational group in your area as they are in desperate need of volunteers.  While today’s FDA announcement is a red-letter date in skin cancer awareness, the real work of education the public needs to continue.

For more information on the Melanoma Education Initiative, visit their website at http://www.melanomaeducationinitiative.org/.  You can also contact Beth Mancini directly at ewmancini@melanomaed.org.

1.          DEPARTMENT OF HEALTH AND HUMAN SERVICES; Food and Drug Administration; 21 CFR Parts 1002 and 1040 [Docket No. FDA-1998-N-0880 (formerly 1998N-1170)] RIN 0910-AG30 Sunlamp Products; Proposed Amendment to Performance Standard.
2.           Boniol, M., P. Autier, P. Boyle, and S. Gandini, “Cutaneous Melanoma Attributable to Sunbed Use: Systematic Review and Meta-analysis,” British Medical Journal, 345:e8503, December 2012.

Does a Tanning Ban Deny Parental Rights?

This morning, a local TV station posted on their Facebook page that Governor Christie had signed legislation to ban tanning in New Jersey for those under 17.  The station asked, “Do you think more states should follow or leave it up to parents?”  As usual, there were supporters for both sides of the argument.  But since I’m a data geek, I had to analyze a little more deeply.  Here’s what I found:

 

 

·         38% of the comments were in favor of such bans.  Most of these respondents had been somehow touched by melanoma. 

·         21% responded that such a ban would violate parental rights.

·         17% stated that the government was already too involved with our personal lives.

·         4% stated that there were more pressing issues to address than a tanning ban.

·         The remaining had other random answers.

Obviously, I was one of the 38% that responded in favor of such a ban.  While I’m usually pretty open-minded in most debates, I’m not sure I can understand the opposing arguments.

The government is “involved” when it comes to many age limits.  Are those opposed to banning the tan for minors also open to allowing minors to drink and smoke without restrictions?  Would they allow children to drive on the highways?  Are they ready for Sponge Bob to be the next president once we allow kids to vote?  Will we expect to find pornography in our children’s back pack along with Diary of a Wimpy Kid?  There are restrictions on such issues for valid reasons and not simply so government can rule with an iron fist. 

I can understand (somewhat) the argument for parental rights.  I’m a parent of two incredible kids and I believe I have the right to provide parental guidance as I see fit.  At the same time, I have already taught them the issues with tanning beds.  They know that not only would daddy be very disappointed if they choose to tan, they know it’s unhealthy and basically a stupid practice.  I have taught them as an informed parent.  The problem is, where tanning beds and skin cancer/melanoma are concerned, many if not most parents are simply uninformed.  They don’t understand that a single visit to a tanning bed can increase the chance of cancer.  They don’t know that melanoma rates in young women are sky-rocketing.  They haven’t become friends with a young woman who died from this horrid disease. 

Right now, at age 10, my kids know that tanning is bad.  When they turn 14 or 15, I’m sure they’ll not agree with all I have to teach.  They may become rebellious.  They may be tempted to tan.  And two teens can most likely find many loopholes right underneath the nose of the best parent.  That’s why I believe even supposedly good parents like me need such a law to ban tanning for minors. 

Your parental rights won’t be denied at all.  You still have a job to do.  Issuing government dictated bans is one thing, but educating our young on WHY such a ban is needed is equally important.  We parents need to be informed so as to teach our kids.  When they whine about wanting a darker glow, we need to help them understand why it’s an unhealthy choice.  We need to teach them about safety in the sun as well and make them understand the importance of wearing sunscreen and hats.  Trust me, even with a tanning bed ban; you’ll have plenty parenting to do.

Good Question

Daddy?

Yes?

How old do you have to be to own a gun?

Hmmm…the law says 18 years old, 21 for hand guns.

Why?

Because the government wisely determined that guns can be very dangerous and it takes an older person to understand the risks and responsibilities.

Daddy?

Yes?

How old do you have to be to buy alcohol?

State law says 21 years old.

Why?

Because the government wisely determined that drinking alcohol can be very dangerous and it takes an older person to understand the risks and responsibilities.

Daddy?

Yes?

How old do you have to be to drive a car?

State law says you have to be 16 years old.

Why?

Because the government wisely determined that driving a car can be dangerous and it takes an older person to understand the risks and responsibilities.

Daddy?

Yes?

How old do you have to be to buy cigarettes?

State law says you have to be 18 years old.

Why?

Because the government wisely determined that smoking cigarettes can be dangerous and it takes an older person to understand the risks and responsibilities.

Daddy?

Yes?

How old do you have to be to go to a tanning salon?

State law says you can go when you're 14 with just written permission from your parent.

Couldn't that be faked?

 

Probably.

Daddy?

Yes?

Didn't you tell me that tanning beds have a link to skin cancer?

Yes.

 

Doesn't drinking, smoking, shooting and wreckless driving also cause problems?

 

Yes.

 

Then why hasn't the government made any wise determinations regarding tanning salons?

 

Good question.

Tanning Myths and Facts

I will be attending an event at the NC State Legislature Building on June 13.  This event will support efforts by the North Carolina Dermatology Association to help spread the word about tanning beds.  I’m sure there will be an itinerary and I’ll stick with any discussions on their agenda.  Still, I hope to steer some legislators towards this blog and have them read some thoughts and facts I’ve gathered for their information and knowledge.

So Mr. /Ms. Legislator, I present to you several myths and facts below regarding indoor tanning.  Please read, learn, and support a tanning ban for minors in North Carolina.

Myth:  Indoor Tanning Doesn't Cause Melanoma

Fact:  The term “causes” implies that if you tan, you WILL get cancer. This is wrong, however the fact remains that exposure to indoor tanning increases the risk of developing melanoma.  A review of 19 separate published studies showed that use of tanning beds boosted the risk of melanoma by 75%.

Myth: You Need the UV Rays to Get Enough Vitamin D

Fact:  No one disputes that sunlight produces vitamin D which improves bone health and possibly heart health and resistance to breast cancer.  However, most medical professionals suggest receiving your Vitamin D intake through supplements and Vitamin D fortified food such as milk, cereal, and yogurt as well as from salmon and tuna.

Myth: Tanning beds are a safe way to tan

Fact:  There is no safe way to tan.  Tanning, whether indoor or outdoor, is evidence of damaged skin at the inner, epidermal region.     

Myth: Tanning beds emit UVA rays which do not burn the skin the way UVB rays will.  Therefore, tanning beds are safer than the sun which emits both UVA and UVB rays.

Fact:  While UVB rays are the main contributor to sunburns, the World Health Organization has determined that UVA rays are equally dangerous and perhaps even more likely to lead to melanoma.

Myth: Tanning beds emulate the natural sun.  The sun isn’t bad for you!

Fact: No one will deny that the sun is essential for life and generally good for you.  But the UV rays within the sun are dangerous.  Tanning beds are concentrated UV rays which have been measured to emit 12X the amount of UV radiation as the outdoor sunshine!

Myth: Getting a base tan from indoor tanning protects your skin.

Fact:  While a base tan offers some minimal protection, any change in skin color, including the base tan itself, is the body’s natural defense against too much UV radiation.  In short, ANY tan is visible evidence that the skin is already damaged.

Myth: Sunless tanning sprays offer protection from the sun.

Fact:  While spray tans are certainly the preferred method of getting that “summer glow,” the sprays offer absolutely no protection against UV rays.  These self-tanners merely color the dead skin cells on the skin’s outer most layer.  Those who spray tan still need to apply sunscreen when outdoors.

Myth:  Tanning beds are the best way to treat various ailments, such as acne and psoriasis.

Fact:  While some practitioners might suggest such treatment, the vast majority of medical professionals will state that the risks of tanning beds far outweigh any such benefits.  For those people who are convinced otherwise, I would propose a law that states any “prescribed” treatments be administered by a licensed radiologist in a controlled medical facility, and not within a tanning booth run by employees working for the summer.

Myth:  Current laws requiring parental consent are effective, thus no further restrictions are needed.

Fact:  There have been reports, including one by the NBC Today Show, where under-aged women were freely allowed to use the tanning facilities despite the local or state laws requiring parental consent.  Also, the House Committee on Energy and Commerce released a report that revealed tanning salons were routinely not providing proper information to teens, including inaccuracies about health risks, in an effort to gain business.  Loose legislation simply will not work.  Tougher laws are necessary to protect our children.

Myth:  Government should not impose age restrictions.

Fact:  If that were the case, we’d be selling alcohol and cigarettes to minors, as well as allowing children to drive cars and vote.  Age limits already exist, and for good reason.  In the case of alcohol and tobacco, such limits are meant to protect the children.  For voting and driving, the limits may be imposed because children simply do not have the intellectual maturity to make the decisions involved with each.  Kids just don’t realize the dangers of tanning and they will continue to use tanning beds despite any potential dangers in their future.  Like with alcohol and tobacco, the government has a responsibility to help protect our children!  The State of California and the City of Chicago have already taken such responsibility!

Myth:  If tanning restrictions are imposed, many tanning salons will close, putting people out of work.

Fact:  When the drinking age was raised from 18 to 21, there was much discussion on the effects towards alcohol sales and bar patronage.  Naturally, business did fall off, but it did not disappear.  Likewise, despite the wishes of those who oppose tanning, the tanning industry will not disappear entirely.  However, safe spray tanning has also grown in popularity.  If government is afraid of increased unemployment, I would suggest a subsidy program for tanning salons to trade in their tanning booths and beds for spraying equipment and training.  This would help keep the children safe from tanning and promote ongoing business.

The studies and facts from which the above claims are made include legitimate sources such as the American Cancer Society, the American Academy of Dermatology, the FDA, and the World Health Organization.   The latter has classified ultraviolet radiation as a carcinogenic, in the same category as plutonium and uranium.

In summary, there is no such thing as a safe tan.  But the fact remains that many teenagers (and adults) consider being tan a fashionable necessity.  It’s time to protect these children and impose an indoor tanning ban on minors.  Once these children grow up to adulthood, they can make their own choices…and hopefully, the healthier choice.

"But at least I know the risk I am taking"

One tends to get snippy when a privilege is taken away.  I recall back when I was a sophomore in college and West Virginia changed their legal drinking age from 18 to 21.  I was 19 at the time and was fortunate enough to ride a grandfather clause that allowed me to continue drinking (never heavily mind you, but socially).  Still, the freshmen behind me were banned.  Well, at least at public bars…not so much at private parties.  But I digress.  The point is, those younger than me were really peeved that they had to sneak around to drink.

There’s a lot of snippiness going around at high schools and colleges lately due to increased pressure to stop tanning.  For many kids, tanning for prom, spring break or a summer “base tan” is a rite of passage.  The thought that government might take away their “right” to tan is upsetting and downright socialist!  At least that’s what they think.

A recent blog commented that the male brain doesn’t reach maturity until the mid-twenties.  Anotherblog cited a book that mentions that the brain may not finish growing until after the teenage years.  What this means is that no matter the information piled upon teens, they just won’t comprehend the data unless they want to.  They will merely get snippy at being denied the “right” to tan and not understand the underlying reason for the ban.

Today I ran across an editorial…from an editor of a high school newspaper called the “The Sailor’s Log.”  The editorial piece was called, “To Tan Or Not To Tan: Editor ConsidersPre-Spring Break Options.”  Erinn Taylor openly admits that two weeks prior to her annual spring vacation to Florida, she visits a tanning booth three or four times per week.  She admits that this is probably not the smartest practice and goes on to quote various skin cancer facts:

“According to mayoclinic.com, being exposed to ultraviolet (UV) radiation (the type of light used in a tanning bed) is dangerous. It does not matter whether the rays come from a tanning bed or the natural sunlight.”

“According to health.harvard.edu, exposure to UV radiation is linked to skin cancer and premature aging.”

“According to livestrong.org, people who have used tanning beds before the age of 30 have increased their risk of melanoma by 75 percent.”

Erinn goes on to state that her mother had a basal cell carcinoma removed this past summer. 

“It looked like a scab, and the dermatologist cut it off, not a problem.”

Unfortunately her mother’s simple procedure to remove the BCC probably reinforced the classic “just cut it out” opinion that so many people have regarding skin cancer.  Still, her mother has now turned against tanning beds and is quite skeptical of Erinn’s use of indoor tanning.

The editorial goes on to state, “Simply looking at the facts, the decision seems obvious, but I have to look at my individual situation as well.”

Erinn decided to get her tan again before her Florida trip.  Her final comment?  “But at least I know the risk I am taking.”

No she doesn’t.  She THINKS she does…but she does not.  Despite the research she’s done and despite her mom’s insistence that she not tan, she’s going to go ahead and do it.    

This goes to support that there MUST be a ban enacted for those under 18.  Teens cannot comprehend the risk they’re truly taking.  Their parents are unable to stop them.  And like the freshmen back in my college days who found a way to get the beer they wanted, today’s teens will find a way past “parental consent” laws for tanning.

As stated by another, the only real way to stop people from tanning on a volunteer basis is to change the general public’s perception of what’s attractive.  This would not be an easy task.  Until then, ban the tanning beds.  Period.