Real Risk

What is the real risk for a sunbed in a professional salon

The public should know that a sunbed is not the risk they think it is in a professional salon. Medical data on the effect of UV exposure continues to evolve and is widely misunderstood. JCTA’s position on the relative risk of indoor sunbathing is based upon these facts:

Statement from World Health Organization (WHO) IARC Report – Page 12: “Epidemiologic studies to date give no consistent evidence that use of indoor tanning facilities in general is associated with the development of melanoma or skin cancer.”
The World Health Organization (WHO) IARC Report [3]does not, as is widely misreported, shows a blanket 75% increase of risk for melanoma from commercial tanning units for people under age 35. When home (40% increased risk) and medical units (96% increased risk (Why? Uses drugs to make you photosensitive and takes you to sunburning levels)) are removed from the IARC data, the weighted increase of risk is only 6% for commercial sunbeds which includes Skin Type I individuals (who are screened from UV tanning in professional Canadian tanning facilities). Removing Skin Type I cases from the studies eliminates the increase in risk entirely [2] and may actually show that UV tanners have a lower risk in this data set. (The IARC data was most recently reviewed by Dr. M Papas [1] at the 3rd North American Congress of Epidemiology in Montreal June 21-24, 2011.)
The WHO-IARC report actually states that a sunbed user’s lifetime increase in melanoma risk is only 15% [3] – a figure that includes commercial, home and medical units and which includes Skin Type I sunbathers. Home units have almost 7 times the relative risk as compared with commercial sunbeds in the IARC data and medical sunbeds have 16 times the risk as compared with commercial tanning units. Yet home units and medical sunbeds would not be regulated.
To put this in perspective, cigarette smoking increases one’s risk of any cancer by 2,000% — 333 times greater than the relative risk increase that the IARC reports for commercial sunbed users. Smoking should never be compared to UV exposure. This will dilute the importance of the anti-smoking message.
The marginal increase of risk (IARC itself referred to it as “limited” in its 2006 report [3]) validates the indoor tanning profession’s position that professional control of exposure is the key factor to minimizing risk.
IARC demonstrates that those who are most at risk are Skin Type I individuals. Professional salons already voluntarily exclude this group from UV tanning with an effective Fitzpatrick Skin Typing evaluation system.
Indoor Sunbathing has been popular in Canada since the early 1980s. Even though the industry has grown significantly since this time, there has been no relative increase in melanoma, according to Health Canada data. The total increase of cancer diagnosis is in fact attributed to population growth.
The population which has exhibited the greatest growth in skin cancer is males over 50, few of whom have ever seen the inside of an indoor sunbathing facility.
WHO IARC 2012 Monograph reported “The four studies on basal cell carcinoma (BCC) did not support an association with the use of indoor tanning facilities. 80% of all skin cancers in Canada are this type.
Non-Melanoma Skin Cancer rates are in fact decreasing in Canada, despite the popularity of indoor sunbathing based on population growth.
The elevation of indoor sunbathing to a ‘Group 1’ by the WHO puts it in the same category as birth control pills and natural sunlight. WHO did not quantify how much UV exposure is carcinogenic nor did they mention that life requires UV exposure, but they did identify risk factors for Skin Types.
The largest risk factor for melanoma is genetic factors such as number of moles [4] (+600% increase risk).
66% of melanoma were not related to UV exposure whether indoors or outdoors according to a piece of research by Dr Davis.
Outdoor workers have lower melanoma risk than indoor workers [5,6] UV light whether produced by sunlight or sunbed is the same. It’s all about dosage and control.
Compare Environment Canada’s stats on summer sunshine with Canadian Cancer Society’s Cancer Stats by province: areas in Canada with the most summer sunshine have the lowest melanoma rates, which would not be possible if melanoma’s UV relationship were straightforward. European study confirm this type of relationship and genetic factor [7]
“Furthermore, the propensity of the skin to burn—rather than tan—in the sun also consistently increases risk” This statement is referring to melanoma risk. [10]
View Dr. M. Papas Report

References:

[1] Papas – Differential risk of malignant melanoma by sunbed exposure type (2011)

[2] Grant – Grant, Critique of the International Agency for Research on Cancers meta-analyses of the association of sunbed use with risk of cutaneous malignant melanoma. Dermato-Endocrinology 1:6, 1-7; November/December 2009

[3] IARC Working Group – The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review
Int. J. Cancer: 120, 1116-1122 (2006)

[4] Gandini S, et al., Meta-analysis of risk factors for cutaneous melanoma I. Common and Atypical Naevi, II. Sun exposure. III. Family history, actinic damage and phenotypic factors doi:10.1016/j.ejca.2004.10.016

[5] Elwood and Jopson – Melanoma and sun exposure: An overview of published studies. Int. J. Cancer: 73, 198-203 (1997)

[6] Garland et al, – Occupational sunlight exposure and melanoma in the U.S. Navy. Arch. Environ. Health 1990 Sep-Oct;45(5):261-7

[7] Shipman et al, Sunnier European countries have lower melanoma mortality Clinical and Experimental Dermatology 2011

[8] Mason 2010 et al, Photoprotection by 1,25-dihydroxyvitamin D and analogs: Further studies on mechanisms and implications for UV-damage

[9] Tang 2011 – Calcium plus vitamin D supplementation and the risk of nonmelanoma and melanoma skin cancer: post hoc analyses of the women’s health initiative randomized control trial

[10] Public Health Agency of Canada, Richard P. Gallagher,Tim K. Lee, Chris D. Bajdik and Marilyn Borugian