Category Archives: Skin Cancer

Children, teens should not use tanning lamps – FDA

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Sun TanningA Consumer Update from the FDA

Using ultraviolet (UV) tanning lamps, like those used in indoor tanning beds, increases the risk of skin damage, skin cancer and eye injury, according to the Food and Drug Administration (FDA) and numerous other health organizations.

According to the American Cancer Society, melanoma—the deadliest form of skin cancer—accounted for 75,000 cases of skin cancer in 2012.

According to the American Academy of Dermatology, indoor tanners are 75 percent more likely to develop melanoma than those who have never tanned indoors, and the risk increases with use.

To help protect consumers from the risks of indoor tanning, FDA is proposing changes in its regulation of sunlamps. The proposals are to enhance oversight of these devices, and to require labeling to include a recommendation designed to warn young people under the age of 18 not to use these devices.

This is due to concerns about long-term effects of exposure to dangerous UV rays. Because the effects add up over a lifetime, UV exposure in children and teenagers puts them at greater risk for skin and eye damage later in life.

Proposed Changes

FDA regulates sunlamp products (including tanning beds and booths) both as medical devices and radiation-emitting products. Manufacturers of sunlamps must comply with FDA regulations regarding these devices.

Based on new risk information and recommendations from experts at an earlier FDA Medical Device Advisory Committee meeting, the agency is proposing to reclassify these devices from Class I to Class II. FDA can exert more regulatory control over Class II devices, notes FDA medical device expert Neil Ogden.

For example, sunlamps would have to undergo premarket review and comply with requirements relating to performance testing, software validation and biocompatibility. “We believe the reclassification will not only strengthen oversight of sunlamp products, but also will ensure that consumers are better informed about and protected from this sort of exposure,” he explains.

In addition, FDA is proposing that manufacturers add a label to the sunlamp warning young people not to use these devices. The World Health Organization, the American Academy of Pediatrics, the American Academy of Dermatology, the American Medical Association and other organizations have previously supported what the FDA is now proposing: a recommendation that minors refrain from indoor tanning.

The proposed order will be published in the Federal Register at www.regulations.gov and FDA will take public comments for 90 days.

FDA also is proposing that sunlamp product labeling include a warning that people who are repeatedly exposed to sunlamp products see their health care professional on a regular basis to check for possible skin cancer.

Skin Cancer Risk

“There is increasing evidence that tanning in childhood to early adult life increases the risk of skin cancer, including melanoma,” says FDA dermatologist Markham Luke, M.D.

In fact, according to an overview of studies recently published in the journal Pediatrics, melanoma is the second most common cancer in women in their 20s and the third most common cancer in men in their 20s in the U.S. Luke adds that many experts believe that at least one cause is the increased use of sunlamp products by U.S. teenagers and young adults.

The overview in Pediatrics suggests that doses of UV-A ultraviolet radiation emitted by high pressure tanning units may be up to 10 to 15 times higher than that of the midday sun, an intense exposure not found in nature.

UV-A rays penetrate to the deeper layers of the skin and are often associated with allergic reactions, such as a rash. This is not to say that tanning outdoors is a safe activity. WHO has classified all UV radiation as carcinogenic (cancer causing).

Practices to Avoid

FDA’s proposal seeks to provide a reasonable assurance of safety and to make prospective users of sunlamps aware of the risks they face. Certain practices involving sunlamps are especially dangerous. These include:

  • failing to wear goggles—this can lead to short- and long-term eye injury.
  • starting with long exposures (close to the maximum time for the particular sunlamp), which can lead to burning. Because sunburn takes 6 to 48 hours to develop, you may not realize your skin is burned until it’s too late.
  • failing to follow manufacturer-recommended exposure times on the label for your skin type (some skin types should not tan with UV radiation at all, for example those with skin that burns easily and doesn’t readily tan).
  • tanning while using certain medications or cosmetics that may make you more sensitive to UV rays. Talk to your doctor or pharmacist first.

This article appears on FDA’s Consumer Update page, which features the latest on all FDA-regulated products.

May 7, 2013

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Burning issue: Tanning bed laws

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Sun TanningBy Maggie Clark, Staff Writer

Talk of banning teenagers from indoor tanning beds has Maine Governor Paul LePage seeing red.

“This is government run amok,” LePage wrote in vetoing a bill that would have made Maine the latest state to institute a ban on indoor tanning for some teenagers, even if they have permission from their parents. “Maine parents can make the right decisions for their families.”

Teens under 18 are banned from tanning beds in California and Vermont. In New York and now in New Jersey, home of the famously tanned cast of MTV’s Jersey Shore, the minimum age for tanning beds is 17, regardless of what a teen’s parents may say.

For Texas teens under 16.5 years-old and Wisconsin teens under 16, the same rule applies. Four additional states ban teens under age 14 from using tanning beds (see map).

New Jersey Governor Chris Christie, who signed his state’s law earlier this week, said the measure there was inspired by the tabloid-sensation “tanning mom,” Patricia Krentcil, who was accused of putting her five-year-old daughter in a tanning bed. Krentcil, of Nutley, N.J., pleaded not guilty to charges of child endangerment and a grand jury chose not to indict her.

Despite LePage’s refusal to bar teens from tanning booths, the trend seems to be headed in the opposite direction. California, Vermont and New York all enacted their bans in 2012, and in the current legislative session, lawmakers in 29 states have introduced measures that would tighten restrictions on teen tanning.

Some would require parental consent, while others would institute outright bans, according to analysis from the National Conference of State Legislatures.

Legislators are responding to research that directly links indoor tanning to skin cancer. Tanning booths deliver10 to 15 times the UV radiation of natural sunlight, boosting the user’s risk of developing deadly melanoma by at least 75 percent, according to the American Cancer Society.

Teenage girls, the most frequent tanners, are more susceptible to melanoma than other groups, according to the National Cancer Institute. Their research found that melanoma is the most common form of cancer for young adults aged 25 to 29 years.

tanning

In response to that same research, tanning beds are also subject to an additional 10 percent tax under the Affordable Care Act. While the tax was put in place to discourage indoor tanning, it hasn’t made much of a dent in demand for indoor tanning, according to a study from researchers at Northwestern University Feinberg School of Medicine. But according to the Indoor Tanning Association, it’s hurt many small tanning businesses.

“These businesses have paid this unfair tax for the past two years and the results are in: over 3,100 tanning businesses closed; over 35,000 jobs were destroyed,” according to a press release from the Indoor Tanning Association. “Since the tax went into effect, we estimate $145 million has been taken out of the pockets of consumers and main street businesses and remitted to the Federal Government.”

The U.S. Food and Drug Administration, which regulates tanning beds, has not taken a formal position on the issue of teen tanning, but the agency is considering modifying regulations for tanning beds to reduce the amount of UV exposures they emit. The FDA, National Cancer Institute and other health organizations advise avoiding indoor tanning entirely.

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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U.S. cancer deaths continue long-term decline

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By Bill Robinson
NCI Cancer Bulletin

According to the latest national data, overall death rates from cancer declined from 2000 through 2009 in the United States, maintaining a trend seen since the early 1990s.

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Mortality fell for most cancer types, including the four most common types of cancer in the United States (lungcolon and rectumbreast, and prostate), although the trend varied by cancer type and across racial and ethnic groups.

The complete “Annual Report to the Nation on the Status of Cancer, 1975–2009″ appeared January 7 in the Journal of the National Cancer Institute.

The report also includes a special section on cancers associated with the human papillomavirus (HPV) that shows that, from 2008 through 2010, incidence rates rose for HPV-associated oropharyngealanal, and vulvar cancers.

HPV vaccination rates in 2010 remained low among the target population of adolescent girls in the United States.

As in past years, NCI, the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the annual report.

Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Incidence Rates Vary, Death Rates Continue to Drop

Among men, the overall rate of cancer incidence fell by an average of 0.6 percent annually from 2000 through 2009. Cancer incidence rates were stable among women during the same time period and rose by 0.6 percent per year among children. (See the table.)

“The continuing drop in cancer mortality over the past two decades is reason to cheer . . . The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections.”

The declines in cancer mortality averaged 1.8 percent per year for men, 1.4 percent per year for women, and 1.8 percent for children (ages 0 to 14 years) from 2000 through 2009.

During the same period, death rates among men fell for 10 of the 17 most common cancers and rose for three types of cancer. Death rates among women fell for 15 of the 18 most common cancers and also rose for three types of cancer.

“The continuing drop in cancer mortality over the past two decades is reason to cheer,” said ACS Chief Executive Officer Dr. John R. Seffrin in a statement. “The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections. We must face these hurdles head on, without distraction, and without delay, by expanding access to proven strategies to prevent and control cancer.”

HPV Vaccination Rates Low

The special section on HPV-related cancers showed that from 2000 through 2009, incidence rates for HPV-associated oropharyngeal cancer increased among white men and women, as did rates for anal cancer among white and black men and women. Incidence rates for cancer of the vulva also increased among white and black women.

However, cervical cancer rates declined among all women except American Indian/Alaska Natives. In addition, cervical cancer incidence rates were higher among women living in lower-income areas.

The annual report also showed that, in 2010, fewer than half (48.7 percent) of girls ages 13 through 17 had received at least one dose of the HPV vaccine, and only 32 percent had received all three recommended doses, a rate that fell well short of the Department of Health and Human Services’ Healthy People 2020 target of 80 percent.

The rate is also much lower than vaccination rates reported in Canada (50 to 85 percent) and the United Kingdom and Australia (both higher than 70 percent).

Vaccination series completion rates were generally lower among certain populations, including girls living in the South, those living below the poverty level, and Hispanics.

“The influence that certain viral infections can have on cancer rates is significant and continued attention to the effect[s] of HPV infection, in particular, on cervical cancer rates is critical,” said NCI Director Dr. Harold Varmus in a statement. “It is important, however, to note that the investments we have made in HPV research can only have the tremendous payoff of which they are capable if vaccination rates … increase.”

Cancer Incidence and Mortality Rates, 2000–2009

Men Women
Incidence Increase

  • kidney
  • pancreas
  • liver
  • thyroid
  • melanoma
  • myeloma

Decrease

  • prostate
  • lung
  • colorectal
  • stomach
  • larynx
Increase

  • thyroid
  • melanoma
  • kidney
  • pancreas
  • leukemia
  • liver
  • corpus and uterus

Decrease

  • lung
  • colorectal
  • bladder
  • cervix
  • oral cavity and pharynx
  • ovary
  • stomach
Mortality Increase

  • melanoma
  • liver
  • pancreas

Decrease

  • lung
  • prostate
  • colon and rectum
  • non-Hodgkin lymphoma
  • kidney
  • stomach
  • myeloma
  • oral cavity and pharynx
  • larynx
  • leukemia
Increase

  • pancreas
  • liver
  • corpus and uterus

Decrease

  • lung
  • breast
  • colon and rectum
  • leukemia
  • non-Hodgkin lymphoma
  • brain and other nervous system
  • myeloma
  • kidney
  • stomach
  • cervix
  • bladder
  • esophagus
  • oral cavity and pharynx
  • ovary
  • gallbladder

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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You’ve been treated for cancer — now what?

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Treatment Summaries and Surviorship Care Planning

What do you do when you’ve finished treatment?

How do you coordinate your ongoing care with your Primary Care doc?

How do you keep track of your medical records and get the right information to the right people about what you’ve been through?

Now we have some answers.

  • Debra Loacker, RN, will provide an overview of the valuable information provided in cancer treatment summary and the survivorship care plan. You will learn where to obtain a copy of your own treatment summary, and how your doctor can use it.
  • Patricia Read-Williams, MD, will share her perspective as a Primary Care Provider on the importance of these documents in the care provided to cancer survivors.

When:

6/21/12 , 6:45-8:30 p.m.

Where:

Gilda’s Club Seattle • 1400 Broadway, Seattle, WA 98122

Phone: 206.709.1400 • info@gildasclubseattle.org • www.gildasclubseattle.org


Gilda’s Club Seattle

Gilda’s Club is a non-profit group that provides meeting places where men, women and children living with cancer and their families and friends join with others to build emotional, social and educational support as a supplement to medical care.

The club’s services are free and include support and networking groups, lectures, workshops and social events in a nonresidential, homelike setting.

The club is named in honor of Gilda Susan Radner was an American comedienne and actress, best known for her years as a cast member of Saturday Night Live.

Radner, who died at 42 of ovarian cancer, helped raise the public’s awareness of the disease and the need for improved detection and treatment.

Lectures are held on Thursday evenings at Gilda’s Club, 1400 Broadway, Seattle.

Please RSVP to attend.

Refreshments served 6:45-7:00 pm

Lecture begins 7:00-8:30 pm

All lectures are open to the public. There is no cost to attend our lectures.

Please RSVP 24+ hours in advance to attend and pre-register for Noogieland childcare a minimum of 72 hours in advance.

When:

6/21/12 , 6:45-8:30 p.m.

Where:

Gilda’s Club Seattle • 1400 Broadway, Seattle, WA 98122

Phone: 206.709.1400 • info@gildasclubseattle.org • www.gildasclubseattle.org

 

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Swedish to open new Women’s Cancer Center

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Seattle’s Swedish Medical Center will open a new cancer center that will provide services tailored specifically for women — next Tuesday, June 5th.

The 23,600-square-foot True Family Women’s Cancer Center will occupy the fifth and sixth floor of the medical center’s Arnold Pavilion at 1221 Madison on Swedish’s First Hill campus.

The goal is to bring the Swedish physicians specializing in treating cancer in women into a single location to better coordinate care and to provide women cancer patients with a place where they can find all the services they need under one roof, said Dr. Patricia Dawson, the medical director of the new center and a breast surgeon with the Swedish Cancer Institute.

Although women and men have many of the same kinds of cancer, these cancers often have a different course in women and respond differently to treatment, said Dr. Dawson.

Women with cancer also often seek the kind of community and support services the new center hopes to offer, she said.

In addition to exam rooms, imaging services and procedure rooms, the new center will have support-group meeting rooms, counseling services and an educational resource center.

The facility’s decor and layout was designed to be both practical and “calming and restful” with the aim of enhancing both the quality of care and the quality of the patients’ experience, Dr. Dawson said.

The new center brings together a variety of clinicians and services that in the past have been scattered across the Swedish Medical Center’s main campuses.

Alexis Vanden Bos, a patient of Dr. Dawson who has been treated for two breast cancers, remembers having to shuttle between campuses during her treatments, often carrying her radiology films under her arm.

Alexis Vanden Bos

“It wasn’t bad, but how much easier this will be,” Vanden Bos said. “Now, I’ll be able to talk to both my surgeon and my oncologist in one place. I’ll love having all my people together.”

Construction of the $11 million facility was funded entirely from philanthropic gifts. The families of Patricia True, Doug and Janet True, and Bill and Ruth True began the fund-raising effort with $2 million donation.

Other major contributors include Eve and Chap Alvord, Robin Knepper, the Norcliffe Foundation, Bruce and Jeannie Nordstrom, Seattle Radiology, and Sellen Construction.

Additional support came from more that 2,500 individual donors.

The center’s staff will include oncologists, surgeons, onsite radiologists, psychological and genetic counselors, physical therapists, social workers and patient education specialists.

The center will provide resources for women with most cancers, including bladder, brain, breast, cervical, colorectal, esophageal, head and neck, leukemia, liver, lung, lymphoma, multiple myeloma, ovarian, pancreatic, renal/kidney, skin, thyroid and uterine.

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U.S. cancer deaths continue steady decline

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By Sharon Reynolds
NCI Cancer Bulletin Staff Writer 

According to the latest data on nationwide death rates from cancer, overall mortality from cancer declined from 1999 to 2008, maintaining a trend seen since the early 1990s.

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lungcolorectalbreast, and prostate), although the rate of decline varied by cancer type and across racial and ethnic groups.

The complete Annual Report to the Nation on the Status of Cancer, 1975–2008 appeared March 28 in Cancer.

The declines in cancer death rates (mortality) averaged 1.7 percent per year for men and 1.3 percent per year for women from 1999 through 2008.

Among men, the overall rate of new cancer cases (incidence) fell by an average of 0.6 percent annually from 1999 to 2008.

Among women, incidence dropped by an average of 0.5 percent annually from 1999 to 2006 but held steady from 2006 to 2008.

Cancer incidence in children ages 0 to 14 rose from 1999 to 2008 (by 0.5 percent a year), continuing a trend seen in previous Annual Reports to the Nation.

However, advances in treatment contributed to a steady decline in mortality rates for children with cancer in the last 5 years (an average of 2.8 percent per year).

“Steady progress, as measured by declines in cancer death rates for many cancers, is good because we have an aging, growing population,” said Dr. Brenda K. Edwards, NCI’s senior advisor for surveillance.

“While the number of people diagnosed with cancer or who die of the disease may be increasing, the decline in cancer death rates for more than a decade is the best indicator of progress due to prevention, screening, diagnosis, and treatment,” she added.

NCI, the American Cancer Society, the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the report. Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and from the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Not All Good News

There were some notable exceptions to the overall decreases in incidence and mortality. From 1999 to 2008, death rates rose for pancreatic cancer in men and women, for liver cancer and melanoma in men, and for endometrial cancer in women.

The cervical cancer death rate, which had been falling for decades, showed no further decrease over the last 5 years.

And, although incidence rates fell overall for men and women from 1999 to 2008, the decline was not distributed evenly across racial and ethnic groups.

Cancer incidence rates did not decrease significantly among American Indian/Alaska Native men and women combined or among black, Asian and Pacific Islander, and American Indian/Alaska Native women.

Although incidence rates in black men did decline, this group still had the highest cancer incidence rate of any racial and ethnic group, 15 percent higher than that of white men and nearly double that of Asian and Pacific Islander men.

Major Modifiable Risk Factors

Each Annual Report to the Nation includes a special feature that focuses on a topic of importance to the cancer research community and the public.

This year’s report featured an analysis on the contribution of excess weight (overweight and obesity) and insufficient physical activity to the nation’s cancer burden.

More than 60 percent of the U.S. adult population is estimated to be overweight or obese, and a similar percentage of adults do not get the recommended amount of physical activity.

The rates of insufficient physical activity are even worse for children; for example, up to 90 percent of high school girls do not engage in recommended levels of physical activity.

Excess weight “is a major modifiable risk factor for cancer and other diseases—probably second only to tobacco use in terms of its impact on cancer incidence and mortality,” said Dr. Edwards. “The risk may be modest but it’s so pervasive that we felt this was the time to look at [cancer] incidence in this context.” Physical inactivity not only contributes to excess weight but is itself a risk factor for several cancer types.

The report was not designed to quantitatively link the trends in excess weight and lack of physical activity to the national trends for cancer, explained Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in NCI’s Division of Cancer Control and Population Sciences.

Many other studies have shown convincing links between excess weight and several cancer types, including endometrial, postmenopausal breast, colorectal, kidneyesophageal, and pancreatic cancer.

The point of the special feature, she noted, “is to highlight specific types of cancer that are related to [excess weight and lack of sufficient physical activity], show how these behaviors relate to these cancers in terms of their relative risks, and briefly describe some of the mechanisms by which they relate.”

The special feature also highlights national- and state-level prevention strategies in policy and environmental change that are intended to help people achieve recommended changes in their diets and physical activity levels.

As the nation’s weight has risen, so has the incidence of some, although not all, types of cancer related to excess weight and lack of sufficient physical activity. From 1999 to 2008, incidence rates of kidney cancer and of adenocarcinoma of the esophagus each rose about 3 percent per year for men and women, while incidence of pancreatic cancer rose 1.2 percent per year among men and women.

In addition, incidence rates of endometrial cancer rose significantly among black, Asian and Pacific Islander, and Hispanic women. Incidence of postmenopausal breast cancer stabilized from 2005 to 2008, after a period of decline.

“Although all of these cancers are influenced by multiple factors, the high prevalence of excess weight and insufficient physical activity likely contributed to these observed increases and to the lack of decline in breast cancer,” the authors wrote. “Continued progress in reducing cancer incidence and mortality rates will be difficult without success in promoting healthy weight and physical activity, particularly among youth.”

Excess weight and lack of physical activity also influence cancer survivorship, explained Dr. Ballard-Barbash, as both can negatively affect outcomes after a cancer diagnosis, further increasing the need for these risk factors to be addressed on a personal and societal level.

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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FDA to issue tougher rules for sunscreen products

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Beginning next year, sunscreen labels must indicate whether they provide protection against the full spectrum of the sun’s skin-damaging ultraviolet radiation or not.

Under the new rules announced today by the U.S. Food and Drug Administration (FDA), only those products that pass the agency’s test for protection against both ultraviolet A (UVA) and ultraviolet B (UVB) rays can labeled as “Broad Spectrum” and claim to help prevent sunburn, reduce the risk of skin cancer, and reduce the risk of early skin aging.

Both UVB and UVA radiation contribute to sunburn, skin cancer, and premature skin aging. Sunburn is primarily caused by UVB radiation.

Products that have sun protection factor (SPF) values between 2 and 14 may be labeled as Broad Spectrum if they pass the required test, the FDA said, “but only products that are labeled both as Broad Spectrum with SPF values of 15 or higher may state that they reduce the risk of skin cancer and early skin aging, when used as directed.”

“We want consumers to understand that not all sunscreens are created equal,” Lydia said Velazquez, PharmD, in FDA’s Division of Nonprescription Regulation Development.

Any product that is not Broad Spectrum, or that is Broad Spectrum but has an SPF between 2 to 14, will be required to have a warning stating that the product has not been shown to help prevent skin cancer or early skin aging, the FDA said.

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Dermatologist joins Minor & James

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Dr. Knox

Minor & James Medical, a multi-specialty physician group located in Seattle, Bellevue and Mercer Island, recently added dermatology to its list of specialties.

New Minor & James Medical dermatologist, John M. Knox, M.D., is board certified in dermatology and specializes in skin cancer and all conditions affecting the skin, hair and nails.

The dermatology division will be located at the First Hill Medical Building at 515 Minor Ave. in Seattle. The dermatology clinic is open Monday through Thursday from 8 a.m. to 5:30 p.m.

For more information or to schedule an appointment:

  • Call 206-386-9540.
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Sun Tanning

Should researchers accept support from industries whose products are linked to cancer?

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Seattle Times reporter Kristi Heim writes in her blog on the philanthropy “The Business of Giving” about the debate whether cancer researchers should accept support from industries whose products have been linked to cancer.

Heim writes:

Should a nonprofit cancer research center partner with the maker of an alcoholic beverage to raise money for breast cancer? The more wine consumed, the more funds for fighting cancer, goes the logic.

Should researchers studying the link between vitamin D and cancer accept money from the tanning industry? Make a donation to breast cancer research when you visit your local tanning salon.

To learn more read Heim’s blog:

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Indoor Tanning: The risks of ultraviolet rays

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Sunlamps and tanning beds promise consumers a bronzed body year-round, but the ultraviolet (UV) radiation from these devices poses serious health risks.

“Although some people think that a tan gives them a ‘healthy’ glow, any tan is a sign of skin damage,” says Sharon Miller, M.S.E.E., a Food and Drug Administration (FDA) scientist and international expert on UV radiation and tanning.

“A tan is the skin’s reaction to exposure to UV rays,” says Miller. “Recognizing exposure to the rays as an ‘insult,’ the skin acts in self-defense by producing more melanin, a pigment that darkens the skin. Over time, this damage will lead to prematurely aged skin and, in some cases, skin cancer.”

Two types of UV radiation that penetrate the skin are UV-B and UV-A rays.

  • UV-B rays penetrate the top layers of skin and are most responsible for sunburns.
  • UV-A rays penetrate to the deeper layers of the skin and are often associated with allergic reactions, such as a rash.

Both UV-B and UV-A rays damage the skin and can lead to skin cancer. Tanning salons use lamps that emit both UV-A and UV-B radiation.

In this Consumer Update video, Sharon Miller, an FDA scientist and expert on UV radiation, explains why it’s important to avoid exposure to UV radiation from devices such as tanning beds, tanning booths, and portable home tanning units.

Cancer Risk

Exposure to UV radiation—whether from the sun or from artificial sources such as sunlamps used in tanning beds—increases the risk of developing skin cancer, according to the National Cancer Institute (NCI). Melanoma, the deadliest form of skin cancer, is linked to getting severe sunburns, especially at a young age.

In July 2009, the International Agency for Research on Cancer (IARC), part of the World Health Organization, concluded that tanning devices that emit UV radiation are more dangerous than previously thought. IARC moved these devices into the highest cancer risk category: “carcinogenic to humans.” Previously, it had categorized the devices as “probably carcinogenic to humans.”

Development of cancer is a long process that may take decades. Therefore, IARC also recommended banning commercial indoor tanning for those younger than 18 years to protect them from the increased risk for melanoma and other skin cancers.

IARC’s conclusions and recommendations were based on its 2006 review of 19 studies conducted over 25 years on the use of indoor tanning equipment. The review found evidence of

  • an association between indoor tanning and two types of skin cancer: squamous cell carcinoma and melanoma
  • an association between UV-emitting tanning devices and cancer of the eye (ocular melanoma)
  • both UV-A and UV-B rays causing DNA damage, which can lead to skin cancer in laboratory animals and humans
  • the risk of melanoma of the skin increasing by 75 percent when tanning bed use started before age 35

IARC’s review had some limitations, says Ron Kaczmarek, M.D., M.P.H., an FDA epidemiologist who analyzed the review. Limitations include possible inaccuracy of people’s memories of their tanning experiences, not knowing the amount of UV radiation emitted by each tanning device, and the inability to separate the effects of individuals’ indoor and outdoor exposure. Nevertheless, IARC concluded that there is convincing evidence of an association between the use of indoor tanning equipment and melanoma risk, and that the use of tanning beds should be discouraged.

“It’s well established that UV radiation from the sun causes skin cancer,” says Miller. “Since lamps used in tanning beds emit UV radiation, the use of indoor tanning devices also increases your risk of skin cancer.”

Other Risks

In addition to the serious risk of skin cancer, tanning can cause:

Premature aging. Tanning causes the skin to lose elasticity and wrinkle prematurely. This leathery look may not show up until many years after you’ve had a tan or sunburn.

Immune suppression. UV-B radiation may suppress proper functioning of the body’s immune system and the skin’s natural defenses, leaving you more vulnerable to diseases, including skin cancer.

Eye damage. Exposure to UV radiation can cause irreversible damage to the eyes.

Allergic reaction. Some people who are especially sensitive to UV radiation may develop an itchy red rash and other adverse effects.

Advocates of tanning devices sometimes argue that using these devices is less dangerous than sun tanning because the intensity of UV radiation and the time spent tanning can be controlled. But there is no evidence to support these claims. In fact, sunlamps may be more dangerous than the sun because they can be used at the same high intensity every day of the year—unlike the sun whose intensity varies with the time of day, the season, and cloud cover.

Tanning in Children and Teens

FDA is particularly concerned about children and teens being exposed to UV rays. Intermittent exposures to intense UV radiation leading to sunburns, especially in childhood and teen years, increase the risk of melanoma, according to NCI.

FDA believes that limiting sun exposure and using sunscreen or sunblock are particularly important for children since these measures can prevent sunburn at a young age.

NCI reports that women who use tanning beds more than once a month are 55 percent more likely to develop melanoma. Teenage girls and young women make up a growing number of tanning bed customers.

“Young people may not think they are vulnerable to skin cancer,” says Kaczmarek. “They have difficulty thinking about their own mortality.” Yet of the more than 68,000 people in the United States who will learn they have melanoma this year, one out of eight will die from it, according to NCI estimates. In addition, the American Academy of Dermatology reports that melanoma is the second most common cancer in women 20 to 29 years old.

Some states are considering laws to ban those under age 18 from using tanning beds. And many states now have laws that require minors to have a parent’s consent or be accompanied by a parent to the tanning facility.

FDA’s current performance standard requires that a sunlamp product’s label include a recommended exposure schedule. FDA has advised manufacturers that this schedule should provide for exposures of no more than three sessions in the first week.

In an NCI-sponsored study published in September 2009 in the Archives of Dermatology, the study researchers hired and trained college students to pose as 15-year-old, fair-skinned girls who had never tanned before. By telephone, the students asked more than 3,600 tanning facilities in all 50 states about their practices.

Less than 11 percent of the facilities followed FDA’s recommended exposure schedule of three or fewer sessions the first week. About 71 percent said they would allow a teen to tan all seven days the first week, and many promoted frequent tanning with “unlimited tanning” discount price packages.

About 87 percent of the facilities required parental consent, leading the researchers to conclude that “many parents are allowing their teens to tan and are providing written consent or accompaniment.”

“Parents should carefully consider the risks before allowing their children under 18 to tan,” says Miller.

FDA Regulation

FDA regulates radiation-emitting products, including sunlamps and products that contain them, such as tanning beds and booths and portable home units. Manufacturers of sunlamps must comply with FDA regulations, including the performance standard for sunlamp products.

In a December 2008 Report to Congress, FDA noted that FDA/NCI studies found that the UV exposures typically provided by sunlamp products are excessive, and that comparable cosmetic effects can be produced with exposures that are only one-third or even one-fourth the levels currently used. FDA is evaluating the results of this research and considering whether those results warrant changes to its performance standard for sunlamp products.

FDA held an advisory committee meeting in March 2010 to seek independent, professional expertise and advice on regulatory issues related to tanning devices. At this public meeting, the agency heard many suggestions from health professionals, scientists, tanning industry representatives, and consumers. Based on the recommendations of the advisory committee and FDA’s own studies, the agency is considering revising some requirements for tanning beds, including strengthening the warning labels to make consumers more aware of the risks.

The Riskiest Practices

FDA, NCI, the American Academy of Dermatology, and other health organizations advise limiting exposure to natural UV radiation from the sun and avoiding artificial UV sources such as tanning beds entirely.

  • All use of tanning beds increases the risk of skin cancer. Certain practices are especially dangerous. These include:
  • Failing to wear the goggles provided, which can lead to short- and long-term eye injury.
  • Starting with long exposures (close to the maximum time for the particular tanning bed), which can lead to burning. Because sunburn takes 6 to 48 hours to develop, you may not realize your skin is burned until it’s too late.
  • Failing to follow manufacturer-recommended exposure times on the label for your skin type.
  • Tanning while using certain medications or cosmetics that may make you more sensitive to UV rays. Talk to your doctor or pharmacist first.

Melanoma: One Woman’s Story

Brittany Lietz Cicala of Chesapeake Beach, Md., began tanning indoors at age 17. She stopped at age 20 when she was diagnosed with melanoma, the deadliest form of skin cancer. The former Miss Maryland says she used tanning beds at least four times a week, and sometimes every day.

“Growing up, until I started using tanning beds, my parents were very strict about me wearing sunscreen,” says Cicala. Although she also tanned in the summer sun during her 3 years of tanning bed use, Cicala estimates that 90 percent of her UV exposure was in tanning beds during this period.

In the 4 years since she was diagnosed with melanoma, Cicala’s surgeries have left her with about 25 scars. Cicala gets a head-to-toe skin exam every 3 months, which usually results in removal of a suspicious growth.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Updated: May 11, 2010

THUMBNAIL PHOTO CREDIT: Tristanb under a GNU Free Documentation License.

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Valley Medical Center Receives Achievement Award for Heart Treatment 

valley-medical-centerThe American Heart Association (AHA) has awarded Valley Medical Center a Silver Performance Achievement Award for its efforts to make sure the care the hospital provides to its heart failure patients meets the AHA’s treatment guidelines. 

The award was given as part of the AHA’s “Get with the Guidelines” program, a national AHA initiative to encourage hospitals to provide heart failure care based on the best scientific evidence.

Under the guidelines, patients with heart failure patients are started on an aggressive therapeutic program while they are sill in the hospital to reduce their risk of recurrent heart failure and other complications.

For example, the guidelines recommend that, when appropriate, heart failure patients should be put on cholesterol-lowering, blood pressure, and anticoagulant therapies and that they be referred for cardiac rehabilitiation before they leave the hospital.

The AHA launched to Get With the Guidelines program after it was determined that many heart patients were not receiving the best evidence-based treatments that had been identified in AHA guidelines.

Valley Medical Center received the AHA award in recognition that it had achieved 85 percent compliance with the AHA heart failure guidelines for one year.

To learn more:

AJC to honor Virginia Mason CEO Dr. Gary Kaplan

kaplan-cuThe Seattle chapter of the American Jewish Committee will give its Human Relations Award to Dr. Gary Kaplan, chairman and CEO of Virginia Mason Medical Center at an awards dinner June 4.

Dr. Kaplan is being recognized for his efforts to improve health care quality, safety and efficiency, his contribution to health care reform, and his work on both regional and national foundations and associations.

To learn more:

Virginia Mason Opens Melanoma Specialty Program

Melanoma - NCI photoVirginia Mason Medical Center has opened a specialty program for patients with melanoma. 

The Center reports it has seen a 50-percent increase in the number of patients with melanoma over the past five years.

Melanoma, the most aggressive form of skin cancer, is diagnosed in nearly 60,000 Americans every year. 

Melanoma causes 75 percent of deaths due to skin cancer.

However, with early detection and treatment melanoma can be cured.

Virginia Mason says the new program will provide:

  • Multidisciplinary care to patients with localized and advanced melanoma.
  • Dedicated dermatologists, oncologists, pathologists, radiologists, surgeons and nurses. 
  • An oncology clinical registered nurse coordinator who assists each patient through the treatment course, from referral to recovery.
  • A detailed treatment summary sent to referring providers upon completion of treatment.

PHOTO CREDIT: Melanoma courtesy of the National Cancer Institute

To learn more:

  • Visit the Virginia Mason Melanoma Program Web page
  • Visit the Seattle Cancer Care Alliance Melanoma information pages.
  • Visit the National Library of Medicine’s MedlinePlus Melanoma information page.
  • Visit the National Cancer Institute’s information page on Melanoma.
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