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Family Health Magazine - ADOLESCENT HEALTH

A Burning Concern
Talking to teens about the danger of artificial tanning

Many of us associate a tan with summer sunshine and good health. Often teens spend a lot of time sunbathing, or try to get a tan when they are active outdoors. In addition, many teens are using artificial tanning beds. The idea that tanned skin is attractive is a strong motivation for tanning, especially for young women. However, many studies show a strong link between ultraviolet radiation exposure and skin cancer.

Erin Welsh used tanning beds for several years. At age 27, she was diagnosed with melanoma skin cancer. She endured surgery and months of chemotherapy after the melanoma spread to her lymph nodes.

Teaching teens to love the skin that they are in is a great defense against skin cancer. If, they still feel that looking tanned is necessary, there are a few safer ways to do so. Topical sunless tanning products, such as lotions and spray tans, are alternatives to UV exposure. However, they must be used as directed. Be sure to protect your eyes, mouth and nose when using these products, and avoid inhaling when using spray tans. Tinted cosmetics and moisturizers can also be used to achieve a tanned appearance. Remember, most sunless tanning products and cosmetics do not contain sunscreen. Use a broad spectrum sunscreen of SPF 30 or higher before applying makeup.

“Today I am cancer-free, but I live every day regretting my choice to use a tanning bed. The color of my skin isn’t worth the living hell I’ve been through in this last year,” says Welsh. “Getting a tan is not worth your life.”

Welsh now sees her dermatologist (skin doctor) every three months and an oncologist (cancer doctor) to ensure that she remains free of cancer.

“I know there is the risk that my cancer could come back and kill me,” she says. “This has taken a tremendous mental toll on myself and my family.”

Teens in particular face pressure about their body image. They feel they must meet social standards of what is considered attractive. Most are concerned with how others see and evaluate them. This need for acceptance can mean choices that increase the risk of injury and illness. Tanning is one example.

Millions of people tan indoors each day. This is in spite of the fact that ultraviolet radiation is the most preventable risk factor for all skin cancers. The World Health Organization (WHO) lists artificial ultraviolet radiation as a known human carcinogen along with tobacco, asbestos, and arsenic. (A carcinogen is something that causes cancer.) The WHO moved tanning beds up to the highest cancer risk category based on a 2006 review of research. The review found that those who used sunbeds before age 35 had their risk of melanoma increase by 75 per cent, and many other studies since then have found a similar risk.

Indoor tanning use may account for hundreds of thousands of cases of skin cancer each year in the US alone, and many more worldwide. A 2012 study in the British Medical Journal found that artificial tanning users had a 67 per cent greater risk of developing squamous cell and 29 per cent greater risk of basal cell carcinoma, and this risk was greater with usage at a young age. As well, having had skin cancer increases the risk of developing other cancers. Someone who has had a basal cell cancer has a 20 to 30 per cent higher risk of developing cancer in other parts of the body. For people who have had squamous cell cancer, the risk of developing a second cancer more than doubles.

Teens and tanning

2012 Alberta Health Services Youth Indoor Tanning Survey (YITSA) Findings:

  • One in three 17 year old girls had tried indoor tanning.
  • Approximately 18 per cent of 15 to 17 year olds in Alberta said they had tried indoor tanning at least once.
  • Girls were much more likely to use indoor tanning, however boys who used it tended to be more frequent users.
  • Teens are starting indoor tanning at a younger age than previously thought.
  • Nearly two thirds of indoor tanners had first used the beds by age 15.

2006 Canadian Partnership Against Cancer Second National Sun Survey (NSS2) Findings:

  • Over a quarter of young Canadian women aged 16 to 24 use tanning equipment.
  • The number that were tanning in western Canada, either in the sun or using tanning equipment was highest in Alberta (30 per cent).
  • This was followed by Manitoba and Saskatchewan (26 per cent), and British Columbia (23 per cent).
  • About a third of those using tanning equipment do so more than 12 times per year.
  • People use tanning equipment to look better (77 per cent), and to relax or feel better (72 per cent).

The 2012 Alberta Health Services Youth Indoor Tanning Survey (YITSA) looked at the amount of artificial tanning done by young Albertans. It also gauged their knowledge, attitudes, and behaviours with regard to indoor tanning.

In spite of the link between ultraviolet radiation and skin cancer, the pressure to tan can outweigh health concerns. According to the YITSA survey, youth are largely aware that indoor tanning can cause cancer. Unfortunately, however, teens often link a tan with beauty.

One survey found that most people use tanning equipment to look better and to relax or feel better (see sidebar).

Body image and appearance are huge factors in indoor tanning. Young people often compare how they look to images in magazines, TV, music videos and advertising. Our culture glamorizes and reinforces the idea that tanned skin is beautiful.

As well, teens often believe that nothing bad can happen to them. Research shows that the less vulnerable a girl feels to risk, the more positive her attitude will be about tanning.

It is important that parents educate their children about the risks of UVR exposure. This may mean exploring and challenging attitudes towards tanning. Informed parents can correct any mistaken beliefs about its supposed benefits.

What doctors say

  • More than one in seven Canadians will develop some form of skin cancer during their life.
  • Skin cancers make up a third of all new cases of cancer each year in Canada.
  • The rate of melanoma has increased in recent decades, including in young adults.
  • Melanoma is the second most common cancer in young adults aged 15 to 29.
  • Every day, three Canadians die of melanoma.
  • Melanoma is one of the most deadly and difficult
    to treat cancers and the most deadly form of
    skin cancer.
  • About half of patients diagnosed with advanced-stage melanoma die in less than a year.
  • Non-melanoma skin cancers are also a major problem — they can cause significant disease, surgical removal of skin cancer that affects appearance, and death.
  • In Canada, 81,300 new cases of non-melanoma skin cancer (basal and squamous) and 320 deaths were expected for 2012.

The Indoor Tanning Is Out Alberta Coalition is raising awareness of the dangers of indoor tanning. Any regulations about limits to youth tanning are up to the provincial government. In Canada, legislation currently restricts youth access to indoor tanning in Nova Scotia, British Columbia, Quebec, and some municipalities in Ontario.

Many teenagers flood into tanning salons before grad night just to have the perfect tan. They do not know the risks and how it may impact their future,” says dermatologist Mike Kalisiak, founding co-chair of the coalition.

Dr. Kalisiak commonly sees young patients with a history of excessive UV exposure from the sun and tanning beds. They are concerned about suspicious moles on their skin.

He says the short-term beauty of a tan will never be worth the ugly long-term results. Kalisiak discourages tanning, saying that cancer is far from pretty.

Dr. Susan Poelman, also a dermatologist and coalition member, says that she sees more and more skin cancer patients in her practice.

“Melanoma used to be regarded as a disease typical of the elderly. Unfortunately, it is not limited to that age group anymore,” says Poelman.

The dangers of UV exposure

Teens may downplay the risks of UV exposure. Ultraviolet light exposure is the most preventable risk factor for all skin cancers. Various studies show that UVR exposure also causes:

  • premature skin aging
  • wrinkles
  • sun spots
  • leathery skin
  • telangiectasia (dilation of the tiniest blood vessels, called capillaries, aka spider veins)
  • eye damage, including cataracts

UVR can suppress the immune system (which defends against infection). Some studies have even found that frequent tanning bed users can have physiological and psychological addictions to tanning.

Please visit for more information.

Myths about indoor tanning

Many people might not realize that an occasional tanning session before a holiday in the sun also puts them at an increased risk. Studies have found that more than ten tanning sessions in a lifetime doubles the risk of melanoma. There are several widespread myths about indoor tanning.

Some believe that indoor tanning is safer than sunbathing, and that a base tan provides protection from the sun. In reality, artificial tanning can be even more dangerous than sun exposure. Some tanning beds emit 10 to 15 times more UVA radiation than the midday sun. As well, those who use artificial tanning likely expose more skin and do not wear sunscreen. Having a base tan only provides the equivalent of SPF 3 to 4 protection. You need at least SPF 30 to effectively protect your skin. There is no such thing as a safe or protective tan. Tanning involves DNA damage to skin cells, which can lead to cancer.

Those who support indoor tanning often talk about the health benefits of vitamin D. Vitamin D can be obtained at a low cost through diet (from fish liver oils, fatty fish, fortified milk products and cereals) and oral supplements, without UVR exposure and skin cancer risks.

What can parents do?

Discuss tanning with your children at an early age. Increasing awareness and education about skin cancer and the risks of tanning will hopefully help reduce skin cancer rates. Protect young children’s skin, and encourage older children to care for themselves by:

  • limiting outdoor activities when the UV index is high
  • applying sunscreen
  • seeking shade
  • avoiding tanning beds
  • wearing protective clothing, hats and sunglasses

Be aware of the warning signs of melanoma. See your doctor if you notice a mole or other skin lesion that changes in size, shape or colour or if a new spot appears on the skin.

Discussing cancer hazards and myths of tanning is important. However, body satisfaction and self-esteem are also vital. Talk to your children about cultural pressures that encourage taking risks with UV radiation. Often, young people tan because they think it makes them look better. Point out the negative effects of tanning on appearance, such as premature aging, sunspots and wrinkles. Explain why tanning is a bad idea, and encourage your kids to be comfortable in the skin they are in.

FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [AD_FHb13]
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