Tanning Bed Addiction is Linked to Rise of Melanoma in Young Women. Even as the rates of other cancers are falling in the United States, the rates of melanoma — the deadliest skin cancer — are rising dramatically, most especially among young women.
That’s according to a new longitudinal study from the Mayo Clinic that spans four decades. According to researchers, the rise is most pronounced among young women.
Skin cancers are the world’s most common cancers, the World Health Organization says, with over two million cases occurring worldwide each year. These include some 132,000 cases of malignant melanoma — the most fatal of skin cancers.
Beginning in the melanocytes — or the cells that make the pigment melanin — melanoma often starts out looking like a mole. That’s when it occurs in the skin. But melanoma can also begin in other pigmented tissues like the eye or the intestines. Symptoms include changes in an existing mole or the development of an unusual growth on your skin (or eye).
This year, about 76,250 people in the U.S. will be diagnosed with melanoma and about 9,200 are expected to die from it, the American Cancer Society says. In the United Kingdom, around 60,000 people are diagnosed every year, and 15,000 are expected to die. Worldwide, about 53,000 people are killed by the deadly skin cancer, WHO says — and warns that Caucasians and other people with fairer skin are at a higher risk.
It’s been a rare cancer for a long time, but melanoma is slowly emerging as one of the most frequently diagnosed forms of cancer in the U.S., the Food and Drug Administation warns. Skin cancers have also been known to occur mostly in people 50 years and older — but the new Mayo Clinic study shows that the rates are rising dramatically among young women. The findings are published in the April issue of the journal Mayo Clinic Proceedings.
For their study, the researchers pored over health records dating back to the 1970s taken from the Rochester Epidemiology Project, a decades-long database of all patient care in Olmsted County, Minnesota. They then looked for first-time diagnoses of melanoma in patients 18-39 years old from 1970 to 2009.
What did they find?
• The number of melanoma cases in young adults increased more than sixfold in the past 40 years.
• In young women, the number of cases increased more than eightfold.
• In young men, the increase was fourfold.
“We anticipated we’d find rising rates — as other studies are suggesting — but we found an even higher incidence than the National Cancer Institute had reported,” says lead investigator Dr. Jerry Brewer, a Mayo Clinic dermatologist. “In particular, (we saw) a dramatic rise in women in their 20s and 30s,” he adds. The authors also note that Olmsted County is populated mostly by whites.
To be precise, these are the study figures:
• The analysis included 256 men and women, ages 18 to 39, with a first lifetime diagnosis of melanoma from Jan. 1, 1970, through Dec. 31, 2009.
• Over the four decades, the incidence rate per 100,000 residents rose from 4.8 in 1970-1979 to 30.8 in 2000-2009.
• In absolute numbers, there were 16 diagnoses in 1970-1979, 44 in the 1980s, 67 in the 1990s, and 129 in 2000-2009.
• Among men, the rate went from 4.3 per 100,000 residents to 18.6 over the four decades, slightly more than a four-fold increase.
• Among women, the rate skyrocketed by a factor of more than eight, from 5.4 to 43.5 cases per 100,000 residents.
• But each one-year increase in calendar year of diagnosis was associated with an eight percent reduction in the risk of death from any cause. This is significant at P=0.005.
• And each one-year increase in calendar year of diagnosis was also associated with a 9 percent decreased risk of death from metastatic melanoma. This is significant at P=0.01.
Dermatologists interviewed by various media outlets in the U.S. say the findings reflect what they see in their own practices. Dr. Jennifer Stein, an assistant professor at the Ronald O. Perelman department of dermatology at the New York City’s NYU Langone Medical Center tells HealthDay News that she is seeing a lot of young women with melanoma.
More treatable — but only if caught early
The good news is: while the rates of melanoma are rising, the new study did show that fewer people are dying from the deadly skin cancer.
According to the study, the number of deaths from melanoma appears to be falling — by nine percent a year over the past four decades. This is most likely because of better awareness that leads to early detection of skin cancer and prompt medical care.
“People are now more aware of their skin and of the need to see a doctor when they see changes,” Mayo Clinic dermatologist Dr. Jerry Brewer says in a statement. “As a result, many cases may be caught before the cancer advances to a deep melanoma, which is harder to treat.”
When treated early, melanoma has a 90 percent survival rate, and it’s relatively easy to treat because of its location on the skin’s surface. But melanoma’s invasive nature means that if left too long, it becomes highly aggressive — it can spread quickly to internal organs and the average survival rate is six to nine months.
Only one-fourth of all people with metastatic or unresectable melanoma survive more than a year and less than 15 percent remain alive after five years. In contrast, 90 percent of all people with localized melanoma survive.
Tanning beds to blame
There are many risk factors for melanoma — including childhood sunburns and ultraviolet (UV) exposure in adulthood — but the study researchers blame the increasing melanoma rates in young women squarely on the use of indoor tanning beds.
For one, females are much more likely to use ultra-violet tanning beds than males — in most tanning salons, females make up 70 percent of the clientele.
WHO warns, “Most skin cancers are attributable to over-exposure to UV radiation, either naturally from the sun or from artificial sources such as sunlamps used in tanning beds. This warning is also echoed by the National Cancer Institute (NCI) on its website.
But tanning beds in particular have long been associated with an increased risk of skin cancer. Here’s some of the growing the evidence:
WHO maintains a fact sheet on the health risks of sun tanning found on its website that warns:
• “Sunbeds used in solariums and sun tanning lamps, are artificial tanning devices that claim to offer an effective, quick and harmless alternative to natural sunlight.”
• But “there’s growing evidence that the ultraviolet (UV) radiation emitted by the lamps used in solariums may damage the skin and increase the risk of developing skin cancer.”
A 2010 study of about 2,300 people by WHO shows that:
• Using a tanning bed just one time increases the risk of melanoma by 15 percent.
• Those who had tanned themselves indoors had a 75 percent higher risk of melanoma than people who never did it.
Based on its 2006 review of 19 studies conducted over 25 years on the use of indoor tanning equipment, in July 2009, the International Agency for Research on Cancer (IARC) — part of the WHO:
• Concluded that tanning devices that emit UV radiation were “carcinogenic to humans.”
• Moved indoor tanning from its previous categorization as “probably carcinogenic to humans” to this highest cancer risk category.
• Said indoor tanning was associated, not only with two types of skin cancers — squamous cell carcinoma and melanoma — but also eye cancer (ocular melanoma).
• Found the risk of getting melanoma increased by 75 percent in people who began using tanning beds before age 35
• Recommended a ban on commercial indoor tanning for under-18s, to protect them from the increased risk for skin cancers.
A study in Iceland found that the melanoma rates among residents — who had very little exposure to the sun– increased significantly after tanning beds were introduced.
“When you look at concentration of UV radiation from a tanning bed, it is significant,” Dr. Brewer said at a recent news conference. “Ten to 12 minutes in a tanning bed is the same as 10 to 12 minutes in the sun in the Mediterranean.”
The IARC categorized tanning beds in the same category as plutonium and cigarettes in terms of cancer-causing potential,” he points out.
“The people most affected are not just Baby Boomers but actually young adults,” Hopwood’s dermatologist, Kavita Mariwalla, director of dermatological surgery at Beth Israel Medical Center in New York tells USAToday. “Tanning before prom or big events has become a ‘norm’ for many teenagers. What they don’t know is that each time they visit a tanning booth, their risk of skin cancer rises.” Nearly 30 million Americans use tanning beds—and about 2.3 million of them are teenagers.
Calls for more restrictions on tanning beds
Dr. Brewer is thus calling for “absolutely” more restrictions limiting adolescents’ exposure to tanning beds.
Right now, 36 states restrict indoor tanning use by minors and California became the first state to ban outright the use of indoor tanning devices for under-18s — and the bill took effect at the beginning of this year.
California’s new law — which bans any minor from using a tanning bed even with a parent’s permission — is the strictest so far in the U.S. But about 30 other states have laws that place limits on indoor tanning for children and teenagers. New York, Pennsylvania and New Jersey are among other states considering similar laws. Last year, health groups in four other states tried, but failed, to have their lawmakers pass an outright ban on indoor tanning for all minors.
The American Academy of Dermatology applauded California for being the first state in the U.S. to pass the measure, and commended Congress for “protecting youth from the dangers of indoor tanning.” it also said it was glad that many other states are considering such bans.
But enforcing those restrictions is where the challenge lies, Dr. Brewer tells Fox News. “It’s like trying to ban cigarettes. It’s very difficult,” he says. “There are efforts already to ban tanning beds in certain state—32 of 50 states already have some kind of restriction. But if you tell kids they need their parents’ signatures, they’ll go home and sign it themselves.”
John Overstreet, executive director of the Indoor Tanning Association, a trade group based in Washington, D.C., refuted the study, saying indoor tanning bed use shouldn’t be singled out as a cause for the rise in skin cancer rates.
“The study itself has almost nothing to do with indoor tanning and the links they cite to indoor tanning are nothing but speculation,” he tells HealthDay News. “They (researchers) attempt to make indoor tanning the story while ignoring other possible risk factors such as sunburning outdoors, sunscreens that for several decades did not block UVA, the more deeply penetrating ultraviolet wavelength, and more frequent travel to sunny vacations locations over the last decade where severe sunburns are more likely to occur.”
Tanning bed addiction
Last year, a study by a University of Texas Southwestern Medical Center psychiatrist and his colleagues found that frequent tanning is an addiction — causing brain changes similar to that found in drug addicts.
The study showed that when participants known to be frequent users of tanning beds were exposed to UV rays in the study, the parts of their brains that play roles in addiction were activated. These are the dorsal striatum, the left anterior insula and part of the orbitofrontal cortex.
“What this shows is that the brain is in fact responding to UV light, and it responds in areas that are associated with reward,” said author Dr. Bryon Adinoff. “These are areas, particularly the striatum, that we see activated when someone is administered a drug or a high-value food like sugar,” he said.
The findings were published in November in the journal Addiction Biology.
More than a million Americans visit tanning salons every day, despite warnings from health authorities about skin cancer. This has led scientists to wonder if people were deliberately ignoring the potential health risks of regular UV exposure because tanning was an addictive behavior.
How can you check if you have melanoma?
Dr. Alicia Terando, a surgical oncologist at Ohio State University’s James Cancer Hospital in Columbus advises people to look for moles that follow the ABCD rule. She says:
• “‘A’ stands for asymmetry, meaning that one half of the mole is a different size than the other.”
• “‘B’ is for border irregularity.”
• “ ‘C’ stands for color. Melanomas are often brown, tan and black.
• “The ‘D’ is for diameter. Most melanomas are greater than 6 millimeters in size.
“A melanoma is the mole that stands out,” she said. “It’s the ugly duckling.”
According to the National Cancer Institute, the best way to prevent melanoma — as well as other skin cancers — is to protect yourself from the sun:
• Avoid outdoor activities during the middle of the day — between 10 a.m. and 4 p.m. — when the sun’s rays are the strongest. When you must be outdoors at this time, seek shade when you can.
• Protect yourself from the sun’s rays reflected by sand, water, snow, ice, and pavement. The sun’s rays can go through light clothing, windshields, windows and clouds.
• Wear long sleeves and long pants. Tightly woven fabrics are best.
• Wear a hat with a wide brim all around that shades your face, neck, and ears. Baseball caps and some sun visors protect only parts of your skin.
• Wear sunglasses that absorb UV radiation to protect the skin around your eyes.
• Use sunscreen lotions with a sun protection factor (SPF) of at least 15. Apply the product’s recommended amount to uncovered skin 30 minutes before going outside, and apply again every two hours or after swimming or sweating.
Melanoma is an aggressive skin cancer that can be particularly hard to treat when caught at an advanced stage. It’s outlook is generally poor when it’s reached this stage: patients generally survive for less than a year and treatment options are few.
But last year, two novel therapies that extended the lives and overall survival of people with late-stage melanoma were approved by the FDA. They’ve also been approved by the European Medicines Agency for use in the countries of the European Union.
The two drug treatments — Yervoy (ipilimumab) from Bristol-Myers Squibb and Zelboraf (vemurafenib) from Roche and Japan’s second largest drug maker Daiichi Sankyo Co Ltd — are unique because of their ability to extend a person’s life. They are also acclaimed for attacking the cancer itself.
Zelboraf targets specific melanoma patients who have a genetic mutation called the “BRAF V600” that leads to the abnormal activation of an enzyme involved in cell growth and death. About half of all melanoma patients have the genetic aberration that the drug targets, and the drug works by blocking the action of this enzyme.
Zelboraf is given as a twice-daily pill and is designed to be used alongside a companion diagnostic test, also from Roche, that identifies which patients have the BRAF genetic mutation.
Yervoy is a biologic therapy — a monoclonal or man-made antibody that blocks a crucial switch on immune cells called CTLA-4. Cancers use this switch to turn off the body’s anticancer immune responses.
Tanning Bed Addiction is Linked to Rise of Melanoma in Young Women. Posted 17 April 2012.