Should tanning salons be legally permitted to provide services to children and teenagers? Many people think they shouldn't -- but I say those people need to think twice.
Oakville, Ont., for instance, recently enacted a municipal by-law prohibiting the commercial tanning of anyone under age 18. Nova Scotia and British Columbia have both enacted province-wide bans, and Quebec followed suit effective February 1, 2013.
The result? According to this report by the CBC, Quebec teenagers have been skipping across the border to visit tanning salons in Ontario. No doubt teens in Oakville have found it feasible (even if somewhat inconvenient) to catch their artificial rays in neighbouring Mississauga or Burlington.
However, Ontario may soon put an end to teen tanning tourism with province-wide legislation of its own. Former premier Dalton McGuinty announced last September that his government would support a private member's bill -- the "Skin Cancer Prevention Act" -- tabled by NDP member France Gelinas. Although that bill died when the legislature was prorogued, I expect it to be reintroduced. According to Gelinas' website, 83 percent of Ontarians polled on this subject in June 2011 favoured such legislation.
Protecting teens from skin cancer seems like a no-brainer, especially when you hear the statistic that tanning opponents repeatedly toss around: namely, that using indoor tanning equipment before the age of 35 increases the risk of developing melanoma by 75%. Scary, right?
But statistics based on percentage increases should set off warning bells in every reader's head. Such numbers can be very misleading unless they also disclose the starting level from which the percentage increase was calculated. For example, suppose that only one person in Canada were to be murdered in 2014. If two people were murdered in 2015, that would constitute a shocking 100 percent increase in the murder rate -- but it would still be only two people, an extraordinarily low murder rate for a country of 34 million people.
I searched long and hard for any hint from tanning opponents about the starting point from which their scary 75 percent increase was computed. How many young people actually get melanoma? Nobody seemed to disclose this information -- neither France Gelinas, nor Cancer Care Ontario, nor the Center for Disease Control, nor the Canadian Cancer Society.
Finally, I consulted Statistics Canada's Causes of Death database (Table 102-0522). It turns out that in the decade from 2000 to 2009 (the latest year for which statistics were available), a total of 5 Canadians aged 19 or under died from malignant melanoma of the skin. That's only half a person per year.
Contrast this with the number of Canadians 19 and under who died of various other causes (StatsCan Table 102-0540) during that same decade: 195 deaths from falls, 627 from drowning, and a whopping 6,972 from what StatsCan calls "transport accidents".
The truth is that the actual risk (not the percentage increase in risk) of young people getting melanoma is tiny -- almost negligible -- compared with the risks of everyday activities that we don't think twice about allowing kids to engage in. We could prevent far more teen deaths and injuries by outlawing teenaged skating, swimming, bicycling and driving than by outlawing teenaged tanning.
Ah, but I can hear the statists cry already: "If it will save even a single teenaged life, it's worth it to ban tanning."
Actually -- no, it isn't.
Those who would ban teen tanning focus so intently on skin cancer that they seem completely oblivious to the health benefits that sun exposure (real or simulated) can confer. The ultraviolet rays of the sun allow our skin to form vitamin D, a hormone crucial for good health. Vitamin D deficiency is widespread in Canada today. As reporter Martin Mittelstaedt wrote in the Globe and Mail, "two-thirds of [Canada's] population has vitamin D levels below the amounts research is associating with reduced risk of chronic diseases...." Among the diseases that vitamin D guards against are "breast cancer, colorectal cancer, heart disease and multiple sclerosis."
A paper by Norwegian researchers entitled "Vitamin D, sun, sunbeds and health" published in April, 2012 in the journal Public Health Nutrition concluded: "The overall health benefit of an improved vitamin D status may be more important than the possibly increased CMM [cutaneous malignant melanoma] risk resulting from carefully increasing UV [ultraviolet] exposure." (The PubMed abstract is here.)
And now a maverick dermatologist, Richard Weller, has produced this TED talk. His research suggests that the sun's rays are not important just for their UVB (vitamin D-producing) component. The UVA rays -- those that tan us -- appear to help us avoid high blood pressure and cardiovascular disease by triggering the release of nitric oxide stored in the skin. This may account for the fact that Australians, with their high levels of sun exposure, have roughly 1/3 lower death rates from heart attacks and strokes than Scots with their low levels of sun exposure.
Dr. Weller says, "I'm a dermatologist. My day job is saying to people: 'You've got skin cancer. It's caused by sunlight. Don't go in the sun.' I actually think a far more important message is that there are benefits, as well as risks, to sunlight...Deaths from heart disease are a hundred times higher than deaths from skin cancer."
Science makes continual discoveries and advances that make our previous "knowledge" look like folly. All too often, we have allowed governments to make health decisions for us that have turned out to be dead wrong. Government agencies have approved drugs that later turned out to be killers. They have forbidden the publication of health information (for instance, that fish oils can prevent heart disease) that might have saved countless lives.
The rush to ban teen tanning looks like another example of legislation that will one day leave governments red-faced and back-pedalling. It could trigger a delayed increase in breast cancer or heart disease that would ultimately dwarf the number of melanomas prevented, but would leave epidemiologists scratching their heads wondering why.
Many tanning salons already insist on getting parental consent before tanning minors. It's a prudent practice that -- speaking as a lawyer -- I would encourage salons to adopt. However, the decision over whether to risk melanoma rather than heart disease should be left to the customer, not to the state.
"Wear sunscreen constantly," says Christine Janus, executive director of the Canadian Skin Patient Alliance (CSPA), an organization that provides support for those with skin conditions. Janus recommends wearing about three quarters of a shot glass full or as much as you need to cover exposed skin. She also says we should reapply the lotion every four to six hours if you're going in the water or working out.
"If your skin looks or feels different, rough like sandpaper for example, get it checked -- don't wait," Janus says. Treatments for skin cancers exist, but the the more you expose your skin, the higher your risks are, she says.
"Limit your time outdoors and during peak hours when the sun is up," Janus says.
Make sure when you're outside you wear a hat. "Men should be wearing hat as well. The top spots for skin cancer for men is on their head and back," Janus says.
Ultraviolet clothing is also another level of protection, Janus says. There are now companies that manufacture specialized items that have a built-in UV layer. She also recommends an umbrella.
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