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.
Follow Karen Selick on Twitter: www.twitter.com/@kselick
Melanoma was predicted to rise by 91% - from an estimated 4,755 cases in 2004, to 9,070 cases in 2031. The study reported “an average of 745 annual melanoma-related deaths from 2000 to 2004 (as compared to 204 annual deaths due to NMSC). This once again represents a substantial burden in terms of medical costs and years of life lost”
“Using data from some Canadian cancer registries and taking into consideration both initial and subsequent NMSC diagnoses experienced by individuals, there were an estimated 76,000 cases in Canada in 2004. As a comparison, the Canadian Cancer Society reported that all other cases of cancer in the country in 2004 totalled to 148,000. Even though the mortality rate of NMSC is low, the sheer volume of cases drives a large burden of treatment costs and lost productivity”
When the effect of an Australian ‘SunSmart’ Type Skin Cancer Prevention Program was used to calculate cost savings, CPAC predicted the direct and indirect Canadian costs “Over the 28-year period of the model (2004 to 2031), total costs avoided were estimated at $2.12 billion compared to the estimated cost of a prevention program of $270 million.”
The disease prevention estimates are staggering: 18,047 melanomas.2,428 melanoma deaths.19,843 BCC’s.641 SCC’s. 85 Non Melanoma Skin Cancer deaths.
bit.ly/Wva31l
“Although NMSC is frequently curable, its high prevalence and expense of treatment place NMSC as a major public health problem and among the costliest cancers in the United States”
“Individuals with a personal history of NMSC may also be at an increased risk for second primary cancers other than just NMSC and melanoma. Despite accumulating evidence that appears to support this association, some have hypothesized that individuals with prior NMSC may in fact have a decreased risk of other cancers. The hypothesis of an inverse association is based on the supposition that the extensive exposure to sunlight among those who develop NMSC serves as a proxy for elevated levels of vitamin D due to the cutaneous synthesis that occurs upon exposure to sunlight. In turn, vitamin D is hypothesized to have anti-cancer properties”
“Clarifying this issue has important scientific, clinical, and public health implications. To help reconcile these divergent views of the relationship between a personal history of NMSC and risk of subsequent malignancies, we carried out a systematic review of the evidence on this topic.”
“For unknown reasons, NMSC may be a risk factor for other cancers.”
http://bit.ly/Wva31l
(Straw man argument comes to mind)
The author, Karen Selick is a board member of the Canadian Taxayers Foundation, an organization dedicated to “lower taxes, less waste and accountable government.” Canadian doctors are telling politicians how to conserve health care dollars and reduce waste. The CTF should support a move to save tax dollars..
In 2010, The National Skin Cancer Prevention Committee, a former subcommittee of the Primary Prevention Action Group of the federally funded Canadian Partnership Against Cancer, published an economic study titled “The Economic Burden of Skin Cancer in Canada: Current and Projected.”
This first of a kind economic study, intended to “better inform the efforts of primary prevention”, estimated the total economic burden of skin cancer in Canada would rise from $532 million annually in 2004, to $922 million by 2031.
http://bit.ly/XQI6hG
@ Karen Selickawyer - "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."
Speaking as a lawyer, Karen Selickawyer, you should be aware that Canadian children also have legal rights. In fact, based on an interpretation of the Infant's Health Act, the BC Supreme Court has permitted a minor to successfully sue for injuries in spite of prior parental consent.
http://www.courts.gov.bc.ca/jdb-txt/SC/09/13/2009BCSC1385.htm
The Canadian Constitution Foundation "defends the constitutional freedoms of Canadians through education and litigation and that they "will NOT consider"
"any situation in which both parties are private individuals or businesses
-for example landlord-tenant disputes, disagreements between consumers and
businesses, and employer-employee conflicts
Family law, divorce, maintenance or custody issues.
http://www.canadianconstitutionfoundation.ca/case.php"
Why are they commenting on a public safety issue regarding school aged consumers?
Karen Selick...I applaud you for taking a subject whose opponents are akin to religious zealots and giving a clear, fact filled argument. I look forward to your future articles.
(Got any evidence high strength artificial light is any safer than 'chemical sunscreen' ....)
http://www.miamiherald.com/2013/02/27/3257093/skeptics-shine-sunlight-on-tanning.html
Something the author seems to forget is that sun damage is cumulative. Like smoking cigarettes - the more you smoke and the longer you smoke, the more damage you do.
AAD "The ITA argued that a meta-analysis, such as the IARC study, is a flawed methodology. But Henry W. Lim, MD, chairman and C.S. Livingood chair of the department of dermatology at Henry Ford Hospital in Detroit, who attended and testified at the hearing, noted that several other studies have since been published — in Cancer Epidemiology, Biomarkers & Prevention, the International Journal of Cancer, and the American Journal of Epidemiology — and all conclude that exposure to indoor tanning increases one’s risk of developing skin cancers. All of these studies have looked exclusively at the use of indoor tanning beds, so the ITA can’t argue that dermatology-supervised phototherapy is included, Dr. Lim added.
http://www.aad.org/dermatology-world/monthly-archives/2012/april/dermatologists-undaunted-by-indoor-tanning-industry-s-claims
Leading cancer epidemiologist, Dr DeAnn Lazovich Ph.D., M.P.H (lead author of one of the studies referred to by the AAD) took the time to refute Dr William B Grant's theory
“In their letter, Grant and colleagues conclude that “those with preexisting high-risk factors… should be careful in using indoor tanning…”. Our data clearly indicate that both persons with and persons without these factors should expect that use of indoor tanning, especially frequent use, will increase their risk of developing malignant melanoma.”
http://cebp.aacrjournals.org/content/19/10/2685.2.full
You are mistaken.. prescriptions are needed for birth control.
Like Mark Twain said "there are three types of lies:little lies, big lies and statistics"
I also wonder if the lack of sunlight just makes them cranky and irritable.
Good Luck