Solariums

From Skin Cancer Statistics and Issues


In 2009, the International Agency for Research on Cancer (IARC) re-classified sunbeds into the highest risk category (Group 1, “carcinogenic to humans”).[1]

Due to the associated health risks, commercial solariums were banned from 1 January 2015 in all Australian states and territories except Western Australia, where a ban was introduced from 1 January 2016, and the Northern Territory, where there are no commercial solariums.

Prior to the ban, the Australian Standard specified that solariums could emit levels of UV radiation up to three times as strong as the summer midday sun.[2] However, a study in 2008 found that 15% of tanning beds in Australia exceeded this level, some emitting up to six times more UVA than summer sun.[3] Older solariums emitted primarily UVA (99% UVA and 1% UVB).[4] However some modern solariums emit a UVA to UVB ratio more closely simulating natural sun exposure in order to shorten tanning times. A more natural UVA to UVB ratio does not necessarily mean these solariums are safer than solariums with a heavier UVA output.[5] Further, solariums expose more of the body to strong UV radiation compared to typical exposure during outdoor activities (95-100% vs. 15-50%),[6] so in that sense are more dangerous than sun exposure.

A systematic review showed that people who use a solarium before the age of 35 have a 59% greater risk of melanoma than those who do not use solariums. There is a 20% risk increase in melanoma regardless of age of first use of a solarium.[7] The same meta-analysis also reported that the risk of melanoma increases with each sunbed session; there is a 1.8% increase in risk of developing melanoma for each additional sunbed session per year. [7] A meta-analysis by Wehner and colleagues found that indoor tanning increased risk of non-melanoma skin cancer, both SCC and BCC, with risk particularly high among people who had used indoor tanning before 25 years of age (increasing the risk of SCC two-fold, and 1.4 times increased risk of BCC risk).[8] Indoor tanning is a strong risk factor for early-onset BCC among people under 40 years of age, particularly among females.[9]

Like overexposure to solar UV, solarium use has been connected to not only skin cancer, but acute sunburn and blistering, photoageing, ocular diseases and local/systemic immunosuppression.[10]

In Australia, it was estimated in 2009 that simply restricting solarium use for individuals below age 18 and with very fair skin could potentially avoid around 250 serious skin cancers, save 31 years through avoided melanoma deaths, and result in a cost savings of approximately $250,000 to the federal government via Medicare, over the lifetime of a population of 100,000 persons.[11] However, compliance by the solarium industry with legislation restricting access among those most at risk, under 18 years of age and fair skin, was less than optimal.[12] Research by Cancer Council Victoria revealed 80% of Melbourne solarium operators surveyed allowed access to teenagers who concealed their age or claimed to be 18 years old. Other key findings show that almost half of the surveyed operators granted access to people with fair skin (skin type I), who were also banned from solarium use under Victorian legislation. Just 10% of operators surveyed were fully compliant with all conditions of the regulations assessed by the study.[12]

Prior to the ban, it was estimated that each year in Australia, 281 new melanoma cases, 43 melanoma-related deaths, and 2,572 new cases of squamous cell carcinoma were attributable to solarium use, at a cost to the health system of around $3 million.[13] A study prior to the ban estimated that one in six melanomas in Australians aged 18 to 29 years would be prevented if solariums were shut down.[14]

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References

  1. El Ghissassi F, Baan R, Straif K, Grosse Y, Secretan B, Bouvard V, et al. A review of human carcinogens--part D: radiation. Lancet Oncol 2009 Aug;10(8):751-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19655431.
  2. Standards Australia, Standards New Zealand. Australian/New Zealand Standard AS/NZS 2635 (Solaria for cosmetic purposes). Sydney, Australia; 2008.
  3. Gies P, Javorniczky J, Henderson S, McLennan A, Roy C, Lock J, et al. UVR emissions from solaria in Australia and implications for the regulation process. Photochem Photobiol 2011 Jan;87(1):184-90 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21091485.
  4. International Agency for Research on Cancer. Solar and ultraviolet radiation. Vol. 100D. Lyon, France: International Agency for Research on Cancer; 2012.
  5. Health issues of ultraviolet tanning appliances used for cosmetic purposes. Health Phys 2003 Jan;84(1):119-27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12498524.
  6. Berwick M. Are tanning beds "safe"? Human studies of melanoma. Pigment Cell Melanoma Res 2008 Oct;21(5):517-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18821856.
  7. 7.0 7.1 Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012 Jul 24;345:e4757 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22833605.
  8. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ 2012 Oct 2;345:e5909 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23033409.
  9. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol 2012 Oct;67(4):552-62 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22153793.
  10. Gordon L, Hirst N. The health effects of using solaria and potential cost-effectiveness of enforcing solaria regulations in Australia. Queensland, Australia: Queensland Institute of Medical Research; 2007 [cited 2008 Jan 16] Available from: http://www.arpansa.gov.au/pubs/rhc/QIMR_solaria07.pdf.
  11. Hirst N, Gordon L, Gies P, Green AC. Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia. Health Policy 2009 Mar;89(3):303-11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18760857.
  12. 12.0 12.1 Makin JK, Hearne K, Dobbinson SJ. Compliance with age and skin type restrictions following the introduction of indoor tanning legislation in Melbourne, Australia. Photodermatol Photoimmunol Photomed 2011 Dec;27(6):286-93 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22092731.
  13. Gordon LG, Hirst NG, Gies PH, Green AC. What impact would effective solarium regulation have in Australia? Med J Aust 2008 Oct 6;189(7):375-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18837680.
  14. Cust AE, Armstrong BK, Goumas C, Jenkins MA, Schmid H, Hopper JL, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011 May 15;128(10):2425-35 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20669232.


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