Skin Cancer Epidemic And Indoor Tanning The Task

Skin Cancer Epidemic And Indoor Tanning The Task Ahead of Us Leslie Christenson, MD Mc. Farland Clinic, PC Ames, IA

Define the Problem Statistics • Skin Cancer: most common cancer in US • >3. 5 million skin cancers in >2 million people diagnosed annually • More new skin cancers each year than breast, prostate, lung & colon combined • 1 in 5 Americans will develop skin cancer in lifetime • Number of NMSC in Medicare population increased ave. 4. 2%/yr 1992 -2006 • $1. 4 billion in 2004, direct cost to treat skin cancer, $2. 36 billion in 2010

problem defined as BIG Problem is highly preventable

Break the Problem Down • Nonmelanoma skin cancer –Basal cell carcinoma –Squamous cell carcinoma • Melanoma skin cancer

Statistics • Basal cell carcinoma, most common, 2. 8 million annually, rarely fatal, can be very destructive • Incidence increased 3 fold (19762003) in woman <40

Statistics • Squamous cell carcinoma, 2 nd most common, 700, 000 cases/yr in US • 1 -15% metastatic rate • Incidence also on the rise

Statistics • Estimated 3, 170 deaths from nonmelanoma skin cancer in US in 2013 • 90% of nonmelanoma skin cancer are associated with UV exposure

Melanoma Statistics • 1970 -2009: incidence of melanoma increased 800% in young woman, 400% in young men • 1 person dies of melanoma every hour • Estimated 76, 690 new cases of invasive MM in US in 2013 • Estimated 9480 deaths due to MM in 2013 • Of 7 most common cancers in US, melanoma is the only one whose incidence is increasing, 1. 9% annually

Melanoma Statistics • Most common form of cancer in young adults 25 -29 • Second most common form of cancer in young people 15 -29 • 86% of melanomas can be attributed to UV exposure • Risk of melanoma doubles if >5 sunburns at any age • One + blistering sunburn doubles chance of melanoma

UV exposure critical role in development of skin cancer UV from natural sun UV from artificial light sources/tanning

Society Pressures • 19 th century started with parasol carrying elite, ended with start of sunbathing • Phototherapy for medical purposes in 1800’s • 1920 Coco Channel, fashion of tan • 1970’s use of tanning beds, started broad spectrum (UVA, UVB, UVC), then “safer” with 99. 9%-95. 7% UVA

Tanning • UVR is proven human carcinogen • International Agency for Research on Cancer, affiliate of World Health Organization include UV tanning devices as Group 1 (most cancer causing substance) ( along with Cigarettes, etc) • WHO declaration: no person under 18 y. o. should use a sunbed

Tanning • Currently tanning beds are regulated by FDA as Class I medical devise. Same category as the tongue depressor. • New high-pressure sunlamps may provide 12 times the annual UVA dose compared to sun

Tanning • 1 indoor tanning session increases users chances of developing melanoma by 20%, +2% ^ with each subsequent use • If use tanning bed before age 35, increase your risk of melanoma by 75% • 4 tanning sessions/yr increases risk of BCC and SCC by 15% • 1 tanning session/yr in high school/college boosts risk of BCC 10%, 6 sessions/yr 73%

Tanning • Nearly 30 million people tan indoors/yr in US, 2 -3 million are teens • >1 million Americans use tanning beds daily • 1% Americans in 1988 used indoor tanning, 27% Americans in 2007 • Indoor tanning rates 14, 15, 16, 17 yo girls were 8. 5%, 13. 6%, 20. 9%, & 26. 8% • Tanning is addictive: 41% of frequent indoor tanners met criteria for a tanning addictive disorder, 33% more met criteria for problematic tanning behavior

Costs • Indoor tanning industry $5 billion annual revenue • 2004, total direct cost associated with treatment of nonmelanoma skin cancer was $1. 4 billion • 2010, costs of $2. 36 billion • In adults 65 yo+, melanoma treatment costs total ~$249 million annually • Morbidity substantial • Loss of life, priceless

Tanning Benefits? The arguement • Skin benefits (psoriasis, atopic dermatitis, etc), dosed by an MD • The Smart Tan Network, Lobby for tanning industry, states that tanning prevents skin cancer by preventing a burn • A TAN IS NOT SIGN OF PROTECTION, IT IS EVIDENCE OF DAMAGE TO SKIN CELL DNA

Tanning Benefits The Arguement • Vit D………. . GOT MILK? –Study from Cincinnati OH, white clothed infants, exposing their hands and face, required 0. 5 -2. 0 hours of sun exposure/week for Vit D production – 10 min after exposure Vit D produced in the skin starts to break down –GOT MILK? • Mental health ……lights, not UV

Review • Problem: Skin cancer on the rise, increasing mortality, increase health care costs • Cause: UV exposure, evidence overwhelming • Solution: Limit sun exposure • Discrepancy in knowledge and actions (Mc. Donalds)

The Paradox • FDA regulates Indoor tanning equipment • US Federal Trade Commission investigates deceptive/false advertising including claims that indoor tanning is safe • Operators of indoor equipment are regulated at state level or not at all. • FDA limits UVC emitted but not UVA or UVB

The Paradox • 1986 FDA recommended max exposure dose of 0. 75 MED, 3 x 1 st week, increasing to 4 MED max • Community-based study in N Carolina showed 95% of patrons exceeded limits, 33% started tanning at max (similar studies Cal, NY show same noncompliance)

Why do we need Government Involved? • Throughout US history, State and Federal Legislatures have used legislation to educate the public and protect our youth from various health hazards

Why Government Involved? • US House of Representatives Committee on Energy and Commerce -Minority Staff • False and Misleading Health Information Provided to Teens by the Indoor Tanning Industry: Investigative report 2/1/2012 • Committee called 300 tanning salons across country

Committee study Findings • 90% of salons stated indoor tanning posed no health risk • 51% denied indoor tanning would increase a fair skinned teenager’s risk of skin cancer • 4 of 5 salons falsely claimed that indoor tanning is beneficial to a fair skinned young person’s health. Several stated it would prevent skin cancer

Committee Study Findings • Salons stated that government regulators had certified the safety of indoor tanning: and that “it’s got to be safe, or else they wouldn’t let us do it” • 3/4 th of salons stated that would let 1 st time users to tan daily despite FDA recommended limitations

Action • 1997 France prohibited tanning in those <18 yo • 2007: Illinois, New Hampshire, New Jersey, New York banned tanning in those <14, Wisconsin banned in those <16, Texas and N Carolina banned in <13 except with MD excuse • Parental consent if <18: AZ, CT, FL, GA, IN, KT, LA, Maine, MN, MI, OH, Miss, OR, RI, SC, TN

Action • 2013: California, Vermont, Oregon, Nevada, Texas, Illinois. Banned tanning in those <18 • 2013: New Jersey banned <17, New York banned <16, 17 and older parent consent • 2013: Legislation introduced- Maryland, Conneticut, Idaho, Alabama, Nebraska, Iowa…. 28 states total with 6 passages for ban in <18

Action • US surgeon general is developing a new campaign to fight skin cancer. CDC began collecting public input on the proposed skin cancer campaign • Congress forms bipartisan caucus on skin cancer: “Caucus will support legislative activities and public policies that are aimed at raising skin cancer awareness, promoting skin screening and early detection of the disease and improving access to skin cancer treatment” Jim Cooper (D-Tenn), Carolyn Maloney (D-NY), Peter Roskam (R-Ill), Charlie Dent (R- PA), ACMS, AADA

Age? • A • B • C • D 40 55 36 18

Let’s Get Going Iowa! Call to work to Ban tanning in Iowan’s Younger than 18 yo Protect our Youth and our Future