Nations Unite Against Tanning: The Impact of the IARC Report

When the International Agency for Research on Cancer (IARC), an affiliate of the World Health Organization, added UV radiation from tanning machines to Group I, its list of the most dangerous carcinogens for humans, it set off a chain of events worldwide that even its authors could scarcely have predicted. It was as if everyone had been primed and waiting for a signature event to launch all-out war on indoor tanning; the event turned out to be the IARC’s “Special Report” published in August, 2009 in The Lancet, announcing its latest review of human carcinogens and prominently featuring its addition of “UV-emitting tanning devices” to Group I.1 The new arrival joined a list of about 120 substances and compounds which already included solar radiation, as well as infamous agents from tobacco and radon to plutonium.2  
 
Spurred by key findings in the IARC’s report – such as an increase in basal cell carcinomas, squamous cell carcinomas, and ocular melanomas among tanning bed users and a 75 percent increase in cutaneous melanoma risk among those who started tanning before age 301 – nations across Northern Europe, Australia, New Zealand, North America, and even South America sought legislation to restrict tanning bed use, especially among young people.
 
United by Tanning Legislation
 
France, Belgium, Germany, Scotland, Spain, Portugal, and the province of New Brunswick in Canada all now limit sunbed use for people under age 18. In France, all UVR-emitting devices must be declared to the national Health Authority; trained personnel must supervise all commercial establishments, and any claim that they provide health benefits is forbidden. Along with banning under-18s from using sunbeds, Scotland has mandated that all sunbed salons be supervised, with proper information provided to customers.3-6
Probably the greatest impact has been made in Brazil and Australia. For Brazil, the IARC’s report was the last straw, and on November 9, 2009, after extensive review and discussion between health authorities and a government working group, the Brazilian National Health Surveillance Agency (ANVISA) banned UV cosmetic tanning altogether nationwide – the only country to have taken such a sweeping step to date.7
 
Australia, already a worldwide leader in sun safety education, had been driven to action against tanning salons even before the IARC report. Clare Oliver, a budding 26-year-old Aussie journalist, had developed and died from melanoma just a few years after several visits to a tanning parlor, and her very public death (she wrote a newspaper story and gave broadcasts from her hospice bed calling for a ban on tanning beds) stirred public outrage that drove legislators to institute far greater controls over the tanning industry. The IARC report has only strengthened the country’s resolve. Today, all five major states in Australia have banned access to tanning beds for everyone under age 18. Most states also ban access to fair-skinned people (skin type I), and operators must display health warnings or risk up to million-dollar fines. All this legislation has driven scores of tanning parlors out of business, leaving the industry hanging by a thread. After more than a 300 percent increase in tanning parlors between 1996 and 2006, the number dropped by 32 percent in the past three years, and sometime this year, the number is expected to have dropped by up to 60 percent.8-10
 
The Battle Stateside
 
In the US, the attack on sunbed tanning has been waged from several directions. California, Texas, and at least 29 other states have passed their own legislation restricting use of tanning facilities by minors,11 and now, in the wake of the IARC report, there is a chance that the FDA will strengthen its regulations nationally.
 
After the IARC report appeared late last year, The Skin Cancer Foundation commissioned a white paper to the FDA urging greater regulation of tanning salons, and began lobbying legislators. This helped lead the FDA to hold a meeting on March 25 of this year to discuss upgrading tanning machines from a Class I medical device, the lowest regulatory category (the same class as tongue depressors) to Class II or III, thereby allowing the FDA to increase safety regulations and oversight. Leading up to the meeting, the Foundation launched a citizen’s petition in favor of reclassification, garnering nearly 300 signatures, and encouraged members and friends to submit testimony in favor of reclassification to the FDA via the Foundation’s website, www.SkinCancer.org. When the meeting took place, physician members of the Foundation presented key testimony about the dangers of tanning and tanning salons.12
 
After four hours of testimony, the FDA’s Medical Devices Advisory Committee unanimously recommended that the FDA upgrade its classification of tanning devices. The Panel concluded that Class I was inappropriate, incorrectly including tanning machines among “devices that present minimal potential for harm to the user.” The majority of the panel also favored an age restriction to limit minors’ access; approved of more disclosure to users about tanning’s dangers, and recommended better placement of labels warning users about these risks. The FDA is now weighing the panel’s recommendations. [Keep posted on the latest news on reclassification at www.SkinCancer.org]12
 
Even as the FDA deliberates its next move, other government bodies have been inspired by the IARC report to take action. A new 10 percent tax on indoor tanning — included in the health reform bill signed in recent months by President Obama — may especially make some cash-strapped young people think twice about tanning. The tax, scheduled to take effect July 1, is expected to raise $2.7 billion over 10 years.13
 
The Federal Trade Commission also has been cracking down on the marketing of indoor tanning, and in late May, the agency made its final settlement on a suit brought against the Indoor Tanning Association (ITA) in January for making false or unsubstantiated health and safety claims in a 2008 advertising campaign. The ITA has had to pull the disputed ads, and in addition to a ban on misleading claims, any ITA ads suggesting that tanning is safe or healthy must henceforth prominently display this disclosure: “NOTICE: Exposure to ultraviolet radiation may increase the likelihood of developing skin cancer and can cause serious eye injury.”14
 
The bottom line is that the IARC report has had a massive impact, providing impetus for multiple actions worldwide to reduce the dangers of indoor tanning.
 
Mark Teich, Executive Editor
 
 References
1. El Ghissassi F, Baan R, Straif K, et al. Special Report: Policy. A review of human carcinogens – Part D: radiation. Lancet Oncol2009; 10 (August):751-2.
2. Overall Evaluations of Carcinogenicity to Humans: Group 1: Carcinogenic to humans. As evaluated in IARC Monographs volumes 1-100A. http://monographs.iarc.fr/ENG/Classification/crthgr01.php
3. Gara R. Sunbeds cause skin cancer, Warns WHO. HEALTH NEWS 17 March 2005. http://health.dailynewscentral.com/content/view/521/63
4. http://www.opsi.gov.uk/legislation/scotland/acts20008/en/08en05-d.htm
5. Canada moves to ban indoor tanning in kids under 18. EmaxHealth. From Canadian Dermatology Association. http://www.emaxhealth.com/1275/66/35364/canada-moves-ban-indoor-tanning-kids-under.18.html
6. Canadian Dermatology Association homepage. http://www.dermatology.ca/indoortanning/
index.html
7. Cumberland S, Jurberg C. From Australia to Brazil: sun worshippers beware. Bulletin of the World Health Organization 2009 August; 87(8):574-5. Doi:10.2471/BLT.09.030809. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733274
8. Solarium ban for under-18s and fair-skinned people, New South Wales, Australia, Medical News Today, April 11, 2008. http://www.medicalnewstoday.com/articles/103748.php
9. Restrictions put on solarium users, from Australian Associated Press, May 11, 2009.
10.       Stark J. Tanning salons are fading fast. theage.com.au THE AGE June 21, 2009. http://www.theage.com.au/national/tanning-salons-are-fading-fast-20090620-crz0.html
11.       Tanning restrictions for minors. A state-by-state comparison. NCSL, National Conference of State Legislatures. Updated January 2010. http://www.ncsl.org/IssuesResearch/Health/TanningRestrictionsforMinorsstatelawssummary   
12.       Sun & Skin News 2010; 27:1:3-4. The panel is unanimous: raise tanning beds to higher medical device classification, p. 3, The Skin Cancer Foundation’s campaign for greater regulation, p.4.
13.       Indoor Tanning Tax Could Save Lives. http://www.skincancer.org/indoor-tanning-tax-could-save-lives.html

14.       Federal Trade Commission settles charges against the indoor tanning association. http://www.skincancer.org/federal-trade-commission-settles-charges-against-the-indoor-tanning-association.html