Correction - Aug. 2: Dr. Laura Shea was previously misidentified below as a pshycologist. Dr. Shea is a psychiatrist at SIU School of Medicine.
Correction - Aug. 3: The CDC statistics listed below were previously identified as skin cancer rates. They are actually statistics for melanoma, a specific type of skin cancer.
Clocking in at three and a half hours, the July 17 Springfield City Council meeting was one of the longest on record. The majority of the meeting was devoted to one topic, and emotions ran high as aldermen interrupted and chided one another, while speaker after speaker took to the public podium in passionate appeals for wisdom and fairness. The issue of the day was not the city’s diminishing water supply, bumpy roads and sidewalks, political hiring, or one of the other hot topics that have aroused controversy in recent memory. This was a new topic which may seem trivial at first, but which raises questions about the balance between safety and freedom.
The discussion centered around a proposal to ban minors age 17 and younger from using tanning beds in Springfield. Introduced by Ward 5 Alderman Sam Cahnman, the proposal would tighten restrictions laid out in state law that require parental consent for teens ages 14 through 17 for indoor tanning. Proponents say the proposed ordinance is a clear win for public safety in light of a drastic increase in the rate of skin cancer. Meanwhile, opponents say the ban would hurt Springfield tanning businesses and simply push teens to tanning salons outside city limits.
Indoor tanning became popular in the early 1980s, after German scientist Friedrich Wolff imported the first tanning beds to the United States in 1978. Tanning beds give off ultraviolet “UV” light that prompts skin cells to produce melanin, the pigment that makes skin look darker. The science behind tanning seems to firmly support the idea that indoor tanning increases the risk of skin cancer. Several organizations, such as the World Health Organization and the National Institutes of Health, classify the UV light from indoor tanning beds as a carcinogen.
Dermatologists say there is a critical difference between the UV light emitted by tanning beds and the natural light coming from the sun. There are three spectrums of UV light, known as UVA, UVB and UVC. Sunlight emits all three spectrums, which are absorbed by the Earth’s atmosphere to varying degrees. Tanning beds emit UVA light as much as 12 times more intense than the sun, while cutting out the UVB light that contributes most to sunburns. Previously seen as benign, UVA light is now known to contribute heavily to DNA damage in the skin. So while tanning beds offer quick tans with less chance of sunburn, the UVA-emitting machines actually have a higher chance of causing the DNA mutations that result in skin cancer.
Research from the Mayo Clinic shows skin cancer rates have increased drastically since the introduction of tanning beds, especially for people under 40. The researchers looked at records of melanoma diagnoses in patients ages 18 to 39 from 1970 until 2009. They found that eight times as many women and four times as many men were diagnosed with melanoma in 2009 than in 1970.
That increase squares with numbers from the Centers for Disease Control and Prevention’s United States Cancer Statistics database. In 1999, the number of people diagnosed with melanomas nationwide was 37,661, but that number steadily increased to 59,695 by 2008 – an increase of 58.5 percent. The trend is borne out in Illinois, as well, with 1,412 melanoma diagnoses in 1999 and 1,936 in 2008 – an increase of 37.1 percent.
Dr. Stephen Stone, a dermatologist and professor at SIU School of Medicine in Springfield, says 76 percent of melanomas are attributable to tanning. Young people are especially susceptible to skin cancer, he says, noting that melanoma is the most prevalent form of cancer among women ages 20 to 29.
Stone says when he first started practicing dermatology in 1974, he rarely saw cases of skin cancer, especially the most dangerous kind, known as melanoma. Now, he sees such cases often.
“I can’t tell you how many years I was in practice before I saw the first five melanomas,” he says. “Now I’ve seen five in the last two months.”
Melanomas often require surgery to remove, potentially scarring the victim. Even after surgery, melanomas can reappear. If left unchecked, melanomas can metastasize and spread to other areas of the body via the lymph nodes. Survival rates vary greatly based on tumor thickness, type of melanoma, location, number of tumors and other factors. The American Society of Clinical Oncology says 15-year survival rates range from about 80 percent survival for Stage I melanomas to about five percent survival for Stage IV melanomas.
Dr. Judy Knox, a dermatologist at Springfield Clinic, says people under the age of 20 who tan at least 10 times have double the risk of skin cancer compared with people who don’t tan. She, too, has noticed the increase in skin cancer.
“All I do is cut off skin cancer all day long,” Knox says. “I can’t tell you how many little bottles of [removed] skin cancer are sitting there.”
Knox says many cases of skin cancer in women are popping up in places that normally don’t receive sunlight, such as around the groin and chest, leading Knox to believe normal sun exposure can’t be the cause.
Stone and Knox say supposed health benefits of indoor tanning are unfounded and overstated.
Claims that indoor tanning prompts the body to manufacture Vitamin D are false, Stone says, because Vitamin D production is caused by exposure to UVB rays, not the UVA rays emitted by tanning beds.
And Stone admits that dermatologists used to prescribe tanning as a treatment for acne, but he says that was misguided.
“We thought it helped, but what it really did was just cover up the redness,” he said. “It didn’t actually reduce the pimple count.”
Knox says people who get “base tans” through indoor tanning to prevent sunburns while vacationing in tropical areas are actually increasing their likelihood of skin cancer. The “base tan” concept relies on the idea that avoiding sunburn is the same as avoiding skin cancer. A sunburn is a symptom of damage to the skin, but skin cancer can develop even without burning.
“UVA rays penetrate deep and stimulate pigment cells to create tan, which prevents burns, but also stimulates cells that make melanoma,” Knox says.
“It sounds strange to think that someone can be addicted to a behavior, but they can be,” Shea says.
Tanning addiction tends to occur in people with a high likelihood of addiction to other things like alcohol, Shea says. Between one-third and one-fourth of admitted tanning addicts began tanning in their teenage years, Shea says, so tanning as a teen may be a risk factor for tanning addiction.
“There are things about tanning that are reinforcing,” Shea says. “It can have a positive effect on mood, so if someone is prone to depression, you can say maybe it has an anti-depressant effect. The downside is people use it too much.”
Robbie Lumb owns California Tan & Tone, the tanning salon at 1297 Toronto Road that she opened in 1999. Her business has nine tanning beds, as well as a spray tanning booth. Lumb says a potential tanning ban for minors would eliminate 10 to 15 percent of her clients, sending them to other tanning salons outside of city limits.
“I think there’s a risk with anything, with any age,” Lumb says. “To me, tanning is not in the same category as something like smoking, which is also on the list of carcinogens. They’ve also put mustard gas on that list. There’s a risk with anything that you do. You just need to be conscious of your body and what’s going on with it.”
Lumb says the current system of regulation and enforcement works well. All salons in Sangamon County are licensed by the Sangamon County Department of Public Health at an initial cost of $150 and $100 for every year after the first. State administrative rules set by the Illinois Department of Public Health prohibit anyone age 13 and younger from using tanning beds, while anyone ages 14 to 17 must have parental consent.
Inspectors from the Sangamon County Department of Public Health make regular, visits – sometimes unannounced – to salons and pull a random sample of tanning records. Any records showing users under the age of 18 must be accompanied by a parental consent form, or else the salon incurs a $1,000 fine.
Lumb says her salon has no complaints or disciplinary actions against it, and the county department even uses her salon to train inspectors.
“I’m in full compliance,” Lumb says. “It’s perfectly fine the way it is. The parent needs to know and approve what their child is doing.”
Tim McAnarney, a Springfield consultant for the Washington, D.C.-based Indoor Tanning Association, says Illinois is one of the most regulated states with regard to indoor tanning. Professional tanning beds in Illinois are heavily regulated, from the eye protection required for users to the length of time each user can tan.
“We believe this is a state regulatory issue,” McAnarney says. “Right now, the state has heavily regulated it already. Public health does a fine job with their inspections. These tanning operators are conscientious small business owners, and we think they’re doing what they’re supposed to be doing.”
Lumb and McAnarney say Springfield’s potential tanning ban would simply send minors to other tanning salons outside the city. Springfield has 12 tanning salons, while the rest of Sangamon County has seven additional salons. All but one of the salons outside of Springfield are located in other municipalities like Sherman or Chatham. Alderman Sam Cahnman, who is pushing the ban, originally sought to coordinate with the Sangamon County Board to pass the same ban county-wide. However, he soon found out the county can’t follow Springfield’s lead.
Under Illinois law, Springfield is a “home-rule unit,” which means it can pass laws and levy taxes without referendums. Sangamon County does not have home-rule power, meaning it can’t restrict behaviors like tanning without the explicit permission of the Illinois General Assembly.
If Springfield bans tanning for teens but the surrounding communities do not, tanning advocates say, teens will simply visit tanning salons outside of Springfield, making salons inside the city less competitive.
“The proposal put forward by Alderman Cahnman would be such a disadvantage for Springfield small businesses,” McAnarney said in an interview. “The cities of Riverton, Sherman, Leland Grove or Chatham would love this ordinance. We think you have to have a level playing field, and we can’t put our Springfield small businesses in an unfair position.”
Cahnman says those fears are mostly unfounded. He points to a study of teen tanning behavior done by researchers at San Diego State University which found that teens living within two miles of a tanning salon were significantly more likely to tan than those not living within two miles of a salon. Essentially, the study implies that if it’s not convenient to tan, most teens won’t.
Instead of losing money when teens don’t tan, Cahnman says, salons would actually make more money through spray tanning. He points to an issue of the Smart Tan industry magazine which discusses the effects of a similar tanning ban in Victoria, B.C. In an article titled “Finding the Brighter Side,” the magazine says, “… the salons in Victoria haven’t seen a decline; business was either steady or up over last year’s sales.”
With the risks of tanning well-established in scientific research, the question remains whether and to what extent the government should regulate risk. At the exceptionally long and contentious city council meeting on July 17, Ward 10 Alderman Tim Griffin likened the risks of indoor tanning to the risk of heart disease caused by fast food. Heart disease killed more Americans than all forms of cancer combined in 2010, according to data released this month by the Centers for Disease Control and Prevention.
“If you have heart doctors come in and talk about fast food, are you ready to ban anyone under 18 having fast food?” Griffin asked his fellow aldermen. “At some point, are we going to stop and let natural selection take its course? These parents have got to learn to take care of their own kids, or these kids are going to have to learn to make their own decisions. We can’t raise everybody else’s kids.”
Asked whether teens understand the risks of tanning, salon owner Robbie Lumb said it’s unlikely, but parents can understand the risks and make the decision for their own children.
“The young ones don’t understand,” Lumb admits. “I was one of the ones who started tanning at age 14 and 15, and there wasn’t much education back then. Whenever a young woman comes in all she wants to do is get a tan as fast as possible. But I’m in full support of parental consent. The parent needs to be involved so when that child walks in and has no idea what they’re doing, we’re speaking to both the parent and the child. They’re both being educated on the proper way to do this.”
The proposal also raises issues of enforcement. Proponents claim some tanning salons don’t enforce the state requirement that parents sign a consent form before teens are allowed to tan. Ward 1 Alderman Frank Edwards questioned how passing a more strict law would prompt compliance.
“I had somebody tell me, ‘Yeah, but they don’t enforce that,’” Edwards said at the July 17 council meeting. “Then don’t go write another new law, new rule, just because something’s not being enforced.”
Speaking at the tanning salon she owns, Robbie Lumb said the tanning salons that don’t enforce the current law are usually those with a single tanning bed in a hair and nail salon – the type of place where tanning is an afterthought. For salons whose main purpose is tanning, adherence to the rules is extremely important because it keeps them in business, Lumb says.
“I can’t lie and say it doesn’t happen,” Lumb says of rule-breakers. “I’ve had customers come in and say they went someplace else and did this or that, but this is what our job is. Our focus is doing it properly and making sure we follow the rules.”
In an interview at his law office, Cahnman responded to the concerns over enforcement, saying a ban on tanning gives parents high ground when telling teens they can’t tan. There will always be scofflaws, Cahnman said, but a ban would make enforcement easier for inspectors while reducing the number of teens who tan.
“Just because you can’t hit a home run doesn’t mean you shouldn’t try to hit a triple or a double,” Cahnman said.
He hasn’t decided whether to call the proposal for a vote at the next city council meeting, saying only that he’ll call it when he’s confident that he has enough votes to pass it. Cahnman says Ward 9 Alderman Steve Dove agreed to co-sponsor the proposed ordinance during the council's most recent Committee of the Whole meeting.
As Springfield considers the proposed tanning ban for minors, state lawmakers sit on a handful of bills to do the same thing.
Heather Eagleton, director of government relations for the Illinois division of the American Cancer Society, says Springfield should set an example that the state can follow. She notes that the City of Chicago has already banned teens under age 18 from tanning.
“We’ve been working on a statewide ban for teens under 18, and it hasn’t gone anywhere,” Eagleton says. “Sometimes, to get a statewide ban passed, we have to chip away and do some local ordinances to get the state on board. As we are the capital of Illinois, the City of Springfield should set an example for other municipalities, that this is the right thing to do to protect the youth.”
Eagleton says even well-meaning parents may overlook the risks of tanning in favor of keeping peace within the home.
“I think it’s important that the state allows some sort of cover for parents with a ban,” Eagleton says. “They can say, ‘No, this is against the law for you to do.’ I think kids need to know that we’re just trying to protect them from having a devastating, life-threatening disease that they’re not thinking about when they’re young. I know I didn’t.”
Contact Patrick Yeagle at firstname.lastname@example.org.