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The examples are drastic, but they highlight another trend, Lee says. About one in four people with melanoma is now younger than forty, and the rate among young women is particularly alarming. Skin cancer is more common than any other kind of cancer among women 25 to 29 years old. "It's the number one killer in women under the age of thirty," she says.
A wealth of studies compiled by the American Academy of Dermatology back up Lee's claims. The head-shaking thing about melanoma is that it's such an easy cancer to avoid. So the idea of purposely tanning -- whether under the sun or in a salon -- strikes Lee and her colleagues as absurd. Since skin damage is cumulative, those who've sunburned as children are more at risk of contracting skin disease later in life, as they incur yet more sun exposure. In other words, tanning is a process of deeper and deeper skin and cell damage, until one day the affected DNA is so damaged, a cancer develops.
But Lee knows that the allure of looking like Britney can be more persuasive than any cautionary tales of possible future harm. "Peer pressure to tan can be intense," she says of young women. "There's a general societal and cultural view that tan skin looks healthier. ... It's unfortunate that Hollywood still has to maintain this image, although it's fake, because it sends the wrong message to our youth that you must be tan to be hip. And the teens can't tell that the stars' tans are fake. So they flock out to the beach and the tanning salons in order to emulate their favorite stars."
Blame it on Coco Chanel. According to tanning industry folklore, that influential fashion maven is credited with making a tan aesthetically desirable after arriving at a 1925 fashion show bronzed from a week's vacation on the French Riviera. Before Chanel's catwalk, leather-colored skin marked the working class. But her sense of couture said something else: The tan now belonged to the leisure class.
Once Hollywood movies began glamorizing ruddy cheeks, Americans officially craved the look. And after World War II, summer travel exploded in the United States, with beaches becoming a more popular destination for the nation's increasingly mobile citizens. By the 1950s, Coppertone's ad campaign included not just a scrappy dog and a freckle-faced, white-butted kid, but also some ham-fisted copy that suggested tans were desirable: "Don't Be a Pale Face." Until then, tanning and its effect on skin and health went largely unconsidered.
A tan is a radical change in the skin's melanin content. Underneath your outer layer of skin, the epidermis, and just above your inner layer of skin, the dermis, you have a bed of cells called melanocytes. These cells produce melanin, and the more you have, the darker your skin. People who live near the equator generally have more melanin; Scandinavians, who get less sun, have much less. Likewise, when melanin absorbs ultraviolet radiation from either the sun or a tanning lamp, the result creates darker skin. According to skin doctors, any change in skin color denotes damage.
At the same time that dermatologists were beginning to learn about the sun's harmful effects, an entire industry of suntan oils and beach products was constructed around the glory of bronzed skin. According to Smart Tan, a lobbying group, the annual tanning industry revenues now total about $20 billion.
When the first indoor tanning salons arrived in this country in the late 1970s, high on disco nights, hip-hugging shorts, and open vests, the existing tanning industry did not greet it warmly, recalls Jeff Nedelman, executive director of the Indoor Tanning Association. He says the lotion companies were worried that their glory days had come to an end. He dubs these companies, along with the dermatologists he believes have demonized the sun, the "Skin Mafia."
"For years, all these companies had been telling people, 'If you go outside -- any time you walk out your door -- wear our product,'" Nedelman says. "Well, here comes this new thing, the solarium, and needless to say, they didn't like it."
Nedelman says ultraviolet radiation was first used commercially to aid people who suffered from seasonal depression. For a brief moment, he recalls, the health world actually embraced tanning salons. "As we all know, sunlight is the catalyst of life," he says. "We need the sun to grow. We feel better when we get sun."
Even with resistance from Nedelman's "Skin Mafia" -- which he believes is responsible for much of the restrictive legislation introduced across the country -- indoor tanning continued to grow. The first major wave occurred in the late 1980s, followed by a sharp dip of closures with the first round of government regulation. The FDA imposed laws that limited beds to 100 degrees, required users to wear eye shields, and posted warning signs on the beds. Nedelman says the FDA rules filtered out the legitimate salon owners from the seedy joints that were actually bordellos and had besmirched the industry's name. Looking back, he welcomes the regulations, and sees the industry's compliance with federal guidelines as a mark of its legitimacy.
On the other hand, the dermatological and cancer communities have been angling for studies to prove that using tanning beds leads to melanoma, Nedelman says. Their motive, he reasons, is they're at the mercy of suntan lotion makers for research grants and it's too late to change course, even if the research proves them wrong. They've argued their case for so long, Nedelman maintains, that when someone like Holick comes along with new evidence, they're too entrenched in their ways to see the light.
"This has become a witch hunt by the dermatology community," Nedelman argues. "What Michael and the ITA is presenting is hearsay to them. If this were the Dark Ages, we'd be burned at the stake for saying the sun is good for you."
Last October, the Journal of the National Cancer Institute published an eight-year study that tracked 106,000 Scandinavian women and found that those who used tanning salons as little as once a month increased their chances of contracting skin cancer by 55 percent. Those odds increased further if they'd used the salons in early adulthood. Researchers found 187 cases of melanoma in their subjects; the women who had used tanning beds in their early twenties had a 150 percent higher risk rate than those who shunned the beds.
The study suggested that tanning bed exposure assisted melanoma.
Even more recently, in March, Australian scientists published a study on radiation from tanning booth bulbs, the main type used in tanning beds. Since UVA does not produce a sunburn, it had never been linked to skin cancer. Examining DNA from two types of skin cancer, researchers showed that UVA radiation had in fact penetrated the skin and damaged the basal layer, where new cells are made. Damaged DNA can lead to cancer.
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