Doctors link sunbeds with cigarettes to make cancer case

Commission report on safety of tanning beds due by end of the month.

Meet Big Tan.

Doctors think they’ve found the perfect way to make their case that tanning salons are dangerous cancer-causing machines: Compare them to cigarettes.

A scientific opinion expected by the end of November from a European Commission committee has led to a battle between dermatologists and the sunbed industry, after a preliminary opinion in January found that no level of ultraviolet irradiance from sunbeds is safe.

“Our first goal right now is to make the sunbeds industry admit that they are selling a product  that can cause skin cancer,” said Mariano Suppa, an Italian dermatologist working in Brussels and a member of the European Academy of Dermatology and Venereology (EADV). “They are a class-one carcinogen, same as cigarettes,” he said.

He’s citing the World Health Organization’s International Agency for Research on Cancer, which in 2009 put sunbeds in the class of substances and products carcinogenic to humans. That class also includes cigarette smoking.

The committee rules only on scientific issues and has no power to recommend regulatory decisions, but the Commission could use its opinion to restrict or even ban sunbeds.

The industry is taking no chances. It has an annual revenue of €2.1 billion at stake, and 100,000 workers in 20,000 indoor tanning facilities across the Continent, according to the European Sunlight Association, which represents the industry’s interests in Brussels.

Tanning salon associations, and sunlamp and sunbed manufacturers packed a public hearing in Luxembourg in April to argue against the preliminary opinion.

They are fighting back with attacks on the make-up of the panel, the relevance of studies from outside Europe and the lack of focus on better enforcement of the current rules.

“The science is of questionable quality,” said Frank Harbusch, secretary general of the lobby group. “We submitted probably 1,000 comments to this draft opinion, where we think the opinion is wrong or looking at it from the wrong side.” His group is working with gPlus Europe, a lobbying and communication firm, and Harbusch has written at least one op-ed to promote its views.

The Commission first reviewed sunbeds in 2006, but was unable to determine a level below which cancer is not a risk. Still, it recommended a limit on exposure. The Commission reopened the debate last year to review the latest data.

The January opinion found “strong evidence that sunbed exposure causes skin melanoma, squamous cell carcinoma and, to a lesser extent, basal cell carcinoma, more especially when first exposure takes place in younger ages.”

Use of sunbeds rose from 2007 through 2012, the opinion found. Young and middle-aged women with white skin in Northern Europe are the main users. The opinion cited an analysis of 16 countries in Western Europe, which found that one in three adults had used indoor tanning and almost one in four teenagers in Northern and Western Europe had done so. In the meantime, 14 EU countries, including France, Belgium, the U.K., Germany, Italy and the Netherlands have introduced age limits for sunbed use.

Casting shadows 

In its 2006 opinion, the Commission’s scientific panel said there was no safe level of exposure to ultraviolet radiation to avoid cancer. But it went on to recommend a maximum radiation intensity from ultraviolet rays that should never exceed 0.3 watts per square meter, “the equivalent of tropical sun, which the WHO describes as extreme.”

That opinion led to lowering an international standard on irradiation produced by sunbeds to this value, according to Frank Richarz, who has been involved in the standardization work and now runs his own business consultancy.

But it did not settle the issue for long. In 2009, the WHO’s International Agency for Research on Cancer said that ultraviolet-emitting tanning devices were carcinogenic to humans.

The analysis of over 20 epidemiological studies found the risk of cutaneous melanoma increased by two-thirds when use of tanning devices started before the age of 30. “These findings reinforce current recommendations by the WHO to avoid sunlamps and tanning parlors and to protect yourself from overexposure to the sun,” the IARC said in a statement at the time.

In early 2015, the Commission went back to its scientific committee and asked it to review recent evidence to “improve the understanding of risks associated with ultraviolet radiation in general and with sunbeds in particular and provide an updated opinion.”

The industry accuses the committee that produced the latest opinion of being slanted, because it relied on external experts that it says calls into question the safety of sunbeds.

“The selection of experts was done in a way that would be clearly negative,” the ESA’s Harbusch said, referring to advisers Rüdiger Greinert and Jean-Francois Doré.

Greinert is a biophysicist and the secretary general of Euroskin, an independent non-profit scientific society, whose principal aims are to reduce the incidence and mortality of skin cancer. Doré is a doctor, working on human melanoma, exposure to ultraviolet radiation and skin cancer prevention.

Doré said the two were being targeted as part of industry spin, and he wouldn’t be dissuaded. Melanoma has a high mortality rate, and “the means to prevent it is to limit exposure to UV [ultraviolet] rays,” he said.

In Europe, almost 3,500 of 63,942 new cases of melanoma diagnosed each year may be related to sunbed use, the preliminary opinion said. Almost 500 women and 300 men may die each year from a melanoma as a result of indoor tanning, it said.

Industry officials are also attacking the opinion’s use of data from the U.S. and Australia, which they call irrelevant due to the latitude and skin type differences.

Committee officials acknowledged an insufficient number of studies on European populations but said they had no choice but to use the best data from published, peer-reviewed scientific studies, according to a report of the public meeting.

Sunbed manufacturers have cut the maximum radiation intensity of their products since the last time the Commission’s scientific committee looked at their risks, and this should be acknowledged, industry argues.

Safer than sun?

Sunbeds are regulated in the EU by the 2014 Low Voltage Directive, which aims to ensure that electrical equipment properly protects consumers.

It does not, however, regulate the way sunbeds are used in tanning salons. National governments are in charge of making sure sunbeds are used in line with specifications and that consumers are informed about the risks.

At least 14 countries prohibit minors from using sunbeds, but two rounds of controls in a number of EU countries have shown little enforcement of the law, according to the committee’s opinion.

Tanning salons were not giving guidance to consumers regularly, and when they claimed they did, it was not verifiable, the opinion said. The maximum radiation levels for sunbeds were violated in some countries, the inspection showed.

The industry representatives say they have made serious efforts to improve the situation since these inspections, the last one of which took place in 2011. The ESA worked with the standards-setting European Committee for Electrotechnical Standardization (CENELEC) to develop a model to training tanning salon staff, according to Harbusch. 

In another argument, the industry seeks to turn the issue of too much sunlight from sunbeds on its head, arguing that exposure indoors can be better controlled than on the beach.

“You have seen all those crazy English men who are out in the sun on the first day [at the beach] for eight hours. It is very dangerous to have an immediate overexposure without any chance to adapt to it first,” Richarz said.

Before exposing himself to the sun, he would start preparing his skin by using a sunbed, otherwise “in the first six days of my summer holiday I would need to be in the shadow or inside much more than I would like to.”

He even expressed regret that his children cannot use sunbeds to get ready for the beach.

But Suppa, the dermatologist, disputes that sunbeds are a real-life necessity. “They talk about sunbed use like it’s necessary for the human race. It’s a recreational product,” he said.

“I would like the Commission to hold the position given in the preliminary opinion that it’s a dangerous product. I am not saying that it’s mathematically harmful to everyone who uses it — it’s the same with smoking — not everyone who smokes will get cancer,” Suppa said.

This story has been corrected with the proper name of the European Academy of Dermatology and Venereology.