The high price of tanning

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Elissa Campbell started tanning when she was 16. She couldn’t stand the pale skin left to her by her Scottish heritage.

Sometimes, she’d slather on the oil and go relax on the beach — her favorite place. Other times, roughly once a week for more than a decade, she’d spend 20 minutes lying in a tanning bed.

“I just always felt I looked better when I was tanner,” said Campbell, 31, of Framingham, and a manager for LF Stores on Newbury Street.

Now when she hears young women in her shop talking about getting a tan before prom or the start of bikini season, Campbell interrupts them. “Let me recommend a good spray tan instead,” she offers, and then tells them her own story.

A year ago, a woman walked up to Campbell at a department store and recommended she go to a doctor right away to check out the large mole on the back of her right leg. A week later Campbell was diagnosed with stage III melanoma, one of the deadliest forms of cancer.

Although most types of cancers are declining, melanoma rates have been climbing in the United States over the last 20 years, mainly among older men and young, fair-skinned women like Campbell. Melanoma rates have nearly doubled over the past several decades for teenage girls ages 15-19: from about 15 per 1,000,000 in the 1970s to nearly 30 per 1,000,000 in the 2000s, according to a study in the journal Pediatrics (online April 15).

There is no hard evidence linking these increases to the rising popularity of indoor tanning. But most dermatologists have no doubt.

“Dermatologists would like to ban tanning beds,” said Dr. Hooman Khorasani, a dermatologist and chief of the division of Mohs, Reconstructive & Cosmetic Surgery at the Mount Sinai School of Medicine in New York. “Tanning beds are directly related to risk.”

“I just always felt I looked better when I was tanner,” said Elissa Campbell, 31, who began tanning at 16 and was diagnosed with stage III melanoma last year.Yoon S. Byun/Globe Staff/Globe staff

Fair skin significantly increases the risk of melanoma, as do sunburns, said Dr. Carlos Rodriguez-Galindo, director of the pediatric solid tumor program at the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, and coauthor of the study in Pediatrics.

“If you are a fair-skinned person, don’t ever sunbathe to the point that your skin will turn red,” Rodriguez-Galindo said. (Campbell said she can’t remember how many times she burned, but it happened regularly.)

Though indoor tanning isn’t as dangerous as say, smoking, Rodriguez-Galindo said it just makes sense to avoid increasing cancer risk.

That’s not what’s on the minds of the 28 million Americans who use tanning beds, though.

Among white women of college age, one in three visited indoor tanning salons in 2010, according to a study published this month by the federal Centers for Disease Control and Prevention. On average, these women tanned indoors nearly 28 times that year — roughly every other week.

American cities abound with tanning opportunities.

A 2006 study found that major cities have more tanning salons than Starbucks, McDonald’s, or other common retail chains. Boston had 90 tanning salons and 23 McDonald’s that year, according to the San Diego State University researchers’ count.

Many of today’s college dorms have tanning beds, as do gym chains and spas. The beds are sold for home use at stores like Walmart and Target for about $1,500 to $2,500.

A scar on Campbell’s leg shows where her cancerous mole was removed. Yoon S. Byun/Globe Staff/Globe staff

Tanning has been popular in America roughly since the turn of the last century, said Meg Watson, an epidemiologist in the CDC’s Division of Cancer Prevention and Control.

There’s still lots of social pressure to look tan, added Dawn Holman, a behavioral scientist at the CDC and a coauthor with Watson of a new study looking at ways to reduce indoor tanning.

Tanning also has its positive side, according to the Indoor Tanning Association, a national trade organization, which argues that tanning makes people feel good as well as look good.

“If it was all about vanity, everybody would be doing the spray tan,” said Rob Quinn, president of the association and owner of Tan Pro, Ohio’s largest tanning bed chain.

He said, “I crave that euphoria you feel with a little bit of sunlight. . . . There’s some trigger mechanisms in your body saying yeah, you need it.”

The use of indoor tanning has been dropping for the last four to five years, Quinn said. When he bought out a rival store in Columbus a few years ago, each store was tanning about 700 people a day; now, the combined store tans less than 500.

“Every year we’re tanning fewer and fewer people,” he said. “It’s really a result of this constant hammering of legislative attempts against us.”

Some states have increased taxes on tanning, others have imposed bans on tanning by minors. At the beginning of the month, the US Food and Drug Administration proposed requiring tanning beds to carry a warning about skin cancer risk, and also recommended against minors using the beds.

In Massachusetts, children ages 14-17 already need parental permission to use an indoor tanning bed, according to the National Conference of State Legislatures. Salon operators have to limit exposure times and provide eye protection for customers.

Quinn said he doesn’t indoor tan much himself — “I drew the short stick. I’m Irish. I have really fair skin.” But he thinks tanning in a bed is safer than outside, because of the extra control. When he’s out on his boat, he said, there’s always a spot he misses with sunscreen. In his home tanning bed he can get out after just a few minutes.

Indoor tanning allows people to “get the most positive out of sun exposure while minimizing the negative,” he said. “I really don’t believe in my heart of hearts that these poor young kids who have gotten melanoma have gotten it from a few visits to a tanning bed.”

A bracelet she bought to benefit Dana-Farber.Yoon S. Byun/Globe Staff/Globe staff

But the association is willing to concede a long-term downside to tanning: wrinkles.

“If you’re worried about wrinkles, sun exposure over years and years will give you wrinkles,” said John Overstreet, the tanning association’s executive director. “I think people are trading off looking good when they’re young for looking good when they’re old.”

Khorasani, the dermatologist, said he shows his young patients pictures of women with wrinkled skin to try to discourage them from tanning.

For her part, Campbell said she’s not certain seeing such pictures would have turned her off her tanning habit.

“I knew [tanning] was not a good idea, but it did not stop me,” she said.

She was relatively lucky. Surgeons at Dana-Farber/Boston Children’s were able to cut the cancerous mole off the back of her right leg, leaving a 6-inch scar from her calf to her knee.

She has to stay out of the sun, and keep checking in with her doctor every three months to make sure it hasn’t spread, but otherwise has a good prognosis.

The advice she now gives those young women in her shop: “It’s not worth it for being tanned. It’s just not,” she said. Either get a spray tan, “or just embrace the way you are.”

Tanning and melanoma statistics:

About 28 million Americans go to tanning salons.

70 percent of them are women ages 16-28.

32 percent of non-Hispanic white women ages 18-21 tanned indoors in 2010, lying in a tanning bed, on average, 28 times.

Massachusetts had about 1,600 cases of melanoma diagnosed each year, and a melanoma incidence rate of 22.9 per 100,000, during 2005-2009 (most recent years for which data are available). That was the 11th highest of all states.

Over 200 people in Massachusetts died each year from melanoma (death rate of 3 per 100,000) during 2005-2009.

Source: United States Cancer Statistics: 1999-2009 Mortality, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention; 2011. Accessed at wonder.cdc.gov/CancerMort-v2009.html