A bit of disclosure before I launch into this post: My dermatologist has said the “M” word – as in melanoma, a deadly form of skin cancer– to me more than once after a biopsy of a suspicious spot. I lost a dear, dear uncle to malignant metastatic melanoma nearly two decades ago. He was in his mid-forties. He spent his last weeks at my parents’ house, in horrible pain despite an on-demand morphine drip. And just a few weeks ago I found out that a neighbor, a vibrant, exquisitely alive woman in her fifties, had been told by her physician that her next referral will be for hospice care. She’s valiantly fought multiple cancers over the last few years, enduring chemotherapy, radiation, drugs, and a complete bilateral mastectomy, for starters. Her original diagnosis? Malignant metastatic melanoma.
Those are some of the reasons why a recent NPR piece about the new federal excise tax on indoor tanning caught my attention. The 10 percent tax, which went into effect July 1, has generated the expected reaction from owners of tanning bed salons and industry representatives, and NPR was happy to cover it. The NPR copyeditor’s title for the story couldn’t have been worse: “Tanning Beds Burned by New Health Law.” Bad pun, bad message.
Thankfully, the story was better than the headline, although it did open with the plight of the poor tanning bed salon owners who are being forced to help finance health-care reform. But the story neglected to mention one important detail: The policy has a major loophole. It applies only to businesses that charge a fee for indoor tanning. Health clubs that offer indoor tanning as part of their membership package are exempted, as are “phototherapy services” performed by licensed medical personnel.
And NPR wants me to feel sorry for those 18,000 tanning bed salon owners and other small business owners who might lose business because of a new tax on the lethal product they sell? Tanning bed industry protestations to the contrary, exposure to ultraviolet light — especially the concentrated doses found in tanning salons — has been unequivocally linked with increases in skin cancer rates, specifically melanomas. Melanoma is the least common type of skin cancer, accounting for about five percent of all skin cancers in the United States, but also the most deadly. Estimates from the American Cancer Society show that about 68,130 new melanomas will be diagnosed in the United States during 2010, leading to about 8,700 deaths.
Evidence for a strong link between indoor tanning and melanoma was strengthened last May when researchers at the University of Minnesota reported that they had found use of indoor tanning increased the risk of melanoma between two and four times, depending on the device and length of time indoor tanning is used. The study was the largest of its kind to examine tanning beds and melanoma risk. Among 1,167 people with melanoma and 1,101 people without the disease, those who had tanned indoors had 74 percent increased risk of melanoma. If the devices emitted primarily UVA radiation, the risk was 4.4-fold. Risk also increased along with greater years of use, number of sessions, or total hours of use.
The International Agency for Research on Cancer, an agency of the World Health Organization, has taken an even stronger stance on indoor tanning (“sunbeds”). The WHO agency found that tanning beds are “carcinogenic to humans” and categorizes UVR from tanning right up there in terms of its cancer-causing ability with mustard gas, plutonium, cigarettes and arsenic. Although there are some genetic risk factors associated with melanoma, the vast majority of the disease results from unprotected exposure to ultraviolet rays, either natural or artificial.
More than one million people in the United States visit a tanning bed every day. About 70 percent of them are Caucasian girls and women 16-29 years of age, according to the American Academy of Dermatology. About one-third of teenage girls in the United States report using tanning beds. Most start using tanning beds at 12 to 13 years, with usage peaking at about 17 years of age. And — no surprise here — rates of melanoma more than tripled among women ages 15-30 between 1974 and 2004. The dramatic increases in melanomas in this age group appears to correspond with increased use of tanning beds by women born after 1965.
So is the new tax on tanning beds a good idea? In my not-so-humble, completely biased opinion, it’s one of the best health policies I’ve seen for a long time, especially as part of health-care reform (now if Congress will only close those loopholes for “health centers” and “phototherapy services”). At the same time that it increases revenue for health-care needs, it dissuades people from engaging in a risky health behavior.
Addressing risky health behaviors at their source, known in public health parlance as a “primary prevention intervention,” is the most economical and effective way to improve health — and reduce costs. Fewer (young white girls and women) tanning, more money for health care overall, less need for treatment of melanomas. That, at least, is the equation that public health policy experts are hoping to see.
And while we’re waiting to see if 10 percent adds up to lives saved, I have a suggestion for a new career for those tanning bed salon owners: hospice work with melanoma patients.