Sunbeds elevated to top cancer risk level: WHO (Implications for the battle against pandemic flu?)

[St Michael]

What are the rates of melanoma compared to the chronic diseases that might be related to low Vitamin D levels due to sun avoidance?

Could sunbed use provide any protective effects in pandemic influenza by normalizing Vitamin D levels?

Sunbeds elevated to top cancer risk level: WHO
Jul 28 07:44 PM US/Eastern
AFP

The International Agency for Research on Cancer announced Wednesday that it had elevated sunbeds, used by tens of millions of people for tanning, to its highest cancer risk category.

Classified in 1992 and a "probable" cancer agent, research since then has left no doubt that soaking up UV rays at tanning salons significantly enhances the chances of developing the disease, the World Health Organisation (WHO) agency found.

"The use of sunbeds is carcinogenic to humans. It causes melanoma of the skin, and melanoma of the eye," said Vincent Cogliano, an IARC researcher who led the new assessment.

"I cannot see any reason why a healthy person should use them," he told AFP by phone.

The risk of melanoma -- the most lethal form of skin cancer -- increases by 75 percent when use of tanning devices starts before the age of 30, according to the findings, published in the British medical journal The Lancet Oncology.

The link between artificial tanning devices and cancer is not new. The WHO and national health agencies have long cautioned against using sunbeds, much as they have warned about the ill effects of overexposure to the sun.

But threshold of scientific proof is high, and required additional research on animals as well as epidemiological studies of cancer rates among humans before sunbeds could be labeled -- along with tobacco, asbestos and alcohol -- as a carcinogen.

Cogliano said it is not the IARC's role to issue recommendations, but that he hoped the new evaluation would focus attention on the issue.

"We are not a regulatory agency. We publish the scientific results so that the public health agencies can take action as they see fit."

Physicians hailed the decision, and called for tighter regulations for the multi-billion dollar tanning industry.

"We welcome the recognition that sunbeds are carcinogenic," said Nina Goad, spokeswoman for the British Association of Dermatologists.

"It is high time that steps were taken to regulate the industry, to prevent children using sunbeds, and to ensure that sunbeds are subject to health warnings like other known carcinogens."

"We have been trying for a long time to call the attention of the government to the potential risks," said George Reuter, head of Frances National Union of Dermatologists.

Both associations stopped short of calling for an outright ban.

"The solution is to inform the public, not to outlaw sunbeds," said Reuter, adding that many dermatologists in France tell their patients not to exceed ten sessions in year.

Those who use the devices to stay tanned year round are especially at risk, he added.

"People have the right to make their own health choices. Other known carcinogens are not banned, so I don't think you want to set a precedent with sunbeds," Goad said by phone.

Sunbeds are more common in northern Europe and the United States than most other regions. According to a survey conducted last year, some 14 million Germans aged 18 to 45 use them, with a quarter starting before the age of 17.

Earlier studies indicate that nearly a quarter of the adult population in many European countries -- including France, Belgium, Germany and Sweden -- have used sunbeds, which emit a higher concentration of UV rays than sunlight.

The sunbed association, and industry lobby group based in Britain, disputed the IARC's reclassification of tanning devices as carcinogen to humans.

"The relationship between UV exposure and an increased risk of developing skin cancer is only likely to arise where over-exposure -- i.e. burning -- has taken place," it said in a statement.

 

[St Michael]

Re: Sunbeds elevated to top cancer risk level: WHO (Implications for the battle against pandemic flu?)

Sunbeds, tanning and UV exposure
WHO Fact sheet N?287
March 2005

The desire to acquire a tan for fashion or cosmetic purposes has led to a large increase in the use of artificial tanning sunbeds in, mostly, developed countries. Use of sunbeds for tanning continues to increase in popularity, especially among young women.

Sunbeds used in solariums, and sun tanning lamps, are artificial tanning devices that claim to offer an effective, quick and harmless alternative to natural sunlight. However, there is growing evidence that the ultraviolet (UV) radiation emitted by the lamps used in solariums may damage the skin and increase the risk of developing skin cancer.

Related fact sheet
Ultraviolet radiation: solar radiation and human health

Some 132 000 cases of malignant melanoma (the most fatal kind of skin cancer) and over two million cases of other skin cancers occur worldwide each year. One in every three cancers diagnosed worldwide is a skin cancer. Most skin cancers are attributable to over-exposure to natural UV radiation. A fact sheet indicating the adverse health consequences from natural (i.e., sun) UV exposure issued by the World Health Organization (WHO) can be found at the link to the right.

This fact sheet is the complement of the above, providing information on artificial sources of UV. Primary among these artificial sources is sunbeds, and this fact sheet looks at the health consequences of sunbed usage and how they can be managed. Information for this fact sheet comes from WHO sponsored meetings and workshops, recent scientific literature, reviews by WHO Member States and the recommendations of international NGOs.
Health consequences
Skin cancers

Exposure to UV, either naturally from the sun or from artificial sources such as sunlamps, is a known risk factor for skin cancer. Short-wavelength UVB (280-315 nm) has been recognized for some time as carcinogenic in experimental animals, and there is increasing evidence that longer-wavelength UVA (315-400 nm) used in sunbeds, which penetrates more deeply into the skin, also contributes to the induction of cancer. A study conducted in Norway and Sweden showed a significant increase in the risk of malignant melanoma among women who had regularly used sunbeds.

Additional exposure to UV from sunbeds is likely to enhance the well-known detrimental consequences of excessive solar UV exposure. There is no evidence to suggest that UV exposure from any type of sunbed is less harmful than UV exposure from the sun. Pre-cancerous actinic keratoses and Bowen?s disease have also been found in sunlight-protected but sunbed exposed skin in fair-skinned users after just two to three years of regular sunbed use.
Skin ageing, eye damage and other adverse health effects

Any excessive exposure to UV, not just from sunbeds, can result in structural damage to human skin. In the short term this damage can be due to burning, fragility and scarring and in the longer-term as photoageing. Photoageing, caused by the breakdown of collagen in the skin by UV, manifests itself as wrinkling and loss of elasticity.

The effects of UV on the eye include cataracts, pterygium (a white coloured growth over the cornea) and inflammation of the eye such as photokeratitis and photoconjunctivitis. Furthermore, excessive UV exposure can suppress the immune system, possibly leading to a greater risk of infectious diseases.
Some skin types are unsuitable for tanning

Based on their susceptibility to sunburn, skin types are classified into six different classes (I ? VI). People with skin type I have the lightest skin and may not have even a light tan after repeated exposure to a sunbed. Instead, their skin generally suffers sunburn reactions. People with skin type I are more likely to use sunbeds than people with darker skin.

The ability of the consumer to recognize their skin type as not suitable for sunbed use is based on either self-diagnosis, or worst, a bad experience of sunburn. For this reason sunbed operator training is needed to ensure correct skin type diagnosis. While skin type II and higher can tan, skin damage can still occur following excessive exposure to UV.
Dangers associated with childhood UV exposure

Childhood exposure to UV and the number of times a child is burnt by UV, either from the sun or from sunbeds, are known to increase the risk of developing melanoma later in life. For this reason, particular attention is required to ensure children and adolescents do not use sunbeds. The United States Department of Health and Human Services has classified exposure to sunlamps or sunbeds as "known to be carcinogenic to humans" and states that the longer the exposure, the greater the risk, especially to people exposed before the age of 30 years.
About sunbeds

Sunbeds emit predominantly UVA and some UVB, both of which can damage the DNA in cells of the skin. However, in recent years, lamps of sunbeds have been manufactured that produce higher levels of UVB to mimic the solar spectrum and speed the tanning process. While UVB has well known carcinogenic properties and whose excessive exposure is known to lead to the development of skin cancers, recent scientific studies suggest that high exposures to the longer wavelength UVA could also have an impact on skin cancer occurrence.

As with sun exposure, recent studies indicate a relationship between the use of sunbeds and malignant melanoma as well as non-melanoma skin cancers such as squamous and basal cell carcinomas. Thus, the consequences of regular sunbed use may include disfigurement from removal of skin cancers, early death if the cancer is a malignant melanoma, as well as substantial costs to national health systems for screening, treating and monitoring skin cancer patients.
Health benefits

Aside from tanning, many people claim that use of sunbeds helps them to be more relaxed and have a feeling of wellbeing. It is difficult to quantify such claims.

While sunbed use may increase vitamin D synthesis, predominantly from the UVB component, for the majority of the population, incidental exposure to the sun, combined with normal dietary intake of vitamin D, provides adequate vitamin D for a healthy body throughout the year. If people require more vitamin D than the sun can provide (for example, because of living in polar regions) this should be supplemented through diet rather than sunbed use.

Only in very rare and specific cases should the medically-supervised use of sunbeds be considered. Medical UV devices successfully treat certain skin conditions such as dermatitis and psoriasis. These treatments should only be conducted under qualified medical supervision in an approved medical clinic and not unsupervised either in commercial tanning premises or at home using a domestic sunbed.

There is a widespread false belief that a tan acquired using a sunbed will offer good skin protection against sunburn for a holiday in a sunny location. In reality, a tan acquired using a sunbed offers only limited protection against sunburn from solar UV. It has been estimated that a sunbed tan offers the same protective effect as using a sunscreen with a sun protection factor (SPF) of only 2-3.
Strong case for effective regulations governing sunbed use

As long as sunbeds are available to the public, there is a need for guidelines or legislation to reduce the risks associated with their use. WHO encourages governments to formulate and enforce effective laws governing the use of sunbeds. In countries where voluntary industry codes of practice exist, the sunbed owners have generally not shown significant capacity to self regulate effectively.

Of highest regulatory priority should be the restriction of use by persons under 18 years as well as banning unsupervised trained personel. WHO recommendations are consistent with those of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) and the European Society for Skin Cancer Prevention (EUROSKIN).
The key reasons why regulations are necessary

* Increase in the number of unsupervised commercial sunbeds - Without trained staff and adequate health care advice, the potential for harm to the uninformed consumer is much greater. This, combined with competitive pricing strategies such as unlimited sessions within a specific time frame, increases the likelihood of skin damage.
* High intensity of UV output - Some machines have the capacity to emit very high levels of UV, many times stronger than the midday summer sun in most countries. In a largely unregulated industry where training of staff is not mandatory, this increases the health risks considerably.
* Exposure time and intervals between tanning sessions - Reasonable sunbed use includes keeping to recommended exposure times (which depends on the type of machine used) and having sufficiently long breaks between tanning sessions. Normally at least 48 hours are needed between tanning sessions for repair of UV-induced DNA damage in skin cells
* Eyewear - UV protective eyewear (such as goggles) must be worn during tanning sessions to protect the eyes.
* Effect of certain drugs and cosmetics - Some drugs, for example anti-depressants, antibiotics, psoralens, antifungals, and antidiabetics as well as some cosmetics make the skin more photosensitive and therefore decrease the time it takes for the skin to burn.
* The size of the skin area exposed - Modern ?clam-type? sunbeds and canopies can expose more skin area to UV than outdoor situations, therefore increasing the health risk. Here young people, , are more sensitive to UV-induced damage from this "all-over" tanning.

ICNIRP recommendations

In its 2003 publication ICNIRP recommends against the use of UV-emitting appliances for tanning or other non-medical purposes. ICNIRP states that the following groups are at particularly high risk of incurring adverse health effects from UV, and therefore should be particularly counseled against the use of tanning appliances:

* People who have skin phototypes I or II;
* Children (i.e., less than 18 years of age);
* People who have large numbers of nevi (moles);
* Persons who tend to freckle;
* Individuals who have a history of frequent childhood sunburn;
* People who have pre-malignant or malignant skin lesions;
* People who have sun-damaged skin;
* Those who are wearing cosmetics. These may enhance their sensitivity to UV exposure; and
* Persons taking medications. In this case they should seek advice from their physician to determine if the medication will make them UV-sensitive.

Action of the World Health Organization

INTERSUN, the Global UV project, is a collaborative project between WHO, the United Nations Environment Programme, the World Meteorological Organization, the International Agency on Cancer Research and ICNIRP that aims to reduce the burden of disease resulting from exposure to UV radiation. The project assesses and quantifies health risks, and develops an appropriate response through guidelines, recommendations and information dissemination. Beyond its scientific objectives, INTERSUN provides guidance to national authorities and other agencies about effective sun awareness programmes. These address different audiences such as occupationally exposed people, tourists, school children and the general public.

In 2003 WHO published a brochure entitled "Artificial tanning beds: risks and guidance" providing advice to the public, operators of sunbed facilities and member states on how sunbeds could be managed to protect public health.
Further information

Agar NS, Halliday GM, Barnetson RS, et al. (2004) The basal layer in human squamous tumors harbors more UVA than UVB fingerprint mutations: a role for UVA in human skin carcinogenesis, Proc Natl Acad Sci 101(14):4954-9.

AGNIR (2002) Advisory Group on Non-ionising Radiation Health. Effects from Ultraviolet Radiation. Documents of the NRPB 13 (1).

ICNIRP (2003) International Commission on Non-Ionizing Radiation Protection. Health Issues of Ultraviolet Tanning Appliances Used for Cosmetic Purposes. Health Physics 84: 119-127.

IEC (1995) International Electrotechnical Commission. Safety of household and similar electrical appliances. Part 2: Particular requirements for appliances for skin exposure to ultraviolet and infrared radiation. Geneva:IEC 335-2-27.

McKinlay A and Repacholi MH (2000) Ultraviolet Radiation Exposure, Measurement and Protection. Radiation Protection Dosimetry 91( vols 1-3).

United States Department of Health and Human Services (2004) 11th Report of Carcinogens. National Institute of Environmental Health Sciences, Research Triangle Park, NC. p III-266-267.

Veier?d MB, Weiderpass E, Th?rn M, et al. (2003) A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant Melanoma in women. J Nat Cancer Inst 95:1530?1538.

WHO (1994) World Health Organization. Environmental Health Criteria 160. Ultraviolet Radiation Geneva.

WHO (2003) World Health Organization. Artificial tanning sunbeds - risks and guidance. Geneva

Young et al. (2003) UV-induced pigmentation in human skin. In: P.U. Giacomoni, ed. Sun Protection in Man. Amsterdam: Elsevier; pp. 357-375

Young A (2004) Tanning devices - Fast track to skin cancer?, Pigment Cell Res, 17: 2-9.

 

[St Michael]

Re: Sunbeds elevated to top cancer risk level: WHO (Implications for the battle against pandemic flu?)

Top cancer doctor says you SHOULD have a sunbed session

By Professor Tim Oliver
24th January 2009
dailymail.co.uk

The message from doctors has long been unequivocal - there is no such thing as a safe suntan because sun exposure causes skin cancer. However, despite being a cancer expert myself, I have just spent the past four weeks on holiday in South Africa, where I made sure I got out into the sun every day.

Current medical advice is to cover up in the sun, but I believe the health benefits of exposure to its UVA and UVB rays greatly outweigh the disadvantages, even if that means using a sunbed during winter months.

This is because the body converts sunshine into Vitamin D, a substance that helps build a healthy immune system and strong bones, and may even fight off depression and cancer.

Vitamin D is known to play a vital role in metabolism of calcium, which is needed for strong bones.

And last week a new study revealed it may help stave off Alzheimer's Disease. Research on English adults aged 65 and over showed that as their Vitamin D levels decreased, mental impairment increased.

Deficiency can also cause osteomalacia - a weakening of the bones that may cause rheumatism or chronic backache - and children can develop rickets, a condition in which the bones do not develop properly.

Research has shown that without it we are more prone to everyday infections such as colds and flu, and also more worrying ones, such as tuberculosis (TB).

But perhaps more surprisingly, there is also evidence that Vitamin D could protect us from cancer.

Recent studies have found those countries with the most annual sunshine have the fewest cases of colon, prostate and breast cancer (although exactly what role Vitamin D plays isn't totally clear in these instances).

In one case, sunshine exposure was linked to a 40 per cent reduced risk of prostate cancer.

And research published in the American Journal Of Clinical Nutrition in 2007 reported a possible reduction of breast cancer in women who took Vitamin D tablets.

The idea that Vitamin D is essential for good health is not new; nor is the connection to sunlight.

In Britain just after the turn of the 19th Century, children in cities had less exposure to sunlight and became crippled by rickets. It was also discovered that TB - which was commonplace - could be treated with cod liver oil, another good source of Vitamin D, and sunlamps - early versions of sunbeds that provide artificial UV light similar to sunlight.

But in more recent years, antibiotic-resistant strains of diseases such as TB are emerging, proving that medicine may no longer be enough.

Combine the anti-sun skin cancer message and the trend for young people to play indoors on computer games rather than running around outside and there is the potential for a health crisis.

In 2009 we are simply not getting enough sunlight to make the Vitamin D we need to stay healthy. Dietary sources of Vitamin D include oily fish, liver, eggs and fortified foods such as cereals, margarine and powdered milk. There are supplements, such as cod liver oil, but it's almost impossible to get sufficient Vitamin D from diet alone. A person would have to drink ten tall glasses of Vitamin D-fortified milk each day just to get the minimum levels.

There are several pills available in low doses (the European Recommended Daily Allowance is 5mcg). But, despite being a doctor, I am not a great fan of pill-taking, especially as there is controversy over what is a 'safe' level of the vitamin.

In the early Fifties, use of Vitamin D supplements in food caused infants to die of heart and kidney failure.

But, by contrast, it is impossible to overdose through sunlight exposure. The skin automatically switches to manufacturing pigment (resulting in a tan) when it has made enough Vitamin D. Sunshine really is the best source.

This doesn't mean you should throw yourself at a beach once a year and let yourself burn. The skin cancer message is right. Melanomas - tumours on the skin - are found on people who have burnt in the sun, particularly when young.

Best estimates from a recent World Health Organisation report are that, on a sunny day, a fair-skinned person will achieve maximum Vitamin D production from exposing face and forearms to midday sunlight for five to ten minutes, up to three times a week. Short exposure gives the benefit and long exposure causes harm.

Of course, in this country, sun can be hard to come by, especially during the winter. It's during these times that many of us may benefit from the UV lamps used in sunbeds. Because the whole body is usually exposed, a single five to ten-minute session once every six weeks should be sufficient.

Those with darker skin may need up to eight times as much exposure as someone of a Caucasian background because their skin is more resistant to UV rays.

The danger with sunbeds comes if they are used by children. The risk of melanoma increases for those who start using sunbeds under the age of 18.

But a recent study of European melanoma rates found that in Sweden - where sunbed use is strictly regulated and tanning salons are supervised, preventing children from using them and protecting adults from over-exposure - there was less melanoma in sunbed users than in non-users.

I doubt GPs will ever prescribe a short sunbed course to someone with a Vitamin D deficiency, but I don't think there would be any harm if they did. Every little helps.

? Professor Tim Oliver is a Medical Oncologist at Barts and the London Hospital.

Read more: http://www.dailymail.co.uk/health/a...says-SHOULD-sunbed-session.html#ixzz0Pbt4GYJ8