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Some docs still 'prescribe' tanning, despite risks

/ Source: Self

Five minutes in a bikini with her eyes closed, relaxing in the heat of a tanning bed, and Delta Payet felt her winter blues easing away. It was just as her doctor had promised.

A high school junior in frigid Vermont, Payet had been tired and unhappy for weeks when her family doctor gave her a diagnosis of seasonal affective disorder, a fall and wintertime melancholy brought on by changes in ambient light, body temperature and hormone regulation. He told her to get some sun. "But it's not like I could take a long vacation," Payet recalls. "He said that going to a tanning bed would do the trick."

She went three times a week from February right through the summer. For about the next three years, she'd pop in now and then. She didn't realize there could be long-term effects: "I loved being tan, and I thought I looked and felt healthy."

Payet, now 40, stopped going to tanning beds in her early 20s, after a dermatologist found a keratosis (an abnormal skin growth) on her right breast. She says he told her it wasn't immediately dangerous but probably had come from tanning too much. During the next 10 years, she became an aesthetician and eventually opened a skin caresalon in Paradise Valley, Arizona; she didn't even think about her time in the tanning bed. But in 2001, Payet got a reminder of the worst kind, this time on her upper arm: a precancerous mole—a harbinger of melanoma, the most serious form of skin cancer.

Her doctor removed it, leaving behind a 1-inch-by-1-inch scar. In subsequent visits, he removed three other precancerous moles and several more that looked suspicious. She says that because she had no family history of skin cancer, the doctor thought it was odd for her to have so many worrisome moles — unless she'd tanned a lot when she was younger.

Today Payet knows the harsh truth: Tanning is not a proven treatment for SAD — but it is a proven carcinogen. In fact, people who lie in a tanning bed increase their melanoma risk by 74 percent, a study from the University of Minnesota in Twin Cities reports. When she catches a glimpse of her scar, Payet can't help but wonder: Did following her doctor's advice, well-meaning as it was, make her susceptible to cancer?

Doctors still prescribe tanning

Payet got her prescription to tan almost 25 years ago. This wouldn't happen now, right? Astonishingly, it does. Forty-six percent of indoor tanners say they've done it for noncosmetic reasons, 11 percent on the advice of their doctor, according to a survey of 6,881 people who went to tanning salons, done by the International Smart Tan Network, a tanning-salon training group in Jackson, Michigan. Those results suggest that thousands of people hit the beds on their doctor's recommendation. The survey showed that providers prescribed tanning for depression, vitamin D deficiency, fibromyalgia, muscle aches, skin disorders and even tooth whitening. "Whenever I would have cramps, my OB/GYN advised me to [lie] in the tanning bed to ease the pain," one respondent wrote.

What are these doctors thinking, recommending a known carcinogen as a treatment for sundry ailments? The dangers of too much UV exposure are well-known by now. UV radiation accounts for about 65 percent of melanomas, according to the Skin Cancer Foundation. And women younger than 39 are almost twice as likely to develop melanoma as are men the same age.

Meanwhile, there are no proven medical benefits to getting a tan. None. Dermatologists might treat some cases of psoriasis with in-office UVB light boxes, but anecdotal evidence that salon tanning helps relieve skin problems and aches or speeds up the recovery from a coldis exactly that—anecdotal, with zero clinical research to back it up. "It's absolutely ludicrous to send patients to tanning salons for any medical reason," says Bruce Brod, M.D., clinical associate professor of dermatology at the University of Pennsylvania School of Medicine. "Indoor tanning doesn't have health benefits. It causes skin cancer!"

Officially, the tanning industry is not allowed to say that its services are good for you. In 2010, the Federal Trade Commission ordered the Indoor Tanning Association, which represents the indoor tanning industry, to stop "making false health and safety claims." Yet a group like the International Smart Tan Network can trumpet the results from its survey, which found that those prescriptions for tanning come from family physicians and dermatologists, as well as nurses, psychologists, physical therapists and acupuncturists.

Some of the doctors named by respondents told Self that they would not send a patient to a tanning salon. But the results suggest that patients, at a minimum, are getting mixed signals about tanning from health professionals, who themselves may be getting ambiguous information. Doctors know that indoor tanning causes skin damage but also that their patients say it makes them feel less depressed. "If someone says they feel better, a doctor might say, 'Why not [let them tan]?' But that's not science," says Alfred Lewy, M.D., a psychiatry professor specializing in light disorders such as SAD at Oregon Health & Science University. He notes that a proven treatment for SAD is staring into a tabletop fluorescent light box, which doesn't emit UV light.

'Tan in moderation'

Grace A. Gibbs, D.O., an OB/GYN surgeon in Lansing, Michigan, recommends tanning to, on average, 15 to 20 patients per week for various medical reasons, such as vitamin D deficiency, osteoporosis and SAD. "I'm not worried about them getting skin cancer," she says, adding that she gives every patient an annual skin check. "I'm more worried about them breaking a bone [due to osteoporosis] or attempting suicide because of depression. And I tell them to tan in moderation."

Of course, not everything in moderation is fine. No doctor would design a regimen of occasional or moderate cigarette smoking for anxiety, even if it seemed to work. And tanning beds are in the highest category for cancer risk, alongside smoking tobacco, according to the International Agency for Research on Cancer.

Although there is some variation among salons, tanning beds typically emit 95 percent UVA light and 5 percent UVB light, about the same as the noontime sun. UVA rays have longer wavelengths of light that stimulate the production of melanin in the outer layer of the skin (a response to damage that rays are causing). Studies have shown that UVA rays — not UVB, the burning rays — are the major culprit in melanoma because of their penetration into skin cells. And continued UV exposure of any kind causes cell mutations that can lead to skin cancer.

Jami Gorneault wishes she could take back her time spent in tanning beds. She went to salons for about 10 years, starting when she was a high school freshman who had been asked to the senior prom. "I wanted a glow like the other girls," says Gorneault, 30, a Colorado native who now lives in Springfield, Massachusetts.

Gorneault would visit salons to maintain her summer tan and before special occasions, usually every few months, with regular visits for a month at a time. "I didn't think it would affect me, as long as I stopped before I got into my 30s," she says. "And anyway, I thought getting skin cancer wasn't a big deal."

She continued to think that until, at 24, she was diagnosed with stage I melanoma after finding a brown and black mole with irregular edges in the middle of her back. Her doctor scooped it out, leaving a 5-inch-long scar. "I had a local anesthetic, but I could hear the cutting of my skin," Gorneault recalls.

Four years later, she felt a lump under her left arm. Some remaining cancer cells —undetectable in skin checks — had spread beneath her skin. She now had stage III melanoma.

After surgery to remove 11 lymph nodes from under her arm, Gorneault began immunotherapy, a grueling course of intravenous alpha-interferon designed to kick-start her immune system. As the treatments went on, the side effects worsened. Gorneault felt exhausted, achy and fuzzy-headed, as if she had a months-long flu. She started to lose her hair. And she was depressed — barely able to get herself out of bed.

Long-term consequences

Slowly, Gorneault became stronger, and two years later, she is cancer-free. But she lives with the knowledge that cancer could return at any time. Her doctors have also told her it's possible that the interferon has compromised her fertility. "To know that something I've dreamed of my whole life [having kids] might be taken away was harder than the illness itself," Gorneault says. "If I'd known going to the tanning beds would affect me at such a young age, I absolutely would not have done it."

Initially, Gorneault thought tanning had benefits. She took note of posters in the salon touting tanning as a healthy way to get vitamin D. "It helped me justify going there," she says. She couldn't know the message was part of a well-funded effort to convince patients — and doctors—that tanning is therapeutic.

Take the UV Foundation, funded in part by tanning-bed bulb makers, distributors and the Indoor Tanning Association. The foundation has channeled money into more than a dozen studies by Michael F. Holick, M.D., a professor of medicine at Boston University, whose research promotes the idea that sunlight decreases risk for chronic diseases. The UV Foundation also supports SUNARC, a pro-vitamin D nonprofit led by physicist William Grant, Ph.D. Grant is a board member of The Vitamin D Council, a group that argues "humans are needlessly suffering and dying from vitamin D deficiency." Meanwhile, the tanning industry uses any research that shows the benefits of vitamin D to justify its claims that tanning is beneficial.

Late last year, the Institute of Medicine, an independent nonprofit that strives to find consensus on health advice, released a report that reviewed more than 1,000 vitamin D and calcium studies and determined that most of the new findings were not well proven or were too new to be conclusive except for the large amount of evidence that D is good for bones. But even if more D does turn out to equate to better health, indoor tanning is not the best way to get it. It's exposure to UVB rays—not the primarily UVA light that comes from a tanning bed—that triggers the production of D (by converting 7-dehydrocholesterol in skin to vitamin D). "Sending a patient to a tanning salon for vitamin D is the definition of insanity," Dr. Brod says. Even Dr. Holick, despite his industry support, told self, "I don't really see a need to tan. Supplements work just as well."

These days, Gorneault is a nanny, waiting to hit the five-year survival mark to decide if she's healthy enough to have a baby of her own—one she'll live long enough to see grow up. She tells everyone she can how tanning imperiled her dream of starting a family. To her, it's an insult that doctors would send patients to a tanning bed. "I'm appalled," Gorneault says. "Maybe if doctors heard what I went through, they would never tell a patient to tan. Tanning beds cause cancer. How does it make any sense?"

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