Swimming pools in many parts of the country will be opening this month, and many Americans -- young women, in particular -- likely will be flocking to those pools or their local tanning salons to get started on their summer tans. That's despite repeated warnings from multiple organizations -- including HHS, the National Cancer Institute and the World Health Organization, or WHO -- about the health hazards of tanning.
About one in three young women used an indoor tanning bed in the past year, says a recently released survey, while four out of five tanned outdoors.
According to the results of a recent American Academy of Dermatology, or AAD, survey(www.aad.org) of nearly 4,000 white females ages 14-22 years, more than 80 percent of respondents indicated they had tanned outdoors frequently or occasionally in the past year, and nearly one-third said they had used a tanning bed during the same time period.
Of those who used tanning beds, 25 percent said they had done so at least once a week. Nearly 90 percent of respondents who used tanning beds said they knew tanning beds can cause cancer(www.aad.org).
Convincing young people to protect themselves from the sun -- and to avoid tanning beds -- is challenging despite the health warnings, said Martin Mahoney M.D., Ph.D., associate professor in the health behavior and medicine departments at Roswell Park Cancer Institute, Buffalo, and associate professor of family medicine in the School of Medicine and Biomedical Sciences at State University of New York at Buffalo.
"This is a difficult message to communicate because adolescents and young adults have a sense of invincibility," Mahoney told AAFP News Now, "and society continues to promote the misinformed image of a 'healthy tan.' I try to explain that a tan is really the body trying to protect itself from too much sunshine, or UV radiation, leading to premature skin changes and aging."
Neither the U.S. Preventive Services Task Force, or USPSTF, nor the AAFP currently recommend that physicians routinely counsel patients about skin cancer prevention. Specifically, the USPSTF concluded in 2003 that evidence was insufficient(www.uspreventiveservicestaskforce.org) to recommend for or against routine counseling by primary care clinicians to prevent skin cancer.
However, an evidence review(www.uspreventiveservicestaskforce.org) conducted by the Agency for Healthcare Research and Quality for the task force in February found new evidence suggesting that counseling in primary care can change behaviors related to tanning and sun protection.
Both HHS and the World Health Organization have noted that natural and artificial sources of ultraviolet light can cause cancer, and the use of tanning beds can increase a person's risk of skin cancer by 75 percent, says the AAD. Overall, one in five Americans will develop skin cancer in their lifetime.
According to the U.S. Preventive Services Task Force, or USPSTF, more than 2 million cases of skin cancer are diagnosed each year in the United States, and incidence of melanoma -- which accounts for 75 percent of skin cancer deaths -- is increasing. In fact, statistics presented by the American Melanoma Foundation(www.melanomafoundation.org) indicate that melanoma is the most common form of cancer among people ages 25-29 years, and it is the second-most common form of cancer among those ages 15-29 years.
Mahoney said patient counseling should include a review of data indicating that rates of melanoma in young people are increasing. The AAD, which released the survey results as part of its Melanoma/Skin Cancer Detection and Prevention Month, said incidence of melanoma is increasing faster among females ages 15-29 years old than among males in the same age group. The majority of young women with melanoma are developing it on their torso, which may be the result of indoor tanning.
"This topic should come up under health maintenance and counseling at preventive care visits," said Mahoney. "That said, every visit represents an opportunity to inquire about tanning behaviors, and it is easy enough to recognize and inquire about tanned skin when interacting with adolescents and young adult patients."
Yet, some parents might not support the message physicians are trying to deliver, the AAD survey suggests. Of respondents who used tanning beds, 94 percent said their parents knew they were tanning, and 42 percent said their mothers also used tanning beds.
According to Mahoney, family physicians have the unique ability to talk to parents and their children separately -- because multiple family members may be patients in the same practice -- and he said he speaks to parents about modeling positive behaviors.
Making the most of opportunities to counsel adolescents and young adults about making smart choices is key to safeguarding these patients' health, said Mahoney.
"It is important to acknowledge that adolescents and young adults tend to complete fewer office visits as they get older," he said, "and when presenting to the office, it is often to address an acute problem rather than a checkup. As a result, it is important to treat every office visit as an opportunity to address preventive care."