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Regulate sunbeds says BMA Cymru Wales

BMA Cymru Wales is deeply concerned about the link between cosmetic sunbed use and the rising incidence of skin cancer in Wales and is suggesting that the National Assembly for Wales, as part of its new powers, passes a bill that would regulate sunbed parlours in Wales and compel local authorities to issue licences regulating cosmetic sunbed premises, also known as sunbed parlours or salons.

Welsh Secretary of the BMA, Dr Richard Lewis said: “BMA Cymru Wales does not recommend tanning devices for cosmetic purposes because their use may result in acute and chronic health effects on the skin and eye.We therefore believe that there should be a thorough regulation of sunbed operators. Tighter controls could have a positive impact on skin cancer prevention efforts.

“We have been concerned for some time about rising sunbed use and the effect this may have on levels of skin cancer. With its new powers to create new Welsh law, the National Assembly now has the opportunity to make a difference on this issue and steal a march on the UK government.”

"Even moderate use of sunbeds, for example once a month, is enough to double an individual’s annual dose of UV radiation."

The risk of skin cancer is related to lifetime exposure to ultraviolet light and intense exposure to such light is the most dangerous to the skin. For example, too much time spent in the sun on holidays abroad or excessive time spent in the sun on the occasional hot day in Wales, constitutes this type of exposure.

Sunbed use also provides a form of intense exposure to ultraviolet light. Just one session a month will double the average individual's annual dose of ultraviolet radiation.

Sunbed use is on the rise in Wales and there is now a significant body of evidence to suggest that the sunbed industry suffers from a lack of regulation. As the hot summer of 2006 fades from memory, more and more people will make appointments at sunbed parlours to keep up their tan. Many of them will suffer as a result.

“I am particularly concerned by evidence that children are using sunbeds as they are especially sensitive to ultraviolet light. Just one day of burning as a child increases the risk of getting skin cancer as an adult," added Dr Lewis.

Dr Sharon Blackford, Consultant Dermatologist at Swansea NHS Trust said “We are seeing more and more younger patients with skin cancer, particularly young women who are frequent sun bed users. In the past some types of skin cancer were only seen in elderly people, particularly outdoor workers, but now it is commonplace to see patients in their 40’s and even younger with these tumours. Dermatologists would never recommend sunbeds for tanning, it's much safer to stay pale and interesting or to use a false tan, or in other words fake it don't bake it.”

The burns unit at Morriston Hospital has also treated patients with burns caused by tanning sessions.

"We believe that a bill on this subject would have a significant effect on the incidents of skin cancer in Wales," added Dr Lewis. "This is a public health issue and an issue on which the National Assembly could make a difference."

The Bill would require providers of cosmetic tanning facilities, or equipment, to obtain a licence to operate from the local authority and the conditions for granting a licence would be set in the bill. The licensing conditions would be set so that local authorities could:


By providing health risk information, the bill would aim to ensure adults are equipped to make informed choices about the risks of sunbed use. The conditions of licensing would require staff to be on premises, which would help to prevent over-exposure to ultraviolet light, especially by those who are more sensitive such as users with fair skins. The hope is that the bill would also reduce the number of burns and accidents currently attributed to the misuse of unsupervised equipment and would drive up standards amongst operators.

Skin cancers are the most common group of cancers in the UK, in England and Wales over 60.000 new cases are reported every year. There are three main types of skin cancer, basal cell carcinoma (BCC) squamous cell carcinoma (SCC) and malignant melanoma (MM). Malignant melanoma is the least common but most dangerous type of skin cancer. The incidence of MM has doubled every decade for the last 30 years, a more rapid increase than for any other type of cancer, this increase is related to changes in behaviour including more foreign holidays, increased leisure time and increased exposure to ultra violet light.

Approximately 5,200 new cases of MM are registered in England and Wales each year, and there are 1,500 deaths due to melanoma annually. Because melanoma can affect young people in their 20s and 30s the potential years of life lost are greater for melanoma than for some other types of cancer.

Notes
The dangers of Ultra Violet Radiation

The sun and certain artificial sources of light such as those found in sunbeds produce ultra-violet radiation (UVR). UVR is sub-classified as classified as UVA, UVB and UVC. The side effects of excess doses of UVR radiation include:


UVR damages the skin because its absorption leads to undesirable primary and secondary photochemical reactions. There is no evidence to suggest that UVR radiation received from artificial sources is in any way safer than that emitted by the sun. UVR exposure affects various layers of the skin, with most ageing damage occurring in the connective tissue of the dermis Ma W, Wlaschek M, Tantcheva-Poor I (2001) Chronological ageing and photoageing of the fibroblasts and the dermal connective tissue. Clinical and Experimental Dermatology 26:592-9. The dermis contains collagen and elastic fibres that together provide mechanical support and elasticity to the skin. In photoaged skin collagen fibrils become disorganised and abnormal elastin material accumulates in the dermis. This is known as solar elastosis and accounts for the increase in wrinkles and lines Kang S, Fisher GJ & Voorhees J (2001) Photoaging: pathogenesis, prevention and treatment. Clinics in Geriatric Medicine 17:643-659.. Exposure to UVR is likely to cause premature ageing of the skin. It is characterised by leathery, wrinkled and sagging skin National Radiological Protection Board (1999) Statement by the advisory group on non-ionising radiation: use of sunbeds and cosmetic tanning. Radiological Protection Bulletin, no. 218., with pigmentary changes.

There are three main types of skin cancer: malignant melanoma, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). These latter two are forms of non-melanoma skin cancers (NMSC).

Malignant melanoma is the most dangerous form as it tends to spread early to lymph nodes and other organs and can be fatal. In 1998, 6,030 malignant melanomas were diagnosed in the UK and by 2002 this figure had risen to 8,028. www.cancerresearchuk.org In the period 1989-1998, the fastest growing incidence of cancers in men in the UK was malignant melanoma at 42% growth. It is known that excessive exposure to UVR can lead to melanoma. However, it is of note that there are subtypes of malignant melanoma that are unrelated to UVR. Nevertheless, UVR exposure is a likely cause to the increased incidence of both melanoma and non-melanoma skin cancers, especially in people that sunburn easily and tan poorly.

Non melanoma skin cancers mainly occur in older people. Over 95% of these cancers are curable but they can be disfiguring if not diagnosed and treated early. There is stronger evidence that tanning devices contribute to the incidence of non-melanoma skin cancers. One study found that sunbed users were 2.5 times more likely to develop SCC and 1.5 times more likely to develop BCC Karagas MR, Stannard VA, Mott LA, et al. (2002) Use of tanning devices and risk of basal cell and squamous cell skin cancers. Journal of the National Cancer Institute 94:224-6. The risks appear to be greatest for the young, with the chances of developing a tumour increasing by up to 20% per decade of sunbed use before the age of 56 . Westerdahl J, Olsson H, Masback A et al. (1994) Use of sunbeds or sunlamps and malignant melanoma in Southern Sweden. American Journal of Eepidemiology 140:691-9..

The eyes (in particular the cornea) are very prone to damage from tanning equipment. It is recommended that sunbed users wear protective goggles but research shows that people may not use them. Acute effects of UVR exposure include photokeratitis and photoconjuctivitis. Exposure to UVR is also a risk factor for developing certain types of cataracts. The NRPB report on the effects of UVR on human health indicated that repeated exposure is a major risk factor for non-malignant lesions of the cornea and conjunctiva National Radiological Protection Board (2002) Effects of ultraviolet radiation on human health. Didcot: NRPB.

There is evidence for an immunosuppressive effect of both acute and chronic low dose UV exposure. Beyond its role in the initiation of skin cancer, sun exposure may reduce the body’s defences that normally limit the progressive development of skin tumours.

Photosensitivity disorders should also be considered. There are a wide range of medical disorders where patients have abnormal sensitivity to ultraviolet and/or visible radiation. These conditions result in a range of skin rashes other than sunburn such as polymorphic light eruption. It is therefore important that new sunbed users are screened for features of these disorders.

Some drugs induce abnormal responses to UV radiation. New sunbed users should be screened to ensure that they are not on any oral medication or applying topical preparations that would induce photosensitivity reactions.

Additional evidence of the risks of sunbed use

Source: BMA

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