Download Slide 0 - Iowa Cancer Consortium

Skin Cancer Epidemic
And Indoor Tanning
The Task Ahead of Us
Leslie Christenson, MD
McFarland Clinic, PC
Ames, IA
Define the Problem
Statistics
• Skin Cancer: most common cancer in US
• >3.5million skin cancers in >2million people
diagnosed annually
• More new skin cancers each year than breast,
prostate, lung & colon combined
• 1 in 5 Americans will develop skin cancer in
lifetime
• Number of NMSC in Medicare population
increased ave. 4.2%/yr 1992-2006
• $1.4 billion in 2004, direct cost to treat skin
cancer, $2.36 billion in 2010
problem defined as
BIG
Problem is highly preventable
Break the Problem Down
• Nonmelanoma skin cancer
–Basal cell carcinoma
–Squamous cell carcinoma
• Melanoma skin cancer
Statistics
• Basal cell carcinoma, most common,
2.8 million annually, rarely fatal, can
be very destructive
• Incidence increased 3 fold (19762003) in woman <40
Statistics
• Squamous cell carcinoma, 2nd most
common, 700,000 cases/yr in US
• 1-15% metastatic rate
• Incidence also on the rise
Statistics
• Estimated 3,170 deaths from
nonmelanoma skin cancer in US in
2013
• 90% of nonmelanoma skin cancer
are associated with UV exposure
Melanoma Statistics
• 1970-2009: incidence of melanoma
increased 800% in young woman, 400%
in young men
• 1 person dies of melanoma every hour
• Estimated 76,690 new cases of invasive
MM in US in 2013
• Estimated 9480 deaths due to MM in
2013
• Of 7 most common cancers in US,
melanoma is the only one whose
incidence is increasing, 1.9% annually
Melanoma Statistics
• Most common form of cancer in young
adults 25-29
• Second most common form of cancer in
young people 15-29
• 86% of melanomas can be attributed to UV
exposure
• Risk of melanoma doubles if >5 sunburns
at any age
• One + blistering sunburn doubles chance
of melanoma
UV exposure critical
role in development of
skin cancer
UV from natural sun
UV from artificial light sources/tanning
Society Pressures
• 19th century started with parasol
carrying elite, ended with start of
sunbathing
• Phototherapy for medical purposes
in 1800’s
• 1920 Coco Channel, fashion of tan
• 1970’s use of tanning beds, started
broad spectrum (UVA, UVB, UVC),
then “safer” with 99.9%-95.7% UVA
Tanning
• UVR is proven human carcinogen
• International Agency for Research on
Cancer, affiliate of World Health
Organization include UV tanning
devices as Group 1 (most cancer
causing substance) ( along with
Cigarettes, etc)
• WHO declaration: no person under 18
y.o. should use a sunbed
Tanning
• Currently tanning beds are regulated
by FDA as Class I medical devise.
Same category as the tongue
depressor.
• New high-pressure sunlamps may
provide 12 times the annual UVA
dose compared to sun
Tanning
• 1 indoor tanning session increases users
chances of developing melanoma by 20%,
+2% ^ with each subsequent use
• If use tanning bed before age 35, increase
your risk of melanoma by 75%
• 4 tanning sessions/yr increases risk of
BCC and SCC by 15%
• 1 tanning session/yr in high school/college
boosts risk of BCC 10%, 6 sessions/yr 73%
Tanning
• Nearly 30 million people tan indoors/yr in
US, 2-3 million are teens
• >1 million Americans use tanning beds
daily
• 1% Americans in 1988 used indoor
tanning, 27% Americans in 2007
• Indoor tanning rates 14, 15, 16, 17 yo girls
were 8.5%, 13.6%, 20.9%, & 26.8%
• Tanning is addictive: 41% of frequent
indoor tanners met criteria for a tanning
addictive disorder, 33% more met criteria
for problematic tanning behavior
Costs
• Indoor tanning industry $5 billion
annual revenue
• 2004, total direct cost associated with
treatment of nonmelanoma skin cancer
was $1.4 billion
• 2010, costs of $2.36 billion
• In adults 65yo+, melanoma treatment
costs total ~$249 million annually
• Morbidity substantial
• Loss of life, priceless
Tanning Benefits?
The arguement
• Skin benefits (psoriasis, atopic
dermatitis, etc), dosed by an MD
• The Smart Tan Network, Lobby for
tanning industry, states that tanning
prevents skin cancer by preventing a
burn
• A TAN IS NOT SIGN OF
PROTECTION, IT IS EVIDENCE OF
DAMAGE TO SKIN CELL DNA
Tanning Benefits
The Arguement
• Vit D………..GOT MILK?
–Study from Cincinnati OH, white
clothed infants, exposing their hands
and face, required 0.5 -2.0 hours of
sun exposure/week for Vit D
production
–10 min after exposure Vit D produced
in the skin starts to break down
–GOT MILK?
• Mental health ……lights, not UV
Review
• Problem: Skin cancer on the rise,
increasing mortality, increase health
care costs
• Cause: UV exposure, evidence
overwhelming
• Solution: Limit sun exposure
• Discrepancy in knowledge and
actions (McDonalds)
The Paradox
• FDA regulates Indoor tanning
equipment
• US Federal Trade Commission
investigates deceptive/false
advertising including claims that
indoor tanning is safe
• Operators of indoor equipment are
regulated at state level or not at all.
• FDA limits UVC emitted but not UVA
or UVB
The Paradox
• 1986 FDA recommended max
exposure dose of 0.75MED, 3x 1st
week, increasing to 4MED max
• Community-based study in N
Carolina showed 95% of patrons
exceeded limits, 33% started tanning
at max (similar studies Cal, NY show
same noncompliance)
Why do we need Government
Involved?
• Throughout US history, State and
Federal Legislatures have used
legislation to educate the public and
protect our youth from various health
hazards
Why Government Involved?
• US House of Representatives
Committee on Energy and
Commerce-Minority Staff
• False and Misleading Health
Information Provided to Teens by the
Indoor Tanning Industry:
Investigative report 2/1/2012
• Committee called 300 tanning salons
across country
Committee study Findings
• 90% of salons stated indoor tanning
posed no health risk
• 51% denied indoor tanning would
increase a fair skinned teenager’s
risk of skin cancer
• 4 of 5 salons falsely claimed that
indoor tanning is beneficial to a fair
skinned young person’s health.
Several stated it would prevent skin
cancer
Committee Study Findings
• Salons stated that government
regulators had certified the safety of
indoor tanning: and that “it’s got to
be safe, or else they wouldn’t let us
do it”
• 3/4th of salons stated that would let
1st time users to tan daily despite
FDA recommended limitations
Action
• 1997 France prohibited tanning in
those <18yo
• 2007: Illinois, New Hampshire, New
Jersey, New York banned tanning in
those <14, Wisconsin banned in
those <16, Texas and N Carolina
banned in <13 except with MD excuse
• Parental consent if <18: AZ, CT, FL,
GA, IN, KT, LA, Maine, MN, MI, OH,
Miss, OR, RI, SC, TN
Action
• 2013: California, Vermont, Oregon,
Nevada, Texas, Illinois. Banned
tanning in those <18
• 2013: New Jersey banned <17, New
York banned <16, 17 and older parent
consent
• 2013: Legislation introducedMaryland, Conneticut, Idaho,
Alabama, Nebraska, Iowa….28 states
total with 6 passages for ban in <18
Action
• US surgeon general is developing a
new campaign to fight skin cancer.
CDC began collecting public input on
the proposed skin cancer campaign
• Congress forms bipartisan caucus on
skin cancer: “Caucus will support
legislative activities and public policies
that are aimed at raising skin cancer
awareness, promoting skin screening and
early detection of the disease and
improving access to skin cancer
treatment” Jim Cooper (D-Tenn), Carolyn Maloney (D-NY),
Peter Roskam (R-Ill), Charlie Dent (R- PA), ACMS, AADA
Age?
•A
•B
•C
•D
40
55
36
18
Let’s Get Going Iowa!
Call to work to Ban tanning
in Iowan’s Younger than
18yo
Protect our Youth and our
Future