Health: Teens, Tans and Truth

Eighteen-year-old Libby Weldon of Canby, Ind., knows the must-haves for the perfect prom: a date willing to dance, a glamorous dress, strappy sandals, dangle earrings and, to set it all off, the golden glow of deeply tanned skin. At first, her parents objected to the tanning because of its link to skin cancer. Then her dad read an article on the health benefits of vitamin D, otherwise known as the "sunshine vitamin." Weldon, who hit the tanning bed 10 times in the two weeks before the big night, says, "They got used to the idea."

That's exactly the message the $5 billion-a-year indoor-tanning industry is hoping every parent gets, as it launches its national "It's time to rethink sun bathing" campaign. Buoyed by research that links low levels of vitamin D (which the skin naturally makes when exposed without sunscreen to ultraviolet rays from the sun) to higher risks of cancer, heart disease and autoimmune disorders, the Indoor Tanning Association (ITA) sees an opportunity to recast the public's view of tanning. Even though skin cancer is the most diagnosed cancer in the country, the trade group is trying to make the case in TV and newspaper ads, as well as on two new Web sites, that UV rays prevent cancer rather than cause it. Any messages to the contrary from dermatologists, oncologists or sunscreen makers are just part of a "sunlight scam," designed to make people fear the sun, the ITA insists. "We are not advocating on behalf of tanning beds," says ITA spokesperson Sarah Longwell, "but on behalf of the sun."

If you find all this a little hard to believe, your instincts are right, experts say. Promoting only the health benefits of UV rays is "like recommending smoking to reduce stress," said Dr. Len Lichtenfeld, deputy medical director of the American Cancer Society. While it's true that vitamin D shows cancer-prevention potential, there's more promise than proof at this stage, scientists say. "There is somewhat convincing evidence that vitamin D is protective against colon cancer," says Cindy Davis, a research nutritionist at the National Cancer Institute. "The evidence for other cancers is not as convincing."

While both sides say they're for moderation, they define the term very differently. The ITA's definition includes regular sunbathing and trips to tanning salons (which use sunlamps that are at least three to four times stronger than the sun and, by some measures, 10 or more times stronger). Doctors say the safe approach is to combine the incidental sun exposure people get in the course of normal living (running out for a sandwich at lunchtime or walking between their car and office) with supplements and foods high in vitamin D (fatty fish like salmon or vitamin D-enriched products like milk and juice). Someone with very fair skin needs only about five minutes in the sun without sunscreen, (three times a week between 10 a.m. and 4 p.m.), to achieve optimal levels of vitamin D, says Davis.

Getting a tan, Davis notes, actually slows the synthesis process, because the darker the skin, the longer it takes to get enough vitamin D from the sun. Age also reduces the skin's ability to synthesize vitamin D. While the tanning industry expresses concern about widespread vitamin D deficiencies, critics point out that two of the groups with the lowest levels of vitamin D—people with dark skin and the elderly—are not the ones targeted by the salons. (Anyone younger than 50 can get the recommended daily dose of vitamin D from two glasses of milk.)

Skin and cancer experts also strongly dispute the ITA ad that contends there is "no compelling scientific evidence" linking melanoma, the most deadly type of skin cancer, and the sun. While it's true that the risk varies by type of melanoma and amount of UV exposure, research dermatologists like Dr. Ken Kraemer of the National Cancer Institute say the overall consensus is that both repeat sunburns (especially acquired as a child or teen) as well as cumulative UV exposure increase the risk of melanoma. Intermittent but intense blasts of UV rays (the type you might get during occasional trips to the beach or tanning salon, for instance) may be particularly risky.

Brittany Lietz says she learned that the hard way. As a high-school junior, Lietz decided she looked too pale in her white prom dress, so she joined friends heading to a tanning salon near Annapolis, Md. What started as a lark soon became a 20-minute-a-day obsession. "I was a 'tanorexic'," says Lietz. "You know how an anorexic never thinks she's thin enough. I never thought I was tan enough." A bleeding mole discovered at the age of 20 sent Lietz to a dermatologist. It turned out to be stage 1B melanoma. Other suspicious growths were tested. "Every one of them turned out to have some cancerous characteristics," she said. Surgeries to remove the growths have left the 23-year-old with 35 scars so far. With no family history of melanoma and a mother who always insisted on sunscreen outside, Lietz is convinced that her time in tanning beds caused her cancer. A former Miss Maryland and now a Redskins cheerleader, she's working with the American Academy of Dermatology as they launch a new public-service campaign against indoor tanning. ITA denies a link between melanoma and tanning beds.

Doctors say they are particularly concerned about the ITA's pro-sun ads because the number of new melanoma cases has been steadily rising since the 1970s, and are increasing faster in females 15 to 29 years old than males the same age. Dr. Anir Dhir, a dermatologist in Lexington, Ky., adds that of the 800 cases of melanoma he's treated in his career, "60 of them were in women younger than 30 years old, and all of them were avid tanning-bed users."

While the ITA prepares its second round of ads pushing the idea of a "healthy tan," teens say this debate is largely irrelevant to them. "I know it's bad," says high-school senior Jessica Carter of Campbellsport, Wis. The reason she goes to her local tanning salon three or four times a week is that she thinks a tan makes her "look really attractive." Her friend, Alex Lloyd, who tans five days a week, says she just ignores the bad press tanning gets. "A lot of people tell me I do it too much, blah, blah, blah," she says. "But I just don't care."

If warnings about cancer won't get teens' attention, maybe the premature wrinkles and skin damage on older tanners will. That's what got Anne Wallis, a high-school senior in Radnor, Pa., to cut back on her time under the sunlamp. "They look older than they are and, sometimes, really leathery," she says. John Overstreet, executive director of the ITA, doesn't try to dispute that. "People get the same thing from us that they get from the sun," he says. "They get wrinkles." On that point, doctors say, you'll hear no argument from them.