By Jessica Firger
Most people know the long-term hazards of frequent sun exposure. Ultraviolet rays can do serious damage to one's skin. And yet, countless people still continue to bake in the sun to get what many call "a healthy tan" -- even some melanoma survivors, according to a new paper presented this week at the American Association for Cancer Research's annual meeting in Washington, D.C.
Anees B. Chagpar, M.D., M.P.H., associate professor of surgery at Yale School of Medicine in New Haven, Conn., and director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven and lead author of the study, said over a quarter of melanoma survivors in her study never use sunscreen. "That kind of blew my mind. Sun exposure increases your risk of getting melanoma a second time." She added that around 2 percent of melanoma survivors had frequented a tanning booth in the last year.
Chagpar based her study on data from the 2010 National Health Survey, the largest population-based source of information collected by the Centers for Disease Control (CDC) of 27,120 adults. Among that group, 171 had a history of melanoma. Chagpar believes her findings indicate skin cancer survivors are unaware of their increased risk for the disease returning, and that doctors must do more to educate their patients on the damage ultraviolet rays have on one's skin.
"What you start to wonder is whether we are doing a good enough job educating the public," said Chagpar, who also found that 15.4 percent of the melanoma survivors in the group rarely or never stayed out of the sun, around 27.3 percent reported never wearing sunscreen when outside on a sunny day for more than an hour versus 35.4 percent of the general population. "Certainly there have been tremendous advances made in diagnosing melanoma and treatment but once people have gotten over that bout of melanoma they really are survivors and want to stay that way."
Cancer of the skin is the most common cancer in the United States, and though melanoma only accounts for around 5 percent of all skin cancer incidences, it's responsible for 75 percent of all skin cancer deaths, according to the American Academy of Dermatology. Chagpar believes the dangers of sunshine are not clear cut for many people. Messaging behind public health campaigns to discourage smoking or encourage safe sex are simple, but sun avoidance is more complex since sunshine is associated with happiness, improved health, and vitamin D, she said. "Sunshine is looked at positively in our culture," said Chagpar. "You have a piece of good news, a ray of sunshine."
Excessive tanning -- known as "tanorexia" -- was most recently in the public light when an orange-tinged bedraggled mother in New Jersey was charged with allowing her 6-year-old daughter into tanning booths. Patricia Krentcil, known as the "tanning mom," said she paid a local tanning salon $100 a month, and went for tanning sessions at least five days per week.
Chagpar's study also raises the age-old question of why people continue to engage in risky behavior -- even after an intimate brush with death. Rosalind Dorlen, a clinical psychologist at Overlook Medical Center, in Summit, N.J. believes tanning addiction is a public health problem.
And there are some lawmakers who agree. Recently, Gov. Chris Christie of New Jersey signed a bill into law that bans minors from using tanning beds, while California and Vermont have also placed regulations on indoor tanning for teens. There are similar bills pending in 25 other states.
Tanning as Addiction
Sherry Pagoto, PhD, an associate professor of medicine in the division of preventive and behavioral medicine at the University of Massachusetts Medical School, has been studying tanning behaviors for more than 10 years. She said, as with other addictions, many people tan as a way to escape reality or to cope with depression. "A lot of them are doing it as a way to relieve stress after classes, or after work, as a way to wind down. It isn't because it makes you look better," she said. Dr. Pagoto also believes what may be driving many of these addicts is a quick fix, and the rush of brain chemicals.
"It's more about medicating the mood," said Pagoto. "Some people do that by overeating, some people will smoke cigarettes, some people will do that by tanning." She said much like drinking or smoking, tanning can start out as a social activity but then may turn into an addiction. And for many young women, the addiction is also driven by peer pressure, she said.
Dr. Dorlen agrees. "The culprit may very well be the endorphins that are activated when they are under the sun," she said. "Research indicates that frequent tanning may be a type of substance abuse. Their brains are not very different than a person who gets a cigarette or UV rays." she said.
Dorlen cites a study published in the journal Addiction Biology in 2011 that examined the brain activity of people from tanning salons who went at least three days a week. Researchers from University of Texas Southwestern Medical Center used two different tanning beds to measure brain activity: one blocked ultraviolet rays and the other didn't. The brain imaging scans showed certain areas of the brain were activated only by the ultraviolet tanning bed, regions that are also activated among people with addiction. Even more, the researchers found participants knew when they were tanning in beds that didn't expose them to high levels of ultraviolet rays.
Recently, Dorlen said she worked with a 19-year-old college student who had a history of excessive tanning, and had been going to tanning booths several days a week over the last year. The young woman's parents sent her to Dorlen when she was diagnosed with a basal cell carcinoma on her left thigh, and soon after, she began binge-drinking. "She came to me because her parents were upset," said Dorlen. "She went from addictive behaviors of sitting in the sun and tanning booths to drinking."
Warped Self-Image
Some young women also become addicted to tanning as an expression of a deeply warped self-image, a psychiatric condition called body dysmorphic disorder, in which one's self-perception is not at all informed by reality. "Tanorexics are like anorexics," said Dorlen. "You look at yourself as skin and bones.They'll say, I'm sorry I see myself as fat, in the same way that a tanorexic would say I'm not tan."
And it turns out that these behaviors sometimes even coexist. One study, published in Psychiatric Quarterly in 2006, looked at the tanning behaviors of anorexics. Among the 200 study subjects, 25 percent were found to engage in body dysmorphic disorder tanning, and 52 percent of these compulsive tanners had received some type of dermatological treatment.
Helping Tanorexics Heal
Managing a tanning addiction can be complicated, said Dorlen, because it is usually informed by another underlying issue. Some experts have found that the treatments that work for other addictions, such as smoking or drinking, can be equally effective on tanning addicts. Dorlen said she uses a cognitive behavior therapy and strategies to "target dysfunctional thinking and to increase awareness of self-harm." Dorlen said typically she also works to treat the patient's depression. "I believe this is a problem that's more than skin deep. The goal is to get beneath it. I try to understand the psychological factors that lead a person to self medicate."
But Pagoto takes a different approach. Currently, she is working with the CDC and the National Institutes for Health to research the topic and find ways to help tanning addicts engage in more productive and healthier habits. Her research team recently surveyed college-age women at the University of Massachusetts at Worcester, to find out what types of activities they find relaxing other than tanning. The study subjects cited activities such as exercise, massage, and socializing with friends.
"For this reason, we will be looking at offering them fun exercise classes they can attend with friends -- Zumba, yoga -- and connecting them to inexpensive massage services at local massage schools," said Pagoto. "The research on the benefits of both exercise and massage on mood is quite strong so we think that if we can get tanners 'hooked' on these behaviors, they may drift away from tanning as a way to unwind and reduce stress."
"For Some, Tanning is a Serious Addiction" originally appeared on Everyday Health.
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