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KEY POINTS

In a move aimed at protecting public health, the Chartered Institute of Environmental Health (CIEH) has called on local authority leisure centres to ban the use of sunbeds on their premises.

Both the sun and sunbeds emit UV rays (UVA and UVB) that penetrate deeply into our cells and can cause gene damage. This damage can trigger the development of cancer.

UVA is the predominant form. Long-term exposure is known to lead to skin cancer.

UVB can cause redness and burning. Exposure is a risk factor for both non-melanoma skin cancers and malignant melanoma.

Many health experts support the notion that sunbeds shouldn't be used as a tanning method, especially by people considered to be at "high risk".

However, some people are concerned that banning sunbeds completely from areas that are regulated may make people go to unregulated sun salons instead. This could endanger their health even more.

For those who yearn for a tan, a safer method is to use tanning lotions.

Should sunbeds be banned?

Bupa investigative news - 30 September 2003
written by Rachel Newcombe, reporter for Bupa's Health Information Team, winner of Norwich Union medical journalism award 2004.

The safety of sunbeds has been a point of concern for some time, as it is thought that regular use is linked to an increased risk of skin cancer. In a bid to help protect public health, The Chartered Institute of Environmental Health (CIEH) has called on local authority leisure centres to ban their use on their premises. But how dangerous are sunbeds and could banning them really offer protection?

What were the headlines?

News of the potential sunbed ban was featured in a number of UK newspapers and websites, gaining headlines such as "Sunbed, sunbad", "Safety experts call for end of sunbeds in health centres", "Ban sunbeds and provide shade, councils told", "Councils urged to ban sunbeds" and "Sunbeds take a tanning from top health experts".

Reports varied from a brief look at the campaign to ban their use, through to a detailed examination of the pros and cons of using the tanning devices.

What is the bigger picture?

The call to ban sunbeds in local authority leisure centres was made at the annual conference of the Chartered Institute of Environmental Health (CIEH) in Belfast (23rd to 25th September). The CIEH believe local authorities should play a significant role in reducing skin cancer, something they believe can be achieved by banning sunbeds in local authority leisure centres.

About 65,000 cases of skin cancer are reported in the UK each year, with 2,000 proving fatal. Most cases are linked to sunburn or prolonged exposure to the sun and it's believed that sunbeds play a role too.

As Jenny Morris, policy officer at CIEH, explained, "Skin cancer is a major problem in the UK and by using sunbeds people are increasing the risk of contracting skin cancer, damaging their immune system and experiencing premature skin ageing. As a lead player in protecting public health, it seems wholly inappropriate for local authorities to make money from the provision of sunbeds. The CIEH calls on all local authorities to phase out sunbeds from their leisure facilities."

This isn't the first time the CIEH has made such a recommendation. Back in 1996, they issued policy guidelines suggesting that local authorities phase out the use of sunbeds within five years. At the time less than 5 per cent of authorities chose to withdraw the service. Since then sunbed use has soared in popularity and, in response to demand, some authorities have now reinstated the service.

"Unfortunately the belief that a suntan is healthy is a myth. A suntan is the skin's response to damage from UV radiation - from sunlight or sunbeds. Regular exposure to UV radiation is known to age the skin, causing sagging and wrinkles; and also increases the risk of skin cancer in the long term. The simple truth is that a suntan fades, but skin damage from tanning does not.

"If people are considering using sunbeds they should be aware of the risks as well as the perceived benefits before going ahead. However, if people do want to look bronzed, the good news is that fake tanning lotions offer great results without any UV radiation - this is one occasion when 'faking it' really is the better option."

Dr. Annabel Bentley,
assistant medical director,
Bupa Group

What does this mean?

A spokeswoman for Cancer Research UK (CRUK) told Bupa, "We would welcome any reduction in the number of sunbeds available. What we want to see is less people using them and being much more aware of the potential dangers of using sunbeds, especially young people."

As far as clinical evidence goes, she admitted that it is difficult to definitively prove that sunbeds are dangerous as "people don't only use sunbeds and then never go out in the sun". Because of this, it hard to separate the effect of sunbeds from that of the sun.

Despite that, a lot is still known about sunbeds and the negative effects they can have. "What we do know is that sunbeds, especially the more modern models, are adapted to mimic the sun's rays and often to intensify it. Users get a mix of UVA and UVB rays and, in half an hour on a sunbed, you'll get far more exposure than spending the same amount of time in the sun," she explained.

She added, "We know that both UVA and UVB rays can lead to all types of skin cancer, so it's only reasonable to assume that sunbeds will also increase your risk of skin cancer."

However, she expressed concern at a possible downside to the proposed ban. "If you look at it from another angle, there is a slight danger that removing sunbeds from leisure facilities overseen by local authorities might push people towards private sunbed salons that may be less well regulated. If that happens, it wouldn't be good."

The UK's Sunbed Association reacted strongly to the banning idea. Kathy Banks, secretary of The Sunbed Association (TSA), said, "I continue to be concerned at the ongoing attack against sunbeds. Let us be clear that there is absolutely no evidence to suggest that responsible use of sunbeds alone contributes to health concerns, including skin cancer. On this basis, I do not understand why local authorities would seek to remove a service that millions of UK adults avail themselves to each year."

Kathy admits that some people should avoid using sunbeds, but still believes that for the majority of people they're a safe method. "Our research shows that the primary reason for getting a tan is to feel and look good. There are a number of contraindications, which determine that certain groups of people should not or will not tan, either in natural sunlight or on sunbeds ... TSA has always been clear that these groups should never use sunbeds," she said.

"However," she added, "the majority of people can tan and TSA member facilities offer advice and control to ensure customers are tanning according to their skin's natural tanning ability."

A spokesperson for the Local Government Association, the organisation representing local authorities, said they'd continue to monitor the situation.

ACTION POINTS

Think carefully about the risks and benefits before using a sunbed, and consider alternative - and safer - tanning methods, for example self-tanning lotions.

If you do choose to use a sunbed, ensure the centre conforms to safety rules and regulations (such as the those of The Sunbed Association).

If you fall into one of the high-risk groups, do not use a sunbed.

What does this mean to me?

The British Medical Association (BMA) has been campaigning for some time for the Government to regulate the use of sunbeds for non-therapeutic purposes. They don't recommend the use of tanning devices for cosmetic purposes "because of the potential risks to health associated with their use". To see their full report, click on this link: BMA sunbed report.

Likewise, CRUK believe there's no such thing as a "safe level of use" and recommend avoiding sunbeds completely. The BMA's sunbed report points out that as well as raising the risk of skin cancer, the tanning devices can cause premature skin ageing and damage the corneas of the eyes. Although wearing protective goggles is recommended, some research has suggested many people don't bother.

There are three types of skin cancer, explain CRUK - basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Both basal cell and squamous cell carcinomas are forms of non-melanoma skin cancer (NSMC) and account for 90 per cent of cases in the UK. Malignant melanoma is more dangerous and rarer, but worryingly is the third most common cancer in 15 to 39 year olds and is rising every year.

In contrast to the BMA and CRUK, the TSA's Kathy Banks maintains that, if used sensibly, sunbeds can be a good method of achieving tanned skin. "What sunbeds can offer that the natural sun cannot is the ability to achieve a tan in a controlled environment, which means avoiding over-exposure to UV. Of course, this can only be assured when the sunbed is used responsibly," she explained.

"Responsible use means that the operator, their staff and the customers are aware and understand all the contraindications and act accordingly. TSA members operate to our very strict Code of Practice which includes the training of all staff to ensure that customers receive the right of information and avoid any risk of over-exposure to UV on equipment that is properly maintained and serviced," she added.

For people who do wish to use sunbeds, the British Photodermatology Group (BPG), part of the British Association of Dermatologists (BAD), recommends that it's best not to exceed two courses a year of no more than 10 sets of 30-minute sessions each.

There are still some people who should never use the tanning devices though and, according to the Health and Safety Executive document "Controlling the risks from the use of UV tanning equipment", these are:

  • People who have very fair skin
  • Under 16s
  • People who burn very easily or tan poorly
  • People with lots of freckles or moles
  • People who've had skin cancer or who have a family history of the disease
  • People taking medication that could make their skin more sensitive to ultra-violet light (such as tetracycline, chlorpromazine, amiodarone and quinolone drugs)
  • People who already have extensive ultra-violet radiation damage

An alternative method of gaining a "tan" is to use a self-tanning lotion. There are many options available, including products designed specifically for sensitive skin. Also, most will no longer turn you a streaky shade of orange.

Summary

As Cancer Research UK sums up, there's really no such thing as a safe tan if it has been gained from sunbathing or using sunbeds. At the moment it's unclear whether the banning idea will be taken up by local authorities, but what is clear is that regular expose to UVA and UVB can damage the skin and can confer a higher risk of developing skin cancer.

Links for more information