September 22, 2014
Barton Bonn, President
American Suntanning Association
PO Box 1907
Jackson, MI 49204
Dear Mr. Bonn,
We have reviewed the materials submitted with your Information Quality request and the information presented on the CDC website regarding indoor tanning. CDC is committed to ensuring that the information presented to the public on its website and in other materials is accurate and represents the best available scientific evidence.
The Information Quality Request for Correction recommended the removal of the following sentence from CDC’s website: “Indoor tanning is particularly dangerous for younger users; people who begin tanning during adolescence or early adulthood have a higher risk of getting melanoma.”
The scientific evidence upon which the statement based includes epidemiological studies, systematic reviews, and meta-analyses. A number of studies have consistently demonstrated an association between indoor tanning and increased risk for melanoma. The risk increases the more an individual uses indoor tanning, with younger and more frequent users having more steeply increased risk.1-9 Initiating indoor tanning at younger ages appears to be more strongly related to lifetime skin cancer risk, possibly because of the accumulation of exposure over time from more years of tanning.2,4,6,7 The magnitude of increased risk with younger age at initiation varies because of differences in collection and reporting of data, but studies consistently show an increase in risk. Risk estimates are based on a compilation of data from U.S. and international studies from different settings.6,7 For example, one 2010 U.S. study found that ever using indoor tanning before age 18 increased risk of melanoma by 85% compared with never indoor tanning; risk for those aged 18–24 years increased by 91%.4 Years of use of tanning devices appeared to be the strongest predictor of increased risk in this study, with increased risk of 47% with 1 year of indoor tanning, 64% with 2–5 years of indoor tanning, 85% with 6–9 years of indoor tanning, and 145% with 10 or more years of indoor tanning.4 Harms of indoor tanning may be accelerated for adolescents and young adults, leading to early-onset skin cancers.3,10,11
1. International Agency for Research on Cancer, World Health Organization. Exposure to Artificial UV Radiation and Skin Cancer. Lyon, France: International Agency for Research on Cancer;2006.
2. International Agency for Research on Cancer Working Group on Artificial Ultraviolet (UV) Light and Skin Cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Cancer. Mar 1 2006;120(5):1116-1122.
3. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. J Am Acad Dermatol. Oct 2012;67(4):552-562.
4. Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Biomarkers Prev. Jun 2010;19(6):1557-1568.
5. Gandini S, Stanganelli I, Magi S, et al. Melanoma attributable to sunbed use and tan seeking behaviours: an Italian survey. Eur J Dermatol. Jan-Feb 2014;24(1):35-40.
6. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012;345:e4757.
7. Boniol M, Autier P, Boyle P, Gandini S. Correction: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012;345:e8503.
8. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012;345:e5909.
9. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol. May 2014;70(5):847-857.e018.
10. Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer. May 15 2011;128(10):2425-2435.
11. Karagas MR, Zens MS, Li Z, et al. Early-Onset Basal Cell Carcinoma and Indoor Tanning: a population-based study. Pediatrics. Jun 23 2014.
Based on our review of the evidence and the extensive literature supporting the link between indoor tanning and skin cancer, particularly for individuals who begin indoor tanning at younger ages, the information is correct as currently presented on the website. Thank you for your interest in this important issue and allowing us clarify that the evidence consistently supports our statements about the risks of indoor tanning.
If you wish to appeal this response to your request for correction, you may submit a written appeal or electronic request for reconsideration within 30 days of receipt of our response. The appeal must state the reasons why the agency response is insufficient or inadequate. You must attach a copy of your original request and the agency's response to it. Also, clearly mark the appeal with the words, "Information Quality Appeal" and send the appeal to the following address:
Centers for Disease Control and Prevention
Management Analysis and Services Office
1600 Clifton Road, NE, Mailstop F-07
Atlanta, Georgia 30333
Fax: (770) 488-4995 or Electronic Mail: InfoQuality@cdc.gov
Samuel Posner, Ph.D.
Associate Director for Science
National Center for Chronic Disease Prevention and Health Promotion
Pamela Protzel Berman, Ph.D., Acting Director
Greta Massetti, Ph.D., Associate Director for Science,
Division of Cancer Prevention and Control