This article was originally published in Maclean’s magazine on June 27, 2005. Partner content is not updated.
Tanning Still Popular, Despite Cancer Risk
IN WINTER, if there's something special going on - a friend's birthday party, say, or a family gathering at Christmas - Norah-Jean Howard, 19, heads to the tanning salon for a little colour. These days, though, Howard might join friends around the pool, or maybe at the trampoline in the backyard, to make sure she keeps that sun-kissed glow for a Saturday night out on the town. She finds a tan from the sun better looking than the ones she gets indoors, or what she and her friends call the "steak and bake" look. The alternative - pallor - is no alternative at all. The Oakville, Ont., woman, who's working part-time in a sporting goods store this summer and returning to school in the fall, doesn't spend a lot of time worrying about skin CANCER. "Nowadays, you can get cancer from anything," says Howard. "I've always noticed Christina Aguilera - when she had her darker hair, she was always so tanned. Lindsay Lohan started looking really tanned, too, and I heard Britney Spears had, like, a tanning bed on her tour bus. So I was like, 'If all these celebrities are doing it, I mean, why can't I?' "
The Canadian Dermatology Association says, "No tan is a good tan," since all exposure to solar radiation - whether from the sun or a tanning lamp - damages the skin to some extent. To the sun-obsessed, you might as well be saying, "No air is good air." Young people, especially, have re-embraced tanning with a vengeance, heading to tanning salons and, in warm weather, soaking up the sun. Last month, the American Academy of Dermatology released a survey indicating 79 per cent of youths between 12 and 17 know suntanning can be dangerous. And 81 per cent recognize that sunburns during childhood up the risk of skin cancer. Yet 60 per cent said they burned last summer. It gets worse: while more than a third of those surveyed said they knew someone who had skin cancer, almost half said people with tans look healthier.
Teenage boys are the worst offenders, with only 32 per cent of those 15 to 17 reporting they're either very or somewhat careful under the sun. "This lax behaviour could explain findings from a previous study published in the January 2003 issue of the Journal of the American Academy of Dermatology in which older white men had a higher incidence of skin cancer," the academy reported.
A new generation of bronzed entertainment and beauty icons is making the tan chic again. Say what you will about Canadian Idol host Ben Mulroney - and there's lots to say - but the guy's an ambassador for the tanned TV glamour set, such as it is in this country, sporting a perpetual amber hue while he blithely mocks his love affair with tanning beds. Further afield, the real glamour queens of the new brown-is-beautiful set include the ubiquitous, café au lait-coloured Paris Hilton, Jennifer Aniston, a.k.a. the "golden girl," bronzed Brazilian supermodel Gisele Bündchen, and Charlize Theron, who had a celebrated tanning-malfunction at last year's Oscars. Theron's fake tan - one commentator remarked she looked like an "over-baked gingerbread" - still served to underscore a growing subset of the current tanning culture: adherents to the sunless spray-on glow.
While observing that the "deep, dark sort of Bain de Soleil look we remember from the '70s is not haute any more," Flare beauty editor Juliette Lie confirms that a "natural, nice, glowing look" is currently de rigueur. "Sort of like the one J. Lo or Jessica Simpson walk around with," she adds. The skin-cancer scare, though, has some turning to the bottle instead of baking, says Lie. "I think there's just this undeniable link with looking healthy and sexy. You go to South Beach, South America, Spain, Italy, you see all these people with beautiful, dark olive skin and it's really sexy. You can't help but be attracted to it, whether it's good for you or not."
We North Americans are chasing UV radiation more vigorously than ever. According to Statistics Canada, Canadians last year made almost 1.5 million trips to countries in the Caribbean for stays of one night or more, a searing 74-per-cent increase over the 860,000 visits made in 2000. Similarly, the US$5-billion tanning-salon market in North America has shown phenomenal growth, going from fewer than 10,000 outlets in the early 1990s to about 50,000 today. "Gold equals healthy and white equals ill," says Daniel Maes, vice president of global research and development for Estée Lauder in Melville, N.Y. "Nobody wants to deal with people who look ill. This is what pushes people to go lie down on a beach and get burned. They look around and everybody looks better than them."
Meanwhile, recent medical reports about the benefits of sun exposure have people taking off their sun hats and scratching their heads. Some recent studies associate ultraviolet light with a decrease in certain cancers. For many sun-worshippers, fed up with being told what they do is bad for them, that news has virtually wiped out two decades of warnings about the dangers of tanning.
The discovery of the ozone hole above the Antarctic in the mid-1980s signalled to many it was time to cover up or risk skin cancer. Broad-brimmed hats, long-sleeved shirts, baby strollers decked in blankets, and sunscreen with a sun protection factor (SPF) of 60 became the height of practical fashion for conscientious parents. Mom and dad covered up, too. Goofy Tilley hats - part African safari pith helmet, part outdated fedora - could be spotted perched incongruously on men and women in business suits striding purposefully to work in financial districts across the country. The sun was taboo.
But lots of people - especially young ones - now seem inured to scientists' warnings. Sun is the new tobacco: it's a bad habit; when we quit, we can't seem to stay quit; and tans are cool. Narmin Hasanova, 20, just graduated from high school and now works part-time as a waitress in a Greek restaurant. The Torontonian, originally from Azerbaijan, is a person of colour, but like many of her friends she doesn't feel right if she isn't darkened by a tan. She's been hitting a tanning salon for three months now, three or four times a week. "A dark skin colour gives me a feeling of, like, power or sexiness," explains Hasanova. "I feel more attractive." And as with so many other young people, celebrities are her role models. "Beyoncé is dark skinned, but she still gets tanned, that's what I heard. All these celebrities getting a tan gives us students the hope to look, in some ways, like them."
Astonishingly, Hasanova feels the way she does despite the fact a friend, just 19, has been diagnosed with skin cancer. "To be honest, I've thought about it. I know I might get skin cancer, but sometimes - especially when you go to parties - you just want to look good no matter what," says Hasanova. "I'd rather look good than worry about what can happen to me - looks are more important to me sometimes than my health."
For anyone eager to get a tan - and risk getting skin cancer as well - this summer is shaping up to be a great one. Environment Canada says the outlook is for temperatures warmer than usual right across the country. Precipitation, tougher to predict, is expected to be below normal despite recent downpours in Alberta. At the same time, the ozone layer needed to filter the sun's harmful rays is anywhere from one to eight per cent below its normal level across Canada. "There's no clear evidence for how much sun is safe," says Dr. Richard Langley, director of research in the division of dermatology at Dalhousie University in Halifax. "We know the sun is a carcinogen, but how much is safe? It's kind of analogous to asking how many cigarettes a day can you smoke."
IT HASN'T always been like this. In the 19th and early 20th centuries, pale was in. European women would casually twirl frilly parasols to shield themselves from the sun, notes Stephen Katz, a sociology professor at Trent University in Peterborough, Ont. Back then, if you showed up in public with a tan, a man could be mistaken for a field hand, and a woman for a prostitute. "Tans were labour tans," explains Katz, "and not leisure tans like they are today." In the early 1920s, "sun therapy" became popular and was prescribed for everything from fatigue to tuberculosis. Also in the '20s, fashion fixture Coco Chanel made a splash with her divine golden hide, compliments of the French Riviera. Baby oil hit the scene in the 1950s, and in '53 Coppertone unveiled its iconic ode to the tan - and one of the advertising world's most recognized trademarks - the little blond girl with pigtails and the cocker spaniel tugging at her bathing suit.
Silver metallic UV reflectors were common tan enhancers by the late 1950s, and the '60s revelled in the sand-and-surf ethos epitomized by the Beach Boys. Then, the Me Decade of the '70s gave rise to the tanning bed. A bronzed and perky Farrah Fawcett gleamed from posters on the walls of many a teenage boy. In '79, sun-meister George Hamilton became the first actor to portray Dracula with a tan, in Love At First Bite. Also that year, Bo Derek scored a perfect 10 for tanning and other attributes in 10. In the 1980s and '90s, tans took a hit, when the world looked up to realize the ozone roof over our heads was raining down radiation.
But by the late 1990s, while many continued to be mindful of the sun's harmful effects, all seemed right again in celebrity land, particularly when Bündchen hit the scene. Soon afterwards Britney Spears and Jennifer Lopez appeared all nice and brown. Aniston gleamed on Friends. By 2003, spray booths offering guilt-free tans took off. "Tans are what sociologists call a signifier, or a sign, because here we have something that doesn't really mean what it means," says Katz. "Unlike good posture, and an appropriate weight, having a tan does not mean you're healthy - at all. It is the 'sign' of health, or myth of health, ruggedness, being outdoors, as well as a sexual sign."
SKIN CANCER is the most common type of cancer in Canada, accounting for one-third of all diagnoses of the disease, with 82,400 cases forecast for this year. There are three kinds: basal, squamous and melanoma. Basal and squamous are less serious and far more common than melanoma, and will account for roughly 78,000 cases in 2005. They're usually treated without hospitalization. But the incidence of melanoma, with 4,400 diagnoses and 880 deaths projected for this year, has risen alarmingly - an average of 2.4 per cent a year in men and 1.8 per cent in women since 1992. Various cancer agencies agree: since sun exposure is linked to most skin cancers, reduced exposure to ultraviolet radiation would cut the number of new cancer cases to the same extent that quitting smoking cuts cancer in tobacco addicts.
Deborah Kellett grew up in Ontario and spent a lot of time sunning herself, slathered in baby oil, in cottage country north of Toronto. Kellett, 47, has olive-toned skin and generally didn't burn. Today, she lives in Bedford, N.S., and has had a year to think about her cancer. She had been keeping an eye on a spot on her back, just below her armpit and above her bra line, for a few years when her family physician noticed it had grown. Kellett was in to see a specialist within a week, and a week after that, the dermatologist used a local anaesthetic and removed the growth, which was about the size of a baby fingernail. Her prognosis - like any melanoma caught early - is very good. "I always thought I was safe - I was proud of the way I would tan - but I basically tell people that it's not worth it," says Kellett. "Get a tan out of a bottle - you're a lot safer that way."
Sun suppresses the immune system. It works this way: dendritic cells with amoeba-like arms fight infections and are found in tissues throughout the body. They surround and swallow the infectious agent and deliver it to T cells, which trigger an all-out attack on the infection and also immunize the body against future assaults. The sun, however, "down regulates" dendritic cells, preventing their activation, says Bhagirath Singh, scientific director of the Institute of Infection and Immunity in London, Ont. "Dendritic cells are really the central mechanism of the immune orchestra," says Singh. "They control how the immune system will mobilize."
Recent research, however, suggests there's a flip side. It urges people to get at least 15 minutes of unprotected exposure to sun a couple of times a week so the body can make enough vitamin D, which is said to combat cancers including breast, colon, ovarian and prostate. But a single study or even a few are rarely sufficient for making definitive declarations. It takes a substantive body of research, the kind that already exists and so clearly links sun exposure to skin cancer, says Langley. "Unfortunately, you've got compelling scientific evidence that sun can generate skin cancers, and then you have all this soft science that has not been demonstrated in careful clinical studies. It's potentially misleading and can cause confusion about what people should do in the sun."
Meanwhile, the fine print in studies about the benefits of sunlight indicate exposure should be to only 25 per cent of your body surface area, roughly meaning your hands, arms and face. "Most people get that going to and from their car, or to get groceries in the summertime," says Dr. Jason Rivers, a professor of dermatology at the University of British Columbia and former national director of the sun awareness program for the Canadian Dermatology Association. "That's much different from somebody lying on the beach for three to four hours with a bikini on."
The seeds of many of today's cancers were sown decades ago, when we didn't know any better. Today, that's changed - or has it? Actually, the 1996 National Sun Exposure Survey, while dated, indicates we're slow learners. Those aged 15 to 24 spend the most time in the sun and rarely protect themselves. That same survey found half of adults had at least one sunburn during the previous summer. Similarly, 45 per cent of children under 12 had been sunburned at least once. Ron Szekely, the Montreal-based marketing director for L'Oréal Paris, says his company's research shows sun protection is used in only 51 per cent of Canadian households.
Even when people put on sunscreen, they often don't put on enough to get the desired SPF rating. That's why Canadian dermatologists have upped their recommendation of SPF 15 to SPF 30, says Rivers. "You can lead by example as a parent, so early education is important, sort of like the church," suggests Rivers. "If you brainwash someone early, they get enough guilt that they'll follow what you want them to do."
IT'S NOT ALL BAD NEWS. The tanning-bed industry is under mounting pressure. In March, the World Health Organization - noting that more than two million cases of skin cancer, of which 132,000 are malignant melanomas, occur worldwide each year - urged regulators to restrict artificial tanning with UV light to those 18 and older. Early this year, Health Canada took steps that will require manufacturers to toughen warning labels on tanning equipment.
There are safer alternatives to UV radiation. The spray-on tanning salons use dihydroxyacetone, a plant-based dye that adheres to the outer layer of the skin. Dermatologists stop short of recommending the practice, but it's better than the sun, and the chemical is safe, according to both Rivers and Langley. The fake tans don't, however, protect against the sun, so you still need a sunscreen. Meantime, tan-in-a-bottle products are going gangbusters. In 2004, the trade in all sunless tanners sold in drugstores and large retailers was worth $17.5 million in Canada, up 16 per cent from 2003, says L'Oréal's Szekely.
Even Coppertone is changing. It used to promote tanning; no one did it better. But John Mercaldi, product manager for sun care at Schering Canada Inc., Coppertone's corporate parent, says they're laying off the tanning market. "Honestly, we're not attacking the tanning product at all," says Mercaldi. "Our focus is protection."
UNDER A SCORCHING noonday sun in Toronto's Beaches neighbourhood, Jason Remenda, 34, languidly pushes his 21-month-old son Jaydn on a swing. Remenda, a parts manager for a Japanese car manufacturer, has a rare day off. He's wearing shorts, a baseball cap and a thick gold chain around his neck. His bare torso is a pristine white, and the only SPF lotion anywhere near him is on his son. It's his first time out this year, and he never uses sunscreen. Thoughts of skin cancer cross his mind only when someone asks him about it. "I'm getting up there in age," shrugs Remenda. "I'm going to die of some kind of cancer, right?"
A few feet away, lying in the sand along the north shore of Lake Ontario, Gillian Parker feels guilty for being caught out in the sun. The 24-year-old TV production assistant - fair-skinned, strawberry blond and freckled - usually doesn't sunbathe. But here she is, white and unprotected, although she says she's watching the time carefully. "I already know that I'll probably get skin cancer," says Parker, explaining how she's burned throughout her life. Four years ago, she fell asleep for 45 minutes in the sun and ended up with blisters all over her chin. Her mother has already had skin cancer - twice. "That's why I feel I'm pretty much doomed."
It's the cry of a tan addict. Many of us, especially young people, just can't say no to the kiss of the sun, even though it could be the kiss of death.
Maclean's June 27, 2005