US tanning salons should close their doors to minors to protect them from skin cancer, a group of 60,000 pediatricians said Monday in a new policy statement.
With the move, the American Academy of Pediatrics joins the World Health Organization (WHO), the American Academy of Dermatology and other groups that are already pushing for a ban.
"There are more tanning facilities in the US than there are Starbucks or McDonald's," said Dr. Sophie J. Balk, who helped write the new statement for the American Academy of Pediatrics. "More than a million visits are made every day."
Since 2009, the International Agency for Research on Cancer, a part of the WHO, has classified tanning beds as cancer-causing.
Research shows people who start going to tanning salons before age 35 have a 75-percent increase in their chances of developing melanoma, the deadliest type of skin cancer.
The actual numbers remain small, however. In one large Scandinavian study, 24 out of every 10,000 young women who tanned regularly developed melanoma compared to 17 out of every 10,000 who had never or only rarely used a tanning bed.
But ultraviolet light - whether artificial or from the sun - also causes less dangerous types of skin cancer.
According to the Centers for Disease Control and Prevention, more than one million skin cancers are diagnosed every year in the U.S. and most of them are sun-related.
About one in 50 white people get melanoma at some point in their life, and the number has been climbing for the past three decades. Each year, about 8,700 Americans die from the disease.
"I see it as a very important public health issue," said Balk, a pediatrician at the Children's Hospital at Montefiore in Bronx, New York. "We're coming out very strongly for legislation that supports banning minors' access to tanning salons."
Surveys have found that nearly a quarter of white teenagers in the U.S. have tried indoor tanning at least once. And many do it regularly.
"Mothers and daughters tend to go tan together," said Dr. June K. Robinson, a dermatologist at Northwestern University in Chicago, who is not affiliated with the American Academy of Pediatrics (AAP). "It's like going to the beauty parlor."
A member of the American Academy of Dermatology, which also supports a ban for minors, Robinson compares tanning to cigarettes and alcohol.
"It's banning things we know have health downsides for people who are not able to make an informed choice at this point in their life," she told Reuters Health.
Eleven states already have tanning restrictions for kids, but none goes as high as 18 years, according to the National Conference of State Legislatures.
Parental permission is a more common requirement, found in 31 states, but Robinson said it had turned out not to be very effective.
"The problem with parental permission is that children have a way of wheedling their parents into letting them go," she said.
The Indoor Tanning Association, which represents the industry, said government intervention was unwarranted.
"The decision whether or not a teenager suntans should be left to his or her parents," Executive Director John Overstreet told Reuters Health by e-mail. "It would be premature for the government to weigh in against an industry that is made up largely of women owning small businesses that employ tens of thousands of people."
The AAP's policy statement, which appears in the journal Pediatrics and is accompanied by a technical report, also warns against sunbathing - even relaxing in the shade when the sun is high (from 10 am to 4 pm).
"A fair-skinned person sitting under a tree can burn in less than an hour," the statement notes. "Clouds decrease UV (radiation) intensity but not to the same extent that they decrease heat intensity and, thus, may promote a misperception of protection."
To protect against the sun, the AAP recommends wearing clothing and brimmed hats and applying generous amounts of sunscreen - factor 15 or higher, every two hours and after swimming.
Sunscreen isn't perfect, and some of the ingredients may end up in breast milk. Still, slashing cancer risks outweighs that theoretical concern, according to Balk.
Neither Balk nor Robinson has ties to the sunscreen industry, they said.
Some people worry that avoiding the sun will decrease the body's levels of vitamin D, which is produced in the skin during sun exposure. Vitamin D is important for bone health. The AAP recommends getting it through the diet instead.
"There are ways to get vitamin D without harming your skin," said Balk, such as eating fish or taking supplements.
But what about those bronzy looks?
"I like to encourage my patients to appreciate who they are and their natural beauty without doing something that is going to potentially harm them," Balk told Reuters Health.
But that's not always easy, added Robinson, who often talks to teenage girls worried about their tan.
"We have to give them alternatives that allow them to still feel good about themselves," she said, noting that self-tanning lotions have been fairly successful. While prices vary widely, some cost less than $10.
The active ingredient in tanning lotions - called dihydroxyacetone - has been approved by the U.S. Food and Drug Administration since 1973, with no harms reported. However, the FDA has not green-lighted the ingredients in tanning pills, which may in fact be harmful, according to the American Cancer Society.
Another tactic she uses with teenage girls is telling them about skin aging, which is sped up by ultraviolet light.
"When you're trying to change someone's behavior," Robinson said, "wrinkles trump skin cancer!"