Thursday January 17 2013
Sunbed UV levels varied significantly across England
'Research reveals nine out of ten sunbeds break safety rules,' ITV News has reported.
This headline is based on a survey of more than 400 sunbeds and artificial tanning units throughout England. Sunbeds tan the skin by emitting ultraviolet (UV) radiation. Exposure to UV radiation is acknowledged as a cause of cancer.
In Britain, safety standards have been introduced that set an upper limit on the amount of UV radiation that sunbeds produce (no more than 0.3 watts of energy per square metre). The researchers report that it is difficult to monitor compliance with this standard.
With this concern in mind, researchers set out to compare this standard with actual UV radiation emissions from artificial tanning units across England.
They found that 89% of the units assessed exposed users to UV radiation levels higher than the maximum threshold set out by safety standards. The researchers found that in terms of skin cancer risk, the average exposure was 2.3 times that of the Mediterranean midday summer sun, with the worst "offenders" giving out up to six times as much.
This study suggests that compliance with UV radiation safety regulations among sunbed operators in England is poor, and that users are being exposed to UV radiation at levels higher than those deemed safe.
Advice that we at Behind the Headlines never get tired of repeating is, a fake tan is a far safer option if you want tanned skin.
Where did the story come from?
The study was carried out by researchers from the University of Dundee and was funded by Cancer Research UK.
It was published in the peer-reviewed British Journal of Dermatology.
While the news reporting on the study was well balanced and accurate, there was some disagreement among the headline writers about how much higher the skin cancer risk from sunbeds is compared with the midday sun.
Some papers chose to go with the average risk (twice, as reported in the The Daily Telegraph, Daily Mail and Daily Express), while others chose to focus on the maximum risk found by the researchers (a six-fold increase, as reported by the Metro and The Sun).
Still, as sunbed-associated cases of skin cancer are an entirely avoidable cause of the disease, and in some cases death, a certain amount of exaggeration could be forgiven.
What kind of research was this?
This was a cross-sectional survey of artificial tanning units (both sunbeds and vertical units – so-called "sunshine showers") across England. The International Agency for Research on Cancer, part of the World Health Organization, has classified sunbeds in their highest carcinogenic (cancer causing) risk category due to the ultraviolet radiation they expose people to.
This study did not directly assess the association between sunbed use and the risk of developing skin cancer. No participants were involved in the study and cancer rates were not directly observed. The aim of the study was to compare actual UV radiation levels to an established safety threshold.
For this aim, a cross-sectional survey is an appropriate study design. In order to assess the link between UV radiation exposure from sunbeds and future risk of skin cancer, a cohort study would be needed.
A European Standard on UV radiations levels was introduced in 2003. This was followed by 2009 regulations limiting the amount of UV radiation permitted in artificial tanning units in the UK and throughout the EU – no more than 0.3 Watts per metre squared (W/m2).
Regulation of artificial tanning varies throughout the UK. The researchers report that sunbed operators in England are not required to provide advice on the risks of UV exposure to customers.
While the operation of unmanned equipment is banned in Scotland, it is permitted in England, where customers of any age may access coin-operated sunbeds, despite a UK-wide ban on their use for those under the age of 18.
Licensing requirements for artificial tanning businesses vary throughout England, with some regions requiring operators to be licensed, while other regions have no such requirements.
The researchers set out to:
- investigate the intensity of UV radiation produced by tanning beds throughout England
- assess how many of these beds complied with the new safety standard
- use a skin cancer risk model to compare risk from a tanning bed with the risk of being exposed to the midday Mediterranean sun
What did the research involve?
The researchers collected information from 402 artificial tanning units located throughout the North, Midlands, southwest and London from October 2010 to February 2011 (after the introduction of new UV safety standards). They assessed UV radiation levels in three types of units: vertical, horizontal and high pressure.
The researchers used a device called a spectrometer to measure the intensity of the light emitted from each of the units. They then compared this measurement with the safety standard.
They used a mathematical model in order to assess the risk of skin cancer from each of the beds. This involved applying a non-melanoma skin cancer weighting factor to the measurements taken during their survey.
Such an approach allowed them to estimate the skin cancer risk posed by each of the beds over a period of time and compare this with the risk posed by natural sunlight when exposure times are the same (that is, one minute of UV radiation in a sunbed versus one minute of UV radiation exposure from natural sunlight).
In order to compare sunbed risk with natural sunlight, the researchers took a similar measurement in the middle of July at 12:30 local time in Thessaloniki, Greece.
Finally, the researchers compared average UV radiation levels between areas that require all tanning unit operators to be licensed and the levels seen in regions with no licensing requirements.
What were the basic results?
The researchers found that the average sunburn-causing radiation from the 402 testing units was nearly twice as high as the safety standard, and that only 11% of the assessed units were at or below the recommended limit.
When comparing the cancer risk from sunbeds with that of the midday summer sun in Greece, the researchers found that for each minute of exposure:
- the average artificial tanning unit in England poses a skin cancer risk 2.3 times that of the Mediterranean midday summer sun
- the maximum risk seen from an individual tanning unit in England posed a risk 6 times that of the July midday Mediterranean sun
- 10% of the tested sunbeds had radiation levels associated with 3.6 times the skin cancer risk of natural sunlight
Within London, there was no significant difference in UV radiation levels between businesses in boroughs that require licenses and those that do not. The study authors found that the average UV radiation level from tanning businesses in the Southwest, which has licensing requirements, were significantly lower than those seen in units from the Northeast, which has no licensing requirements, although all regions and boroughs had average levels above the threshold set in 2009.
How did the researchers interpret the results?
The researchers conclude that nine out of 10 of the sunbeds assessed exceeded the maximum UV radiation levels set out by recent EU standards, and that these beds pose a significantly higher cancer risk than the midday Mediterranean sun in the summer. They say that, "This situation is unacceptable and stricter control measures must be put in place."
This well-conducted and useful study suggests that, on average, the UV exposure from tanning units throughout England is higher than the recent standard level introduced throughout the EU, and that cancer risk from the average level of radiation seen across these units is more than twice that of the midday summer Mediterranean sun.
The researchers say that there is a recent trend of increasing UV levels, and that this coincides "with the development of new high-power sunlamps".
There are some discrepancies between the reporting of this research and the methods used in the study. Some newspapers reported the risk of skin cancer from sunbeds is twice as high as the Mediterranean sun, while others reported the risk as six times higher than natural sunlight.
The headlines reporting six times the risk are misleading, as this figure is based on a single sunbed that had the highest levels of UV radiation. This is an inappropriate interpretation of the data and results. While this is certainly not a healthy level of exposure, it does not represent the average exposure of sunbeds in England, as implied by the headlines, but rather one extreme end of the range of sunbeds tested.
At the other end, researchers found that a single tanning unit exposed users to 2.5 times less skin cancer risk than the Mediterranean sun. Neither of these results should be interpreted as representing the risk of sunbeds across England as a whole.
The researchers report that there have been inconsistent results regarding the association between sunbed use and skin cancer risk, with some studies finding a significant link between artificial tanning and melanoma, while others find no significant link. They report that a recent meta-analysis of 25 studies found that sunbed use increased melanoma risk by 20%, and that this was especially pronounced when sunbed use started before the age of 35 years.
Overall, this study suggests that sunbeds and other artificial tanning units in England may be exposing users to higher radiation levels than are deemed safe and levels that are higher than users expect.
Before using sunbeds, people should consider both the overall risk of UV radiation from UV exposure, as well as their individual risk of developing skin cancer. Better yet, it's probably better not to use them at all.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.