Starting this July, people who visit tanning salons will be taxed an additional ten percent every time they buy a session, which has re-sparked the debate over the health costs that come exposure to the sun, and the ultraviolet light emitted from tanning beds.
The measure is part of the federal health care law that passed last month.The tanning industry says the tax is unfair, but public health groups say it's an effective way to discourage what they see as an unhealthy behavior.
Kevin Johnson owns nine Catch a Tan studios in the Twin Cities and said he feels under siege. In the past year his industry has come under increasing scrutiny.
"What are we doing that's wrong? Why are we being singled out? There's this myth or misconception in the marketplace, in the media, that indoor or outdoor or sun exposure causes cancer," Johnson said.
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Studies that show a relationship between tanning and melanoma get the most press, says Johnson. But he thinks the findings defy common sense. He's found plenty of reasons to be skeptical of the tanning and cancer link while searching the Internet.
"I printed off a whole bunch of studies," Johnson said.
Some of the internet articles praise the Vitamin D-boosting effects of tanning and say the practice could actually protect against certain types of cancers that are associated with Vitamin D deficiencies. Several other articles question the safety of chemicals used in some sunscreen products, suggesting that might be the cause of rising melanoma rates.
As far as Johnson is concerned, researchers have been too quick to implicate tanning beds.
"I've got pretty high moral standards, and I wouldn't do it if I felt I were hurting anybody," he said.
Researchers say the evidence linking tanning bed use to higher rates of melanoma is convincing, yet it's not perfect. Some studies show a strong cancer link, while a few others show virtually no increased risk.
DeAnn Lazovich, an epidemiologist with the University of Minnesota said that's a common research outcome, that's not as problematic as it may seem.
"If you do enough studies, you will have a few studies that show the opposite of what perhaps the majority show," she said.
In the case of indoor tanning, several of the most recent studies do show a strong association with melanoma. Lazovich said that makes sense based on what we already know about radiation from the sun.
"Even while the data is still being accumulated about indoor tanning as a risk factor...It just seems prudent to be cautious about using artificial indoor tanning," she said.
But some scientists believe there's already enough evidence to settle the debate over tanning and cancer risk.
Last summer the International Agency on Research and Cancer, based in France, asked a team of international researchers to review 20 studies on tanning beds and melanoma. The agency doesn't set health regulations, but its research often guides global health policy.
In addition to the 20 population studies, IARC researchers also looked at experimental studies using laboratory animals that were exposed to ultraviolet rays. Based on its review, the agency decided to classify UV-emitting tanning devices as a Group 1 carcinogen. That means that the devices are known to cause cancer in humans.
Beatrice Secretan is one of the researchers who worked on the literature review.
"Once we have made this decision, we really strongly believe in it," Secretan said.
Secretan said the population studies were convincing, but the experimental lab studies really helped validate the agency's decision because they clearly showed the damage to cell DNA.
"Experimental studies show that UV damages the cells and creates lesions in the DNA and these lesions can lead to cancer," Secretan said. "They are the same lesions that are produced by the UV that is irradiated by the sun."
But as compelling as that evidence is to Secretan and her colleagues, it's not clear if it's enough to convince tanning bed users to cut back on the practice.
Lisa Seeley of Maplewood has been coming to Kevin Johnson's tanning salon for eight years. She said she knows she's damaging her skin and she's not surprised to hear that she could be increasing her risk of getting skin cancer.
The only thing she said that might influence her decision to keep tanning is the ten percent tax scheduled to take effect in July. Tanning bed prices can range from $8 to $35 dollars per session depending on the technology.
"Depending on how much it is...I probably wouldn't do it anymore," Seeley said.
If it takes a tax to get Seeley to cut back on tanning, David Arons, with the Minnesota chapter of the American Cancer Society, is happy with that.
"You hope that if you make a harmful product more expensive, for some people it's going to discourage the same level of use," Arons said.
For example, higher taxes on tobacco products have dramatically reduced smoking rates. But Arons realizes that tanning could be different. The tax may not be as financially painful because unlike smoking, people don't usually tan every day.
Organizations like the American Cancer Society are pushing for even tougher regulations that would prohibit anyone under 18 from using tanning beds. A scientific advisory panel recently made that recommendation to the Food and Drug Administration. The FDA is reviewing the panel's advice.