The Hidden Truth In Sun-Scare Statistics

In December 2011, indoor tanning was hit by another Press-Release lambasting the use of tanning beds.

Indoor tanning and the risk of BCC“Indoor tanning associated with a 69% increased risk of skin-cancer”, was the headline of the Press-Release, followed by a description of the study from the Yale School of Public Health, Yale Cancer Center, and Yale University School of Medicine.

This title was (and still is) being echoed in all kind of on- and off-line media all over the worlds together with the statements condemning the use of tanning beds.

The real title of the report is: “Indoor tanning and risk of early-onset basal cell carcinoma” and it was published online December 8, 2011 (0190-9622/$36.00), copyright 2011 by the American Academy of Dermatology, Inc. (doi:10.1016/j.jaad.2011.11.940).

Since this looked like a typical sun-scare product, I set out to try to penetrate the popularized and polarized press-messages in order to see what was really said in the report.

To do that, I first had to spend 36 US$ to buy the report. Then, and since I am only a layman in statistics, I asked a specialist, Dr. Philipp Schapotschnikow, to review the report and the statistics presented in it.

One thing that immediately hits anyone (layman or specialist) reading the report, is the lack of peer-reviews. This means that neither the content nor the methods have been impartially evaluated and whatever is in the report should be considered to be biased information.

The second noticeable thing even for a layman is the figures themselves.

The study consisted of 376 participants, all gathered from patients with identified BCC (Basal Cell Carcinoma, i.e. Non-Melanoma skin cancer), and 390 control subjects.

This is how the basic statistics for use of tanning beds looked like:

Indoor tanning and risk_basic stat

This means that from the 376 patients diagnosed with BCC, 247 had ever sometime used a tanning bed and 129 had never used a tanning bed. From the control group (i.e. people without diagnosed BCC), 249 had ever sometimes used a tanning bed while 141 had never used indoor tanning.

Now, and just by looking at those basic numbers, it seems like there would not really be any significant difference between those with BCC and the control group. I mean, from the 390 persons in the control group, 249 had used tanning beds, obviously without attracting BCC. So, from where then, did the 69% increased risk came?

The answer is in the footnote:

y)Adjusted for age at diagnosis (continuous), body site (head/neck, trunk, extremity), gender, skin color (olive, fair, very fair), family history of melanoma and/or nonmelanoma skin cancer (yes, no), first exposure of season to 1 hour of summer sun (turn brown with no sunburn, mild sunburn followed by some degree of tanning, painful sunburn for a few days followed by peeling, severe sunburn with blistering), prolonged exposure to sun (very brown and deeply tanned, moderately tanned, only mildly tanned because of tendency to peel, only freckled or no suntan at all), and melanocortin 1 receptor gene nonsynonymous variants (0, 1, $2).

By adjusting the result to factors that are bound to give a certain outcome, the authors can present a statistically correct report.

As Dr. Schapotschnikow states in his review:

“The authors draw the conclusion that “Ever indoor tanning was associated with a 69% increased risk of early-onset BCC”. This conclusion is, in principle, correct, but it reflects only part of their findings. The full truth is that this increase of the risk is very unevenly distributed between different groups. For example, the increase of risk for men is found to be statistically insignificant. Moreover, the number 69% is very inaccurate.

The study has one really important result: The risk of early BCC onset increases by a factor 3- 6 for people who had multiple burns from indoor tanning; especially if there were multiple burns on the same part of the body. In contrast, the association between indoor tanning and early BCC onset for the rest is small to statistically insignificant for other patients.

The authors also make a very strong statement: “Approximately one quarter (27%) of early-onset BCCs (or 43% among women) could be prevented if individuals never tanned indoors.” It is not clear from the paper where these figures come from. Furthermore, this statement is much more restrictive than it needs to be. It would be sufficient to compute the number of early-onset BCCs that could have been avoided when individuals stopped indoor tanning after their third burn or after their second burn on the same place. For all other individuals, it would have had very little effect whether they tanned indoor or not.”

Dr. Schapotschnikow also comments on the data-collection:

“… At this point, one may argue how trustworthy the data are. A lady at 38 (representative for a large number of patients!), having a couple of kids, and with a few relationships and jobs behind her, may not exactly recall how much time she spent in the tanning cabin over the past 20 years, or whether she ever had burns. Healthy patients may  underestimate (or simply forget) such things. Patients with BCC onset, on the other hand, may slightly overestimate these data. This effect is called recall bias, and the authors correctly state that it may distort the true statistics. …”

And …

“The group of patients with positive test has distinctly different characteristics from the control group. These are people with fair skin and red or blond hair, who react more sensitively to sunlight. They are more likely to have skin cancer cases in their family, and to have genetic predisposition. In other terms, the two groups (cases and controls) are different.”

All in all, this evaluation of the hidden truth in the sun-scare report shows that it was made for a certain purpose, in this case most likely to fuel the prohibition side in the debate of legal restrictions for indoor tanning.

As always, my investigation also included to look at the authors of and contributors to the report. Even if the report states “Conflicts of interest: None declared”, doesn’t mean that they don’t exist.

Using Google to search for connections between the authors and the known sun-scare contributors did not yield any immediate results. However, looking at this sentence in the report:

“acknowledge the following individuals for their overall support and assistance with the coordination of this project: Dr Jennifer McNiff, Robert Criscuolo, and James Platt from Yale Dermatopathology;  …”,

we find the interesting fact that James T. Platt from Yale Dermatopathology, in the end of 1990 patented “Cosmetics Melanin” as “… methods for preparing cosmetic melanins and methods for using these compositions topically to produce a natural-appearing tan and to prevent damage to skin caused by UV exposure.”

This patent was the base for the commercial substance “MelaSyn™”, licensed to a company “Vion Pharmaceuticals Inc.”, in which James Platt has (or at least had) an ownership.  MelaSyn™”, was one of the main ingredients in cosmetics made by the company “Dermablend” which later was bought by L’Oréal (through Vichy Laboratories).

In my opinion, a person with financial interests in a substance that artificially darkens the skin must of course consider any natural method of tanning as a competitor. And again we see here an example of financial ties between a sun-scare report and L’Oréal, the world’s largest manufacturer of chemical sun-protection cosmetics and the founder of the sun-scare campaign.

Looking further into the names behind the report, we find another interesting connection.

This is how the ownership to the report is described:

“From the Yale School of Public Health, Yale Cancer Center, and Yale University School of Medicine. Supported by the National Cancer Institute of the National Institutes of Health (1P50 CA121974 Yale Specialized Program of Research Excellence in Skin Cancer, Principal Investigator: R.Halaban; 1F32 CA144335) and a Clinical and Translational Science Award Grant from the National Center for Research Resources of the National Institutes of Health (UL1 RR024139). Conflicts of interest: None declared.”

So let’s take a closer look on the potential conflicts of interests for the Principal Investigator Dr. Ruth Halaban.

In 2011, Dr. Halaban received a reward from the INTERNATIONAL FEDERATION OF PIGMENT CELL SOCIETIES (IFPCS). And who do you think are the main sponsors of IFPCS?  – Yes, you guessed right – L’Oréal (together with some other beneficiaries of the sun-scare propaganda: Johnson & Johnson, Clairol, Shiseido and Unilever).

Unfortunately the resources of the sun-scare lobby, thanks to the contributions from cosmetic giants like L’Oréal, by far exceed the resources of the representatives for common sense. And as long as journalists continue to spread the anti-tanning propaganda without doing even the basic research of facts, our rights to healthy tanning will continue to be neglected.

The statistics in the report referred to in this article could just as well be used as proof of the fact that regular and moderate (i.e. non-burning) indoor tanning while taking precautions for sensitive skin-types, does not lead to any increased risk for non-melanoma skin cancers (the most common and most frequently diagnosed skin-cancers).

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