Tanning addiction? Study finds many can't stop, even after cancer

Even after being diagnosed with skin cancer, a stunning one in seven patients will go back to a tanning bed, new research has found -- suggesting that for some, tanning can become almost an addiction.

The study, which appears in a recent edition of JAMA Dermatology, focused on 178 skin cancer patients from Connecticut who had admitted to going to tanning salons before they were diagnosed.

All the patients were white or non-Hispanic, most were women, and all been diagnosed with basal cell carcinoma, the most common form of all cancers.

Four years after their diagnosis, the patients filled out an online survey and 26 reported having returned to indoor tanning. The median number of times they had tanned that year was 10, though some reported going as many as 20 times.

The patients who admitted tanning the most often before their bouts with cancer were also the most likely to still be visiting tanning salons after, the researchers found.

As well, among those who returned to tanning salons, 58 per cent showed signs of "tanning dependence" -- a rate much higher than those who stayed away from tanning beds afterward.

Dr. Richard Langley, the president of the Canadian Dermatology Association, says he has seen many patients who have developed skin cancer and yet continue to tan -- either in the sun or in tanning booths.

"What's always surprising, both in this study and in prior research, is that the people who have a diagnosis of skin cancer -- the ones who should be the most vigilant because they have been educated about skin cancer -- are often the ones who are continuing to expose themselves to a known carcinogen," he said, speaking from his office in Halifax.

Langley notes that anyone who has been diagnosed with skin cancer is at a higher risk of getting skin cancer again, including the most lethal form, melanoma.

So he says it's hard to explain why so many skin cancer survivors continue to take chances.

"A patient with a cancer diagnosis from a known carcinogen who continues to expose themselves to that carcinogen is often in denial," Langley says. "That's a prominent sign of dependency."

Some of the patients he speaks to, for example, refuse to believe that ultraviolet radiation from the sun or tanning lights can lead to skin cancer; he says they're simply in a "state of disbelief."

Others will rationalize their diagnosis by insisting that cancer runs in their family.

The problem for many regular tanners, he says, is they get hooked on the feeling of being tanned.

"Patients will often describe that it feels good when they get sun exposure or go to a tanning salon … They talk about needing to do it and craving it, and when they don't do it, a feeling of withdrawal," he says.

Those are all signs of a psychological dependence to tanning, he says.

There is even some research suggesting that some people can become physically addicted to the endorphins emitted during UV light exposure.

While the jury is still out on how real physical tanning addiction is, Langley says doctors are starting to accept the idea of psychological dependence.

"I think it's still under-recognized, in part because it hasn't been well documented in the medical literature," he says, noting there have probably been fewer than 10 published studies or articles on the phenomenon.

"However, those of us in the (dermatology) field certainly have recognized it for some time."

Langley says he often sees patients who are referred to him by their family doctors, who have grown concerned with how tanned or damaged a patient's skin looks.

He says when he talks to these patients about their risk for cancer, he tries not to lecture. Instead he uses "motivational interviewing" techniques to encourage a patient to recognize the problem for themselves and to make the decision on their own to change their behaviour.

Langley says basal cell carcinoma is not something to be taken lightly. While it's true that form of cancer has a high recovery rate, the surgery needed to remove the skin cancer can be painful and disfiguring, particularly if the disease occurs on the nose or the face. If it occurs near the eyes, it can result in the need to remove the eye.

"It has a high recovery rate but it causes significant morbidity," he says. "It's like a bulldozer; it invades deep down into tissues, and destroys tissues."