UV emissions from artificial tanning devices and their compliance with the European technical standard

Effect of the ultraviolet unweighted irradiance on the compliance of sunbeds in Spain

The use of tanning devices in Spain is regulated by the Royal Decree 1002/2002, which is based on the European standard EN60335-2-27. The European standard establishes that the total unweighted irradiance between 200 and 280 nm must not exceed 0.003 Wm-2, a requirement that the Spanish regulation modified to 0.03 Wm-2 from 250 to 295 nm. With these differences, the compliance consideration of an artificial tanning device can vary. Spectral irradiance measurements of 41 tanning devices performed with a high-resolution spectroradiometer were analyzed. None of the tanning devices had irradiances higher than 0.003 Wm-2 between 250 (the shortest wavelength measured by the spectroradiometer) and 280 nm, but the limit required by Spanish regulation was exceeded by 11 devices, of which one would have been considered compliant according to the European standard since the effective irradiance was lower than 0.3 Wm-2. Beyond noting the differences that can occur in sunbed inspections according to the established criteria, this work has shown the differences in the spectral and total values of devices in use in Spain, validating the need for periodic inspections.

Ultraviolet Radiation Exposure: Some Observations and Considerations, Focusing on Some Italian Experiences, on Cancer Risk, and Primary Prevention

Solar ultraviolet radiation may cause acute and chronic health effects on the skin, eyes, and also on the immune system. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects. In the white population, the most common type of cancer worldwide is skin cancer, and the incidence of this cancer has increased during the last decades. The most important risk factor responsible for this trend seems to be Ultraviolet Radiation (UVR). IARC has classified UVR as being carcinogenic to humans. UV radiation exposure is ubiquitous; to study skin cancer risk, it is important to take into account the fact that UV exposure may occur both for occupational activities but also during vacation or recreational activities. Furthermore, exposure to artificial UVR such as those emitted by artificial devices, classified by IARC as carcinogenic to humans, is also to be considered. Due to the prominent role of UVR, primary prevention of skin cancer is very suitable, because when following specific rules this risk factor can be reduced. The incidence rate of skin cancer is higher in people with fair skin. Outdoor workers exposed to solar UVR are at risk of developing skin cancer, particularly non-melanoma skin cancers, and welders exposed to artificial UVR are at risk of developing ocular melanoma. A specific project on solar UVR risk in outdoor workers in Tuscany, Italy, has shown that outdoor workers had an unsatisfactory sun protection behaviour. The project demonstrates the complexity of studying UVR exposure and recommended the need for prevention programs. Risk increases with increasing ambient solar radiation and with unsafe behaviours in the sun or when using artificial UVR (e.g., sunbeds). Effective prevention strategies have to be adopted both for the outdoor workers and for the general population exposed to UVR. A standardized program of proven efficacy, such as that implemented in Australia, should also be implemented in other countries. All these strategies could contribute to the aim of decreasing the morbidity and mortality of cancers associated with this exposure. The aim of this paper is to provide an overview of UVR exposure risk, particularly occupational risk, and to give some elements to understand the complexity of the relation between UVR exposure and cancer risk, as well as to outline primary prevention measures, focusing also on Italian experiences that could be useful for providing additional elements of knowledge on this topic.

Skin cancer projections and cost savings 2014-2045 of improvements to the Danish sunbed legislation of 2014

BACKGROUND

Sunbed use increases the risk of skin cancer. The Danish sunbed legislation (2014) did not include an age limit.

AIM

To model skin cancer incidences and saved costs from potential effects of structural interventions on prevalence of sunbed use.

MATERIALS AND METHODS

Survey data from 2015 were collected for 3999 Danes, representative for the Danish population in regards to age, gender and region. Skin cancer incidences were modelled in the Prevent program, using population projections, historic cancer incidence, sunbed use exposure and relative risk of sunbed use on melanoma.

RESULTS

If structural interventions like an age limit of 18 years for sunbed use or complete ban had been included in the Danish sunbed legislation in 2014, it would have reduced the annual number of skin cancer cases with 455 or 4177, respectively, while for the entire period, 2014-2045 the total reductions would be 3730 or 81 887 fewer cases, respectively. The cost savings from an age limit or ban, respectively, are 9 and 129 millions € during 2014-2045.

CONCLUSION

Legislative restrictive measures which could reduce the sunbed use exists. Danish politicians have the opportunity, supported by the population, to reduce the skin cancer incidence and thereby to reduce the future costs of skin cancer.

A Holistic Approach to Assessment of Population Exposure to Radiation: Challenges and Initiatives of a Regulatory Authority

A regulatory authority for radiation safety should continuously evaluate and improve the national safety framework, in line with current requirements and standards. In this context, the Greek Atomic Energy Commission initiated a series of concerted actions. The radiation dose to the population due to public and medical exposures was assessed. The assessment of dose due to public exposure was based on measurements of radon concentrations in dwellings, radionuclide concentrations in environmental samples, and air dose rates; the assessment of dose due to medical exposure was based on dose measurements for typical examinations or procedures and data on their frequency. The mean effective dose to a member of the population was found to be 4.5 mSv (1.8 mSv and 2.7 mSv from medical and public exposures, respectively). Regarding occupational exposure, aircrew dose assessment, eye lens monitoring, and the national dose registry were significantly improved. With respect to artificial tanning (sun beds), the ultraviolet radiation produced was assessed and the practices followed were observed. Results demonstrated exceedance of the 0.3 W m erythema effective irradiance limit set in European Union standards by 63.5% of the sun beds measured, along with general noncompliance with standards. An overarching activity was the upgrade of the Greek Atomic Energy Commission information system in order to collect and disseminate radiation data electronically, launch a networking strategy for interaction with stakeholders, and facilitate the process of regulatory control. In response to the above findings, regulatory actions have been initiated.

A strategic framework for the development and enhancement of safety culture in the artificial tanning sector in Greece

Herein, a strategic framework for the development and enhancement of safety culture in the artificial tanning sector in Greece is presented. This framework has been designed and promoted by the competent national regulatory authority, which is the Greek Atomic Energy Commission (EEAE). The aim is to ensure a common understanding regarding ultraviolet radiation (UVR) and artificial tanning among artificial tanning professionals, stakeholders and the general public. The strategic framework is founded on the recommendations of international organizations, EU requirements and the relevant technical standards. It comprises three autonomous but interconnected components: (A) a sunbed operators' e-training course and certification process; (B) a code of practice addressed individually to business owners, sunbed operators and sunbed users; (C) communication strategies aiming to raise awareness regarding UVR and artificial tanning among all interested parties. The artificial tanning safety culture framework presented here is the policy option undertaken by the EEAE and is embedded in the upcoming legislation and regulations for the provision of artificial tanning services in Greece. EEAE considers that the structure of the artificial tanning safety culture strategic framework will serve as a guide for the development and promotion of relevant strategic safety culture frameworks for the provision of aesthetic/wellness services utilising other non-ionising radiation sources, which do not currently exist.

Sunbeds' ultraviolet radiation measurements with different radiometers and criteria for compliance assessment set by the national competent authority in Greece

In order to ground the credibility of the sunbeds' ultraviolet radiation compliance assessment with the 0.3W/m(2) erythema effective irradiance limit, it is highly important to use reliable measuring equipment and to justify reasonably the measurement's result. Recently, the first surveillance action of the artificial tanning sector in Greece has been finalised. The action consisted of in situ erythema effective irradiance measurements from sunbeds at commercial premises offering artificial tanning services at various cities throughout Greece. Four different broadband erythemal weighted radiometers were used in order to compare them during in situ sunbeds' radiation measurements, at commercial premises, and to choose the most suitable one for compliance inspections. Furthermore a rationale has been introduced in order to compare the measurement's result with the limit, and decide about compliance or not, taking into account the measurement's expanded uncertainty. According to this approach, compliance, probable compliance or non-compliance is verified when the measurement's result taking into account the measurement's expanded uncertainty does not, probably or does exceed the 0.3W/m(2) limit, respectively. Ultraviolet radiation exceeded the 0.3W/m(2) erythema effective irradiance limit in 63.5% (33 out of 52) of the sunbeds and probably exceeded the limit in 11.5% (6 out of 52) of the sunbeds, according to the measurements performed with the radiometer which was chosen as the most suitable one and the proposed rationale for compliance justification.

Ultraviolet exposure from indoor tanning devices: a systematic review

Use of indoor tanning devices increases the risk of cutaneous melanoma and nonmelanoma skin cancer. Indoor tanning devices have become important sources of ultraviolet (UV) exposure, both UVB and UVA. This systematic review assessed UV measurements performed in indoor tanning devices related to irradiance level, wavelength distribution and similarities to natural sun. The study was performed in accordance with the MOOSE and PRISMA guidelines. We searched PubMed, Embase and Web of Science from inception to May 2015, and also examined the reference lists of the retrieved studies. Eighteen studies were included. Twelve studies examined the erythema-weighted UV irradiances of indoor tanning devices, 11 studies examined UVB and 13 studies studied UVA. Compliance with irradiance limits was reported in nine studies. Erythema-weighted irradiances were highest in the most recent studies. Most studies had mean values higher than from natural sun and with large variations between devices. All studies except two had mean unweighted UVB irradiances lower than from natural summer sun (at latitudes from 37°S to 35°N), while mean unweighted UVA irradiances were, with one exception, substantially higher than from natural sun. The high values of UVA exposure from modern tanning devices are alarming in light of the increased focus on UVA irradiance as a carcinogen, and as UVA exposure confers little protection against subsequent UV exposure.

Association Between Indoor Tanning and Melanoma in Younger Men and Women

IMPORTANCE

In the United States and Minnesota, melanoma incidence is rising more steeply among women than men younger than 50 years. To our knowledge, no study has examined age- and sex-specific associations between indoor tanning and melanoma to determine if these trends could be due to greater indoor tanning use among younger women.

OBJECTIVE

To examine associations between indoor tanning and melanoma among men and women younger than 50 years.

DESIGN, SETTING, AND PARTICIPANTS

Population-based case-control study conducted in Minnesota of 681 patients (465 [68.3%] women) diagnosed as having melanoma between 2004 and 2007, and 654 controls (446 [68.2%] women), ages 25 to 49 years.

EXPOSURE

Indoor tanning, defined as any use, first age of use, and total sessions.

MAIN OUTCOMES AND MEASURES

Crude and adjusted odds ratios (ORs) and 95% CIs were calculated for melanoma in relation to indoor tanning exposure for men and women by diagnosis or reference age (<30, 30-39, 40-49 years). Sex-specific associations for indoor tanning and melanoma by anatomic site were examined.

RESULTS

Compared with women aged 40 to 49 years, women younger than 40 years initiated indoor tanning at a younger age (16 vs 25 years, P < .001) and reported more frequent indoor tanning (median number of sessions, 100 vs 40, P < .001). Women younger than 30 years were 6 times more likely to be in the case than the control group if they tanned indoors (crude OR, 6.0; 95% CI, 1.3-28.5). Odds ratios were also significantly elevated among women, ages 30 to 49 years (adjusted OR, 3.5; 95% CI, 1.2-9.7 for women 30-39 years; adjusted OR, 2.3; 95% CI, 1.4-3.6 for women 40-49 years); a dose response was observed among women regardless of age. Among men, results by age were inconsistent. The strongest OR for indoor tanning by anatomic site was for melanomas arising on the trunk of women (adjusted OR, 3.7; 95% CI, 1.9-7.2).

CONCLUSIONS AND RELEVANCE

Indoor tanning is a likely factor for the steeper increase in melanoma rates in the United States among younger women compared with men, given the timing of when women initiated indoor tanning relative to diagnosis. The melanoma epidemic can be expected to continue unless indoor tanning is restricted and reduced.

Melanoma Epidemiology and Prevention

The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as high-penetrant genes, moderate-risk genes, or low-risk genetic polymorphisms. Subtypes of tumors, such as BRAF-mutated tumors, have different risk factors as well as different therapies. Prevention of melanoma has been attempted using various strategies in specific subpopulations, but to date optimal interventions to reduce incidence have not emerged.

Effective ultraviolet irradiance measurements from artificial tanning devices in Greece

Artificial tanning remains very popular worldwide, despite the International Agency for Research on Cancer classification of ultraviolet (UV) radiation from sunbeds as 'carcinogenic to humans'. Greek Atomic Energy Commission has initiated a surveillance action of the artificial tanning devices in Greece in order to record the effective irradiance levels from the sunbeds and to inform and synchronise the domestic artificial tanning business sector with the requirements of the European Standard EN 60335-2-27:2010. In this direction, in situ measurements of UV emissions from sunbeds in solaria businesses all over Greece were performed from October 2013 until July 2014, with a radiometer and a portable single-monochromator spectrophotometer. Analysis of the measurements' results revealed that effective irradiance in ∼60 % of the measured sunbeds exceeded the 0.3 W m(-2) limit value set by EN 60335-2-27:2010 and only 20 % of the devices could be categorised as UV type 3.

Chemopreventive mechanism of polypeptides from Chlamy Farreri (PCF) against UVB-induced malignant transformation of HaCaT cells

To investigate polypeptide from Chlamy Farreri (PCF)'s protective effect against skin cancer, we used a cellular model of ultraviolet B (UVB)-induced malignant transformation. The human keratinocyte cell line HaCaT was repeatly exposed to UVB (10 mJ/cm(2), 20 times) and malignant transformation was confirmed by Gimesa staining, cell cycle analysis and various assays [anchorage independent growth, matrix metalloproteinase-9 (MMP9) activity, plating efficiency]. The malignant transformation was found to be effectively prevented by PCF pretreatment (2.84mM for 2h prior to each UVB exposure). We investigated the mechanism of PCF-mediated action by determining its effect on DNA methylation status of the tumour suppressor genes [P16 and ras association domain family 1 A (RASSF1A)] in the UVB-transformed cells. Both genes were found to be hypermethylated by chronic UVB exposure. The expression levels of P16, RASSF1A, DNA methyltransferases (DNMTs) and DNA damage inducible protein a (GADD45a) were measured by reverse transcriptase-polymerase chain reaction and western blotting. While chronic UVB exposure was found to suppress the expression of P16 and RASSF1A, it enhanced the expression of DNMT3b. In the early phase of UVB-induced malignant transformation, the GADD45a expression was increased, however, it declined with a continued irradiation of the cells. The UVB-induced DNA hypermethylation of P16 and RASSF1A and subsequent gene silencing was reversed by PCF treatment. The inhibition of DNMTs expression suggested that PCF blocked DNA methylation and thereby the silencing of tumour suppressor genes. Furthermore, the PCF-mediated substantial increase in GADD45a expression indicated that PCF promoted demethylation of tumour suppressor genes via GADD45a induction.