Seventeen-year-old Sophia Ventresca used to drive herself to Body Images Tanning in Wilmington about four times a week.
But when the new year began, she had to bring her mother.
That's because new state regulations require parental consent for teens from 14 to 17 to tan. They also ban any child 13 and under from tanning without a prescription.
"My mom and I go tanning, but I know some of my friends' parents wouldn't approve of their daughters tanning," said Ventresca, a senior at Brandywine High School. "I think it's kind of smart, because I think parents should know what their kids are doing."
Local tanning salons don't take issue with the new rules, which threaten fines from $250 to $1,000. But they say opponents of the tanning industry -- such as some local lawmakers, dermatologists and members of the American Cancer Society -- have been misleading the public into thinking that tanning beds cause cancer without the evidence to back it up.
At least 31 states regulate the use of tanning facilities by minors, according to the National Conference of State Legislatures. One county in Maryland recently banned indoor tanning for all minors.
At the national level, U.S. Sen. Carolyn Maloney, D-N.Y., introduced a bill this year to further regulate the tanning industry, calling tanning beds "the cigarettes of our time: cancer-causing and poorly regulated."
The U.S. Senate's health care reform legislation also contains a 10 percent tax on tanning services added because of lobbying by the American Academy of Dermatology. It is expected to bring in $2.7 billion over the next decade.
"It's always something against us," said Eileen Morris, owner of Body Images Tanning. "But they're not using science to back up what they say."
Ultraviolet exposure
Dr. Joseph Andrews of Delaware Dermatology, which has offices in Dover and Lewes, suspects indoor tanning is related to the rising number of melanoma cases he sees each year. Tanning beds, like the sun, give off ultraviolet rays, which are on the federal government's list of cancer-causing chemicals.
"It's like smoking," said Andrews, who has been in practice for 24 years. "I would say that any UV exposure, whether it's natural or in a tanning bed, increases your risk."
While overexposure to UV rays can lead to melanoma, the strength of the link to tanning beds has been in question.
A report published last summer by the World Health Organization summarized that "there was no consistent evidence for a dose-response relationship between indoor tanning exposure and risk of melanoma."
The report's strongest study -- which followed more than 100,000 women over eight years -- found that less than three-tenths of 1 percent who tanned frequently developed melanoma while less than two-tenths of 1 percent who didn't tan developed melanoma. Almost all the other studies in the report did not establish a strong link between the two.
Opponents of indoor tanning have emphasized one statistic in the report to justify increased regulations, a conclusion that the risk of getting melanoma is 75 percent higher among people who begin using tanning salons under age 30, compared with those who don't.
The overall risk of contracting melanoma -- whether using tanning beds or not -- remains well under 1 percent.
For that reason, using the 75 percent statistic is misleading, said Dr. Lisa M. Schwartz, co-author of "Know Your Chances," a consumer-oriented book on understanding health statistics.
"Melanoma is pretty rare and almost all the time, the way to make it look scarier is to present the relative change, the 75 percent increase, rather than to point out that it is still really rare," said Schwartz, a general internist at Veterans Affairs Medical Center in White River Junction, Vt.
18,000 salons
The first tanning salons opened in the mid-1970s, and today there are roughly 18,000 across the country. About 30 million Americans tan at least once a year, according to the International Smart Tan Network, the educational institute for North American indoor tanning businesses.
Even as salons proliferated, melanoma struck less than one-half of 1 percent of the U.S. population and fewer than five of every 100,000 people die from melanoma, a rate that has not changed over three decades, according to the federal National Cancer Institute, which tracks deaths and diagnoses of cancer.
Stakeholders in favor of regulations on the tanning industry are quick to bring up the World Health Organization's 75 percent statistic but reluctant to speak about the lack of evidence that frequent tanning-bed use causes melanoma.
"I don't know if it's my role to speak about that," said Sen. Bethany Hall-Long, D-Glasgow, who sponsored the consent legislation. She cited the 75 percent statistic but said she wasn't prepared to discuss the validity of using it.
The Delaware chapter of the American Cancer Society supported the legislation. Jeanne Chiquoine, the public policy initiatives manager for the local chapter, said she didn't "feel comfortable commenting."
Dr. Ron Shelton, of the American Academy of Dermatologists, questioned the World Health Organization's studies when asked about the lack of a strong link between tanning salons and melanoma, even though the academy cites the "75 percent" statistic on its Web site.
"I don't have the lab research but clinically what I've been seeing is that the people diagnosed with melanoma at an early age seem to have more exposure to the sun and are more frequently using suntan parlors," said Shelton, medical director of New York Aesthetic Consultants.
Dermatologists also liken tanning to smoking, which in the United States causes 90 percent of lung cancer deaths in men and 80 percent in women.
Schwartz said there's no similarity.
"It's not like the researchers are finding very large statistically significant effects from tanning," she said. "It's totally different from smoking, which has compelling evidence that it causes lung cancer."
The intent of the local regulation, Sen. Hall-Long said, was to encourage parents and teens to discuss tanning dangers. Parents of frequent teenage tanners say they dismiss the dangers because they suspect it's politically driven.
"I don't think that they have any scientific proof to back up what they say," said Laura Ventresca, Sophia's mother. "It's just competing interests."