Indoor tanning is feeling the heat this week. Thanks to the health reform legislation passed on Sunday, the industry is facing a 10 percent excise tax, while on Thursday the U.S Food and Drug Administration will meet to determine whether to apply stricter regulations on indoor tanning beds.

Depending on how it fares in the Senate, which will debate the reconciliation package this week, the tanning tax, set to start as early as July 1, could raise almost $2.7 billion over the next 10 years to help defray part of the health care bills' $940 billion price tag.

The tax on the nation's 25,000 salons replaces the so-called "Botax," a proposed 5 percent tax on elective cosmetic surgery procedures that ultimately got snipped in Congressional wrangling over the final version of the health care bill.

For the medical groups that had been lobbying for the tanning tax, it could discourage a practice they say is linked to rising skin cancer rates. But the indoor tanning industry believes the tax will hurt small business owners still reeling from a weak economy.

"It's a regressive tax that's going to fall on an industry already struggling in a recession, a tax on working people, working women," John Overstreet, executive director of the Indoor Tanning Association, an industry group, tells DOTmed News.

The federal tax would be in addition to taxes levied by states - in some places, this would burden tanning salons with almost 17 percent in excise taxes. New Jersey, for instance, with one of the nation's highest state taxes for tanning salons, levies a 7 percent tax on the Garden State's hundreds of tanning parlors.

"This affects small businesses, folks that mortgage their homes to get started, and they're not making a lot of money to begin with," observes Overstreet.

The push for the tax came largely from dermatologists who blame indoor tanning for contributing to the nation's growing skin cancer rates, especially of melanoma, the deadliest form of the disease. According to the American Cancer Society, there were 68,720 cases of melanoma last year, leading to around 8,650 deaths.

"A tax on indoor tanning services would serve as a signal from the federal government to everyone, especially young people, that indoor tanning is dangerous and should be avoided," American Academy of Dermatology Association president David M. Pariser, M.D., said in a statement last year.

Risk controversy

The FDA will try to figure out how dangerous tanning beds really are on Thursday, when the group will gather in Gaithersburg, Md. to hear recommendations from its scientific advisory panel. The FDA is considering upgrading the status of tanning beds, currently Class 1, the lowest risk for medical devices, and also recommending new warning signs about skin cancer risks.

Part of the concern among medical organizations is that of the 30 million Americans who frequent tanning salons, nearly 2.3 million are teenagers - one of the groups most vulnerable to developing skin cancers, according to the AADA.

According to the July 2009 report from the International Agency for Research on Cancer (IARC), part of the World Health Organization, indoor tanning use by those under 35 is correlated with a 75 percent increase in rates of melanoma. In the report, the IARC also shifted indoor tanning into its highest-risk category - "carcinogenic to humans."

Basing their conclusions on around 19 studies conducted over a period of 25 years, the IARC recommended banning indoor tanning for children under 18 years of age, which the AADA also supports. In addition to the link between youth exposure to indoor tanning and skin cancers, the groups also claim to have found an association between ultraviolet-emitting tanning beds and eye cancer.

Other studies finding a link between tanning beds and skin cancer are a Swedish paper from 1994 that showed young women who used tanning parlors ten times a year had seven times the risk for developing melanoma, and a 2002 Dartmouth study that showed tanning bed users had an increased risk for getting other forms of skin cancer. According to the study, they were 2.5 times more likely to get squamous cell carcinoma, and 1.5 times more likely to develop basal cell carcinoma.

Nonetheless, critics feel there are methodological flaws in the studies cited by the IARC. An FDA epidemiologist who reviewed the IARC study for the federal agency said possible limitations included people inaccurately remembering their tanning history and the difficulty in separating outdoor and indoor UV ray exposure when determining cancer risk.

And in a report posted to the FDA's website on Tuesday, the agency noted that due to a "paucity of studies" the IARC report was not able to establish a dose-response relationship, an important tool for determining real cancer risk. Most troubling, they observed that for melanoma, only four of the 19 studies examined by the IARC were statistically significant in suggesting a greater risk for those who used tanning salons at least once as opposed to those who never used them.

Still, the FDA does largely come down on the IARC's side, acknowledging that "the IARC Report...add[s] to a body of literature suggesting that there may be a small to moderate risk of skin cancer, independently due to the use of tanning beds or lamps."

But ITA's Overstreet believes the evidence is more ambiguous, citing a British study from last year that consulted a cancer registry and found melanoma was more common in areas "not regularly exposed to UV light," such as the trunk or limbs. "You repeat it enough times, it sort of becomes common in the literature," Overstreet says, about the anti-tanning research. "The data on melanoma, skin cancer, is all over the place."