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As a child, Karen Irons, 47, spent her summers at a beach house in Massachusetts, where the primary pastime was lying out in the sun. Irons never wore sunscreen, so her fair Irish skin inevitably burned once or twice, but the annual agony seemed like a small price to pay to achieve her ultimate goal: a perfectly bronzed body. "I loved being tan," she says. "And in those days I really didn't know any better."
Yet even after Irons learned about the tanning/skin-cancer connection while working as a paramedic in her early 20s, that didn't stop her from soaking up the sun every chance she got. In fact, when she was 40 she and her husband moved to Bristol, Rhode Island, specifically so they could live on the beach and spend more time catching rays. "I was aware of the risk, but I was naive," she says. "I didn't have any moles, so I thought it wouldn't happen to me."
But in January 2006 it did happen. Irons went to her doctor with an enlarged lymph node in her right armpit. She figured it was probably nothing serious, but her doctor, concerned about breast cancer, ordered a mammogram and an ultrasound. Both were negative, so she sent Irons to a surgeon to have the node removed and biopsied. The shocking results? She had stage-3 melanoma.
"I was completely blindsided," she recalls. "I thought, 'What is this woman talking about?' Once she started discussing oncologists and surgery and how the cancer already might have spread to other organs, reality began to sink in. I just sat there and sobbed."
It turned out that the melanoma originated from a mole on her upper arm, which Irons had never noticed before because it was atypical; in fact, six doctors had overlooked the pale, pimple-like growth in the search for the source. After two surgeries -- one to remove the mole and the surrounding tissue, the other to take out the remaining 32 lymph nodes under her arm -- and a grueling year of interferon treatments, she was pronounced cancer-free, with the caveat that the overall five-year survival rate for her type of melanoma is just 50 to 70 percent.
Despite her fear of a recurrence, Irons confesses she misses the feeling of the sun's rays on her skin. "I crave it," she says. "It sounds kind of crazy, but the sun was like a drug and I was addicted to it."
Irons may be closer to the truth than she thinks. Recent studies on the psychology of tanning suggest that sun worshippers and tanning-booth devotees really could be hooked on the effects of those UV rays. "Some people may be tanning for a real physiological reason, perhaps even a need," says Steven Feldman, MD, a professor of dermatology at Wake Forest University. This new science of sun worship may finally provide insight into one of the most troubling public health questions in recent memory: Why do so many smart, informed women continue to tan, especially when they know very well that exposure to sunlight can cause skin cancer as well as premature aging?
Obviously, the promise of golden skin is a major reason why people love to bask in the sun, but the mood-boosting effects are also a powerful motivator. And the sensation isn't all in your head: When UV light hits your skin it triggers the production of endorphins, opiate-like chemicals responsible for the high you get from exercise, sex, and chocolate.
Dr. Feldman's research suggests that it's these mood-lifting chemicals that may drive our desire to soak up UV rays. In one study, he had tanning-salon regulars lie in two identical-looking tanning beds twice a week, one of which was rigged to block UV light (a detail Dr. Feldman didn't reveal). At the end of the study, when he asked participants which bed they preferred, 95 percent chose the one without the blocker. "They told me it was more relaxing," he says.
In a follow-up study, Dr. Feldman gave a group of frequent and infrequent tanners a drug that blocks the release of endorphins before they baked in tanning beds. "The drug didn't have any effect on the infrequent tanners, but half of the regular tanners went into withdrawal," he says. "They got jittery and nauseated, just like drug addicts do when they try to go off narcotics." Two participants dropped out of the study owing to their symptoms.
Research conducted at the University of Texas Medical Branch at Galveston also appears to support the addiction theory. When dermatologist Richard Wagner, Jr., MD, and his colleagues surveyed beachgoers about their tanning habits using two substance-dependence screening tools (asking questions such as "Do you think you need to spend more and more time in the sun to maintain your tan?" and "Does your belief that tanning can cause skin cancer keep you from spending time in the sun or going to tanning beds?"), they found that anywhere from 26 to 53 percent of people met the criteria for tanning dependence.
Cindy Booth, 48, who was diagnosed with melanoma two years ago, might put herself in that category. "When I was younger I would go into a near panic if I didn't get a chance to work on my tan on the weekends," says Booth, who lives in Raleigh, North Carolina. Though she stopped tanning after her diagnosis, the lure of the sun remains powerful. "I still put on SPF 30 sunscreen and sit outside for a few minutes," she confesses -- an extremely dangerous move for a skin-cancer survivor but one that doesn't come as a surprise to most dermatologists. "I treat women who have had three bouts of skin cancer and still tan," says St. Petersburg, Florida-based dermatologist James Spencer, MD. "For some people it's a very hard habit to break, possibly because of its addictive qualities."
Even if you don't think you fit the "tanorexic" profile, you might be one of the millions of women who skip SPF in order to get a "healthy" glow -- a potentially deadly routine that experts believe is fueled more by vanity than biology. "Being tan made me feel healthier and more attractive," says Teresa Baglietto, 44, of Roseville, California, who had a squamous-cell skin cancer removed from her lip last summer. "I'm a fitness coach, so it was important to me to have a tan because I thought it enhanced my muscle tone."
Many women claim that being bronze makes them look thinner and that it minimizes the appearance of cellulite, acne, and other skin flaws. And how's this for a vicious cycle? "When some women start getting wrinkles -- which were probably caused by sun exposure -- they may tan to try to hide them," says Carolyn Heckman, PhD, an assistant professor at the Cancer Prevention and Control Program at Fox Chase Cancer Center, in Philadelphia.
Perhaps it's not surprising then that excessive tanning has recently been associated with body dysmorphic disorder (BDD), in which a person obsesses over a perceived physical flaw. "Sufferers are often women in their 30s who look normal but think they're deformed or ugly," says Katharine A. Phillips, MD, a professor of psychiatry at the Warren Alpert Medical School of Brown University. She conducted a study that revealed that 25 percent of people with BDD try to manage their symptoms by tanning, whether it's a preoccupation with acne or the size of their thighs. If you tan frequently and worry more than an hour a day about how your skin looks, you may have BDD. Fortunately, cognitive behavioral therapy and antidepressants known as selective serotonin reuptake inhibitors seem to help about two-thirds of people.
If you think UV addiction might be behind your urge to tan, try to wean yourself off it gradually to prevent side effects such as mild depression, suggests Dr. Feldman. "Cut your exposure in half for a few weeks, then continue halving the time until you've stopped tanning completely," he says. At the same time, get an endorphin buzz from healthier activities like exercising, getting a massage, or eating small amounts of chocolate.
Need more motivation to shun the sun? "I have to go to the doctor every six months for a CT scan of my chest, abdomen, and pelvis to make sure the cancer hasn't spread. Sometimes I have an MRI of my brain, too," says Karen Irons. "Basically, every six months I have to worry about whether my doctor will tell me I'm dying. Trust me, a tan really isn't worth it."
Sorry, there's no justifying your love of lying in the sun. We asked experts to rebut these common rationales.
A tan makes me look thinner. Maybe a little bit, but so does wearing dark colors and clothes that flatter your shape and even standing up straight -- none of which has the potential to kill you, says dermatologist Amy Wechsler, MD, author of The Mind-Beauty Connection.
There's no point worrying about UV damage now -- haven't we been told that up to 80 percent of lifetime sun exposure occurs before age 18? Actually, that figure is only about 23 percent, according to the Skin Cancer Foundation. Childhood sun damage is important, but the skin's ability to repair itself gets even weaker with age, says dermatologist David E. Fisher, MD, a member of the scientific advisory committee for the Melanoma Research Foundation. The sun exposure you get at any age sets you up for skin cancers when you get older.
I need to get vitamin D from the sun. You can just as easily get your daily dose of D from fish and fortified foods such as milk or from a supplement, says Dr. Fisher.
I only tan at the salon. I've heard it's safer than sitting in the sun. Nope, fake-baking is just as dangerous as the real thing, if not worse, according to the FDA, which is considering imposing restrictions on tanning beds. A new tax on their use starts this month. And the International Agency for Research on Cancer moved them to its highest cancer-risk category, along with arsenic and tobacco.
The hilarious 30 Rock star -- and former tanning fanatic -- has teamed up with Jergens to promote safe, sunless tanning with her "Get in the Glow" educational video. Now through August 31, Jergens will donate $1 (with a maximum donation of $20,000) to the Skin Cancer Foundation every time someone watches the video. Check it out at youtube.com/jergens.
Coming in August: Would you recognize the first signs of skin cancer? We'll give you the latest lifesaving info on how to do a truly thorough skin check.