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Skin cancer is on the rise in France, with around 80,000 new cases diagnosed each year.

Melanoma is the most serious type of skin cancer. Exposure to ultraviolet (UV), whether from natural or artificial sources, such as tanning booths, increases the risk of skin cancer, particularly by underestimating the risk of UV-A rays. This is one of the results of an expert assessment conducted jointly by Afsse, InVS (Institut de Veille Sanitaire) and Afssaps (Agence Française de Sécurité Sanitaire des Produits de Santé) in 2004 at the request of the French Ministries of Health and the Environment. The report was published in 2005.

UV rays are part of the non-ionising electromagnetic radiation emitted by the sun, in the same way as visible rays (light) and infrared. Although UV rays are invisible to the human eye, the body reacts to these rays with protective mechanisms: tanning and thickening of the skin surface. Because they penetrate the skin and have a mutagenic potential, exposure to natural or artificial UV rays can pose considerable health risks in the medium and long term, particularly for sensitive populations such as children.

It must be noted that, skin cancers are on the rise in France, with around 80,000 new cases diagnosed each year. Melanoma is the most serious type of skin cancer. The InVS estimates that there are between 7,000 and 8,000 new cases of melanoma a year in France. In 2000, skin cancer was responsible for 1,364 deaths. Sun exposure is now considered to be a major cause of melanoma and a risk factor closely associated with the emergence of other skin cancers (epidermoid carcinoma and basocellular cancer).

This assessment focuses on the whole population, including professionals, particularly those working in the open air.

Summary of the request:

Through a solicited request dated 6 September 2004, the French Ministries of Health and the Environment asked Afsse and the InVS to reassess the health risks associated with exposure to UV rays of natural origin and the use of tanning booths.

The ministerial solicited request concerns the following points:

 conduct an expert assessment of the work published or being published on the health effects of UV exposure, particularly carcinogenic, and the use of tanning booths emitting UV rays; the expert assessment of existing literature should try to adopt a critical viewpoint taking account of features specific to France (intermediate skin prototypes, UV types authorised by French regulations);
 assess the relevance of the use of limit values based on the minimal erythemal dose (inducing acute effects) regarding the assessment of carcinogenic risks (melanomas, basocellular epitheliomas and spinocellular epitheliomas);
vassess the relevance of using lamps that only emit UVA;
 justify the ban on using any type of cosmetic product during sessions in tanning booths and particularly anti-oxidant substances;
 present through a comparative study the most relevant European and international positions, scientific on the one hand and regulatory on the other, seeking to regulate tanning booths emitting UV rays.

However, because the consequences of exposure to natural and artificial UV rays are hard to differentiate in terms of overall effects, the expert group decided to base the report on an overall analysis of UV risk. Beyond the objectives of the solicited request, Afsse broadened the study to include the possible risks associated with household use (in homes or public places such as offices and schools) of so-called "full spectrum" lighting which emit UV rays in the form of visible rays, including a significant amount of UVB according to available documentation. The expert group also looked into the possible consequences of using sun protection products, the efficacy of which is focused on UVB, which may increase exposure time and therefore the risk associated with UVA exposure.

Working method:

To respond to the solicited request, Afsse set up a group of experts not only from the InVS and Afssaps, who were targetted by the request, but also representatives of the Académie de médecine (Medical Academy), IARC, members of Inserm research laboratories and dermatologists specialising in this area, to provide answers to the questions raised by the ministerial solicited request.




The working group set up in January 2005 to answer the questions raised in the solicited request produced an expert assessment report drawn up jointly by Afsset, InVS and Afssaps, called “UV rays – Current knowledge on exposure and the health risks” together with recommendations. This report was submitted to the Agency on 3 June 2005 and contained the following conclusions among others.

UV exposure is carcinogenic to humans. This effect has long been known for UVB (280-315 nm). Evidence for the mutagenicity of UVA is more recent. Exposure to UV rays from the sun is the main environmental cause of non melanocytic skin cancer (epidermoid carcinoma and basocellular cancer) and melanoma. Skin cancer can be prevented by reducing sun exposure. As for the use of artificial UV sources for tanning, this practice was long considered to be safe, and even able to provide protection against the harmful effects of natural radiation. It is now known that this is not the case at all. In some individuals (melano-competent), UVA exposure causes pigment redistribution, without increasing melanin synthesis and without increasing the thickness of the stratum corneum of the skin. This fleeting “cosmetic” effect provides no protection against the effects of UVB radiation, and the UV doses received during these sessions are added to the doses received during natural exposure, thereby increasing the risks.

The risk of melanoma associated with the desire to tan through exposure to artificial sources of UV has been the focus of numerous epidemiological studies. The recent publication of a meta-analysis of 9 control-case studies and a vast prospective cohort study now confirms that tanning through exposure to artificial UV rays incurs an overall increase in the melanoma risk of a factor of 1.25, or a quarter more. This risk is further increased by early or frequent exposure (1.6 to 1.7, and 2.6 in women who have exposed themselves in the 20-29 age group, i.e. an increase of 160%). As for the risk of other skin cancers, there are fewer studies, but a recent publication implies that the increase in the risk of epidermoid cancer and basocellular cancer is the same as the risk of melanoma (1.5 to 2.5).

It should be noted that a moderate increase in the risk may equal a considerable increase in the total number of patients when the fraction of population exposed is significant. The increase in the practice of tanning by artificial UV rays currently observed is a cause for concern in terms of public health.

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