Brooke Budke can never be sure what led to her skin cancer.
Was it all the time spent outdoors on vacation without wearing enough sunscreen? Or was it the tanning bed?
A survivor of melanoma going on nine years, Budke, now 30, believes both could have contributed. But looking back, there’s one certainty.
Budke would have skipped those visits to the tanning salon so long ago, even if it was “the thing to do” among her peers when she was a teen.
“There’s no benefit to it,” Budke said.
Already targeted by government regulators nationwide, the tanning bed is coming under growing scrutiny in Kansas and Missouri.
Kansas lawmakers are considering legislation banning minors from indoor tanning. Missouri is considering a measure requiring anyone under 17 to get their parents’ consent before tanning.
“It’s a very, very important public health issue,” said Kansas Rep. David Crum, an Augusta Republican and chair of the House health committee.
The legislation is a response to public health advocates sounding alarms about risks associated with indoor tanning and added exposure to ultraviolet light, especially among teens.
The federal Centers for Disease Control and Prevention warns that tanning beds are especially dangerous for those who begin tanning before they are 35.
The CDC says they have a 59 percent increased chance of contracting melanoma, the deadliest type of skin cancer.
“It’s kind of like playing Russian roulette,” said Jerry Brewer, a dermatology specialist at the Mayo Clinic who studied a rise in the number of melanoma cases from 1970 to 2009.
The industry supports the Kansas and Missouri measures, hoping the bills will cool what it sees as rhetorical overstatements about dangers from indoor tanning.
“We need to get away from that. The public is not helped by that,” said Joseph Levy, scientific adviser to the American Suntanning Association, which represents about 700 salon owners nationally.
Levy and others in the tanning business say the legislation will only affect a sliver of their clientele. Yet a 2011 study showed that about 13 percent of high school students use a tanning bed.
Levy said not all ultraviolet exposure is hazardous. He said consumers are more exposed to ultraviolet radiation from the sun than they are from a tanning bed, but he acknowledged the indoor tan is more intense.
“This isn’t any different than sunshine,” Levy said. “The point of indoor tanning is to be a surrogate for what nature intended.”
Momentum has been building in recent years against the tanning industry, which is estimated to serve 28 million Americans annually including 2.3 million teens.
Five years ago, the International Agency for Research on Cancer — an arm of the World Health Organization — determined that tanning beds posed a cancer risk to humans. The agency recommended banning commercial indoor tanning for minors.
Two years ago, researchers at the University of California at San Francisco concluded that indoor tanning was responsible for more than 170,000 new cases of nonmelanoma skin cancers in the United States each year.
Another study done at the Mayo Clinic found that melanoma cases among women under 40 were eight times higher in 2009 than in 1970. Melanoma in men increased fourfold. Researchers suspected tanning beds were the culprit.
Kansas and Missouri are just the latest to consider tighter restrictions on the tanning industry.
• The federal government enacted a 10 percent tanning tax as part of the Affordable Care Act in 2010. The tax, coupled with the recession, was blamed for closing nearly half the tanning salons nationwide.
• The Food and Drug Administration is considering a rule requiring labels for tanning beds that would discourage teens from using them.
• Six states now ban tanning for anyone under 18. Legislation is pending in the state of Washington to do the same. At least 33 states regulate tanning for minors, many requiring parental consent for teens or parents accompanying their kids to the salon.
Two years ago, Congressional Democrats, led by Henry Waxman of California, released a report accusing the industry of providing misleading health information to teens about tanning.
The mounting government pressure is getting too heavy-handed for some salon owners. They say they take safety precautions for their customers. They say initiatives like the tanning tax give them a dirty name.
“I can get really mad about the whole situation,” said Terri Wheeler, owner of the Sun Scene salon in Raymore. “I think that the government is overstepping their bounds. It’s up to the parents to parent. It’s not up to the government to parent the children.”
Wheeler and other salon owners say they restrict tanning for minors. They say they survey their clients about skin type and provide them with educational material about how to tan safely.
“As a business owner, you have to make sure that you’re educating your customer,” said Lori Chapman, owner of Bask Tanning in Bonner Springs. “It’s not all about making money.”
In Kansas, tanning salons like Chapman’s are already regulated and must be licensed. There are 500 licensed tanning salons in Kansas, including 45 in Johnson County and 10 in Wyandotte County.
Kansas law already requires tanning salons to give customers a written statement warning about the risks of tanning, including the possibility that repeated exposure could lead to skin cancer.
Tanning salons in Kansas also must post signs alerting consumers to the risks of tanning. Salons are barred from claiming or distributing promotional material stating that tanning beds are safe.
If Kansas eventually bans tanning for minors, it would be a setback for Chapman’s salon, which is down the road from Basehor-Linwood High School. She estimates 40 percent of her clients are teens. She already requires parents’ permission for clients under 18.
“By no means is it going to put me out of business, but it will definitely hurt my bottom line,” Chapman said.
Alexis Nichols, 17, tans for a couple of weeks twice a year to get ready for school dances. She recognizes the health issues. So she limits her tanning.
“In the winter, I get really, really pale,” she said. “When spring time comes and you want a bright dress for a dance, then you want color or otherwise it will wash you out.”
A law banning teens from tanning would probably tick off her friends. She said they sometimes tan for self-confidence, but she understands the worry.
“I feel like they are looking out for our best interests.”
Johnson County salon owner Howard Terry preaches a basic tanning gospel to his customers. “Do it safe, do it smart, don’t overdo it,” he said. “That’s our most important message.”
Terry, the owner of Electric Sun in Lenexa and Gardner, wonders just how far lawmakers are willing to go.
“Are they going to legislate how long somebody is allowed to hang out at the pool?” he asked.
Missouri has no state laws or regulations for tanning salons. The lack of regulation was highlighted in a Washington University in St. Louis study.
The study, led by dermatologists at the school, found that 65 percent of the 243 businesses surveyed would allow someone under 13 to tan. Employees at 43 percent of the businesses said there was no risk associated with indoor tanning.
In Kansas, the bill was the idea of Joshua Mammen, a surgical oncologist at the University of Kansas Medical Center. He believes the time to act is now.
“We can’t really change the risk for many cancers. This is one cancer where we can change the risk,” Mammen said. “Only by acting early will we be able to prevent cancers that develop 10, 20 years down the road.”