Jenny Hetrick knows that tanning increases the risk of skin cancer, but for two years she's been a regular customer at Electric Beach tanning salon in Odenton.
Warnings about exposure to ultraviolet light - from the sun and tanning lamps - are not lost on her. But when the weather warms up, she likes to wear shorts and short-sleeved tops and, like her friends, she wants to look good in them. So she compromises and limits her tanning salon visits to about two a week.
"I think it's right that people should be careful. For teenage girls, tanning can really be addictive," said Hetrick, 20, of Severn.
As this year's outdoor tanning season begins, dermatologists know that millions will ignore warnings about the risks of skin cancer from overexposure to UV light. And, while a decade of warnings has put a crimp in the tanning salon business, up to 30 million people still bronze themselves in booths and tanning beds each year.
The peak indoor months, industry officials say, are May and June, when tanning enthusiasts are getting ready for a summer outdoors. "We're a species that evolved in the sun," explained John Overstreet, executive director of the Indoor Tanning Association.
But the fixation makes no sense to dermatologists.
"It's kind of like what happened with seat belts and cigarettes. People are recognizing the dangers, but for some individuals, it'll be years before they see the damage and it hits home," said Dr. John DiGiovanna, a dermatologist at the National Cancer Institute.
This year, there will be an estimated 108,230 new cases of melanoma, the most serious form of skin cancer, and the disease will cause 8,110 deaths, according to the American Cancer Society. At least
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some of those deaths could have been prevented if people just stayed out of the sun, experts say.
"We have a huge amount of evidence, from many, many different types of studies and sources, showing the role of UV light in skin cancer," DiGiovanna said.
More than 20 states restrict the use of tanning salons by minors, requiring them to have parental consent or prohibiting use by minors altogether. In Maryland, Del. Anne Healey has sponsored legislation for the past two years to ban young children from tanning in salons altogether. She plans to sponsor similar legislation next year.
"I'm still thinking about what the best way is to go about this," the Prince George's County Democrat said.
Why do people slow-roast themselves in the sun for hours or pay for a place in what is essentially an enclosed warming tray?
"People tan because they're going to a wedding or on vacation, and they want to look good," said Robin Eason, who owns six SunSeeker salons in the Baltimore area. Most of her customers are women between 18 and 35, she said.
Others say that tanning just feels good.
"This is my stress reliever. This is how I chill out," said Ronda Jerman, a 34-year-old mother of three from Gambrills, who comes to Electric Beach three times a week. "Everything else I do is about my kids, my husband and my kids. But I do this for me."
Tanning salons offer a way to control exposure to UV light and prevent the kind of sunburns that often accompany a trip to the beach, salon owners say. Those who tan easily or have dark pigmentation are less likely to develop skin cancer than people with light skin and less melanin to protect them, experts say.
Research also shows that people who maintain a constant tan have less risk of melanoma, the deadliest form of skin cancer, than those with a history of sunburns. And a few minutes a day in a tanning bed, for about a week, is often enough to prevent a sunburn, they say.
"It's far more dangerous to go to Ocean City and spend six hours on the beach than go to a salon," said Jim Wint, who owns Electric Beach with his wife.
Business has increased steadily in the five years that Wint and his wife have operated the salon along Route 175. A recent visit revealed a steady stream of customers who pay from $8 for a single session to $400 for packages. The salon offers 11 tanning beds and one tanning booth.
Wint's Web site notes studies pointing out how UV light is a source of vitamin D, which is essential for healthy bones. Studies also have linked vitamin D deficiencies to increased risks of colon, breast, ovarian and prostate cancers. A recent Harvard study proposed that vitamin D deficiencies each winter may predispose people to flu and other infections.
"I think there's been a changing of opinion, just in the past year or so, with more recognition about the importance of vitamin D," Wint said.
One medical expert says dermatologists have gone overboard with warnings about UV exposure and are causing vitamin D deficiencies by driving people completely away from sunlight.
"The entire world's population has been brainwashed about the risk of ultraviolet light from sun," said Dr. Michael Holick, an endocrinologist and professor of medicine at the Boston University School of Medicine.
Holick, who has accepted research funding from the indoor tanning industry, doesn't advocate use of tanning salons. But he says anyone using them should limit visits to once a week and should use beds and booths for only half the recommended time.
He also recommends five to 15 minutes of unrestricted sunlight per day and after that, use of a sunscreen with an SPF of 15 or greater.
"Just like with everything else, I recommend moderation," he said.
Dermatologists acknowledge that vitamin D is important for good health. But they worry that Holick's message, conveyed in a book sold by many tanning salons, is confusing people about exposure to UV light.
"He's adopted positions some people consider counterproductive," said Dr. Martin Weinstock, chairman of the American Cancer Society's skin cancer advisory group.
Some researchers say tanning may be addictive. Among frequent tanners, UV light releases endorphins, the same hormones that produce a high for athletes when they exercise, said Dr. Steven Feldman, a professor of dermatology, pathology and public health sciences at the Wake Forest University School of Medicine.
"There's a physiological basis to what is going on; that is driving these tanning behaviors," he said.
Feldman took eight frequent tanners and eight infrequent tanners and gave them access to tanning beds. He defined the frequent tanners as those who tanned more than eight times a month. But before placing them in the beds, he gave them either a placebo pill or an endorphin blocker, starting with a low dose of the endorphin blocker.
No one taking the placebo had withdrawal symptoms, but when given the endorphin blocker, half of the frequent tanners had some symptoms consistent with withdrawal - jitters, nausea and shaking. None of the infrequent tanners had such symptoms when given the blocker.
"If people want to relax and get away from the world, they could go lay down in a warm dark closet. The reason they go to a tanning bed is they get the endorphin hit," Feldman said.
Last year, Dr. Robin Hornung, a dermatologist at the University of Washington Children's Hospital in Seattle, polled 385 University of Washington students about their tanning habits, using a four-question survey designed to determine if someone is addicted to alcohol or drugs.
"They are questions like, 'Have you ever felt the need to cut down?' or 'Do you ever feel guilty about the time you spend doing it?'" Hornung said.
Up to 18 percent of the students showed addictive tendencies. The findings, published in March in the Journal of the American Academy of Dermatology, confirmed what Hornung had suspected about dermatology patients who continued to tan despite warnings.
"As dermatologists, we had been thinking for years, as much as we kept telling patients to avoid tanning and they were going out and doing it anyway, there was something like addiction going on here," Hornung said.
Wint criticized the studies as flawed. His customers come on average about 16 times a year and many come for only a month out of the year, such as in May or June, he said. Tanners are no more addicted than people who exercise regularly, he said.
"How can tanning be addictive if people only do it one month out of the year?" Wint asked. "That's absurd."
But Feldman says only the frequent tanners - those who show up at salons at least two times a week - may be addicted.
"The people who are going in maybe once a year - or maybe to get two or three sessions to get ready for a wedding - that isn't the people who have a problem," Feldman said. "The people who are at risk are going day in and day out. Why are they doing it? They're addicted."