4.9 million — yes, million — people are diagnosed with skin cancer every year in the United States. It costs an estimated $8.1 billion —with a “B — to treat those skin cancers, according to the Centers for Disease Control (CDC).

Do I have your attention? I hope so. The problem is we don’t have enough attention. There is no other way to explain why too many states still allow those under 18 to access tanning beds across this country.

Have we made progress? Yes, but not nearly enough according to a research paper and editorial published today in JAMA Dermatology.

The study, from the CDC, looked at surveys of high school students done every two years between 2009 and 2015. The researchers found that overall the frequency of tanning bed use in the previous year declined from 15.6 percent of all high school students in 2009 to 7.3% of all students in 2015.

That’s progress. However, when they took a closer look at different groups of students, they found that among non-Hispanic white female students the numbers using a tanning bed the previous year dropped from 37.4% to 15.2%.

Sound good? Maybe — until you look at the percentages for those 17 and older: in 2009 almost one in two of these young women used a tanning booth in 2009, while in 2015 about one out of four still used a tanning booth. Keep in mind that this is a percentage of all young, non-Hispanic women in that age group throughout the country. That’s a lot of young people still exposing themselves to a cancer-causing agent (also known as tanning beds) on a regular basis.

In addition, the study found that those who used tanning beds had a higher frequency of sunburns, one of the other known related causes of skin cancer, including melanoma which is the deadliest form of skin cancer and is on the rise among young white women in the United States.

So is the cup half full or half empty?

Personal experience suggests this is not a benign behavior, especially if one is fair skinned and burns easily. A member of my family had a severe burn from a tanning booth, and I will never forget that. And I will never forget that they are at a significantly increased risk of skin cancer or worse, in no small part because of disastrous visits to a tanning booth.

Tanning beds are a carcinogen according to the World Health Organization. They cause skin cancer. They don’t provide a health benefit that can’t be achieved with other, much safer alternatives such as diet supplements for vitamin D. And “base tans” are a fallacy, as confirmed by this study where those who used tanning beds had a higher rate of sunburns each year.

As pointed out in the article and the editorial, five states had laws that limited youth access to indoor tanning. In 2015, 42 states had such laws, including 13 states that prohibited access to tanning beds for those under age 18. There is a proposed federal regulation from the Food and Drug Administration that is held up in in the federal review process that would prohibit tanning bed use by anyone under 18 nationwide. Right now, it appears that regulation is not going to see the light of day (pardon the pun) anytime soon and that is a shame.

The one state that has taken action is Minnesota, which passed a law in 2014 prohibiting minors from tanning at indoor facilities. The impact of that legislation was recently reported by the Minnesota Department of Health: In 2013, 33% of white females in Minnesota who were in the 11th grade used indoor tanning in the previous 12 months, and 9% in 2016. That’s a pretty impressive decline. Laws and regulations work.

Here is the bottom line: skin cancer is incredibly common. If you know someone who has skin cancers you know, they can sometimes be difficult to treat, and melanoma can be fatal. We can do much better at educating the public about prevention. One of the keys to prevention is sun-safe behavior, including avoiding tanning beds—starting in childhood and young adulthood.

We are making progress, but as noted in the editorial, it isn’t enough. Better education, better public health policies to restrict access to tanning beds and increased awareness have made their mark, but we still have a way to go on this particular journey.

J. Leonard Lichtenfeld is deputy chief medical officer, American Cancer Society. He blogs at Dr. Len’s Cancer Blog.

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