Tattoo exposure associated with increased risk of malignant lymphoma

People with tattoos are at higher risk of developing malignant lymphoma, new research has found, highlighting the need for continued research into the long-term health effects of tattoos. Clinical Medicine.¹

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Tattoos have grown dramatically in popularity over the past few decades, with tattoo prevalence estimated at 30% in the U.S. Research into understanding the long-term health effects of tattoos is still in its infancy, but according to the International Agency for Research on Cancer, a significant number of chemicals found in tattoo inks are classified as carcinogens.¹

When tattoo ink is injected into the dermis, cell-mediated translocation to local lymph nodes occurs. It is estimated that 32% of injected tattoo pigments translocate after 6 weeks, with a potential of 99% over a lifetime. This is a troubling problem because lymph nodes contain proliferating cells and are susceptible to carcinogens.¹

There has only been one published study to date that looks at tattoos as a risk factor for lymphoma, conducted by Warner and colleagues, who analyzed more than 1,600 patients with non-Hodgkin's lymphoma (NHL) or multiple myeloma who had tattoos to look for any associations.²

No statistically significant associations were found between tattoos and risk of multiple myeloma, NHL, or NHL subtypes.² The researchers in the current study, conducted by Warner and his colleagues, used data collected between 2000 and 2004, when tattoos were first becoming mainstream, which likely made their analysis underpowered.¹

In this population-based case-control study, we aimed to analyze whether exposure to tattoos increases the risk of malignant lymphoma. Furthermore, we investigated the exposure-response relationship, including the effect of exposure duration, taking into account the time from the first tattoo to the index year.¹

A total of 11,905 people participated in the study. The overall response rate was 48%, with response rates of 54% and 47% in the case and control groups, respectively. According to the study authors, the prevalence of tattoos was 21% in the case group and 18% in the control group.¹

Matching analyses showed that participants with tattoos had a higher adjusted risk of lymphoma than those without tattoos (IRR = 1.21; 95% CI, 0.99-1.48); when unmatched, the estimates became more precise (IRR = 1.18; 95% CI, 1.01-1.39).¹

Those with less than 2 years between their first tattoo and the index year had the highest risk of lymphoma (IRR = 1.18, 95% CI, 1.03-3.20).Interestingly, risk decreased with intermediate duration of exposure (e.g., 3 to 10 years) but increased again for participants who got their first tattoo 11 or more years before the index year (IRR = 1.19, 95% CI, 0.94-1.50).¹

The risk of developing lymphoma associated with tattoo exposure was highest for diffuse large B-cell lymphoma (IRR = 1.30; 95% CI, 0.99-1.71), followed by follicular lymphoma (IRR = 1.29; 95% CI, 0.92-1.82).¹

The risk of DLBCL appears to be highest in individuals for whom 11 or more years have elapsed between their first tattoo and their index year. In contrast, the risk of follicular lymphoma was elevated over the same period and in individuals with 0–2 years between their first tattoo and their index year.¹

“It is important to remember that lymphoma is a rare disease and our findings apply at a population level. The results need to be further validated and investigated in other studies, which are currently underway,” Christer Nielsen, MSc, PhD, a researcher at Lund University who led the study, said in a news release.³

Surprisingly, the risk of lymphoma was not different between people with large body surface area tattoos and people with small tattoos, and there was no clear difference in risk between different color combinations, despite the different chemical compositions of colored and black inks.¹

“People will continue to express their identity through tattoos, so it's really important that we as a society make sure tattoos are safe,” Nielsen concluded.³

References

1. Nielsen C, Jerkeman M, Jöud A. Tattoos as a risk factor for malignant lymphoma: a population-based case-control study. Clinical Medicine2024;72:102649. doi:10.1016/j.eclinm.2024.102649

2. Warner F, Darvishian M, Boyle T, et al. Tattoos and hematopoietic malignancies in British Columbia, Canada. Cancer epidemiology biomarkers Previous 2020;29(10):2093-2095. doi:10.1158/1055-9965.EPI-20-0515

3. ScienceDaily. Possible Link Between Tattoos and Lymphoma Revealed. Lund University. Published May 24, 2024. Accessed July 3, 2024. https://www.sciencedaily.com/releases/2024/05/240524115341.htm