Tattoo Exposure Associated With Increased Risk of Malignant Lymphoma

Individuals who receive a tattoo are at an increased risk of developing malignant lymphoma, emphasizing the necessity for continued research into the long-term health effects of tattoo exposure, according to the results of a study published in eClinicalMedicine.¹

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Tattoo popularity has dramatically increased over the past decades, with tattoo prevalence in the United States estimated at 30%. Research on understanding the long-term health effects of tattoos is just beginning; yet according to the International Agency for Research on Cancer, a concerning number of chemicals in tattoo ink are classified as carcinogenic.¹

Once tattoo ink is injected into the dermis, cell-mediated translocation to the local lymph nodes takes place. It is estimated that 32% of injected tattoo pigment is translocated after 6 weeks, and possibly as much as 99% may be translocated over a person’s life. This is troublesome, as lymph nodes contain proliferating cells and are sensitive targets for carcinogenic substances.¹

Only one study has been published that addresses tattoos as a risk factor for lymphoma. The study, conducted by Warner et al., analyzed over 1600 participants with non-Hodgkin lymphoma (NHL) or multiple myeloma with tattoos to examine the relationship.²

They found no statistically significant associations between tattoos and the risk of multiple myeloma, NHL, or any NHL subtypes.² The investigators of the current study that Warner et al. used data collected between 2000 and 2004, early in the mainstreaming of tattoos, likely leading to an underpowered analysis.¹

Thus, in the present population-based, case-control study, the investigators aimed to analyze if tattoo exposure increases the risk of malignant lymphoma. Additionally, they investigated exposure-response relationships, including the effect of the duration of exposure by accounting for the time between the first tattoo and the index year.¹

In total, the study population included 11,905 participants. The overall response rate was 48%, while the response rates among cases and controls were 54% and 47%, respectively. The prevalence of tattoos was 21% among cases and 18% among controls, according to the study authors.¹

According to the matched analysis, tattooed participants had a higher adjusted risk of malignant lymphoma than those without tattoos (IRR = 1.21; 95% CI, 0.99-1.48). Once the matches were broken, the estimate was more precise (IRR = 1.18; 95% CI, 1.01-1.39).¹

Individuals 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, the risk decreased with intermediate exposure duration—3-to-10 years, for example—but increased again in participants who got their first tattoo 11 or more years before the index year (IRR = 1.19; 95% CI, 0.94-1.50).¹

Risk of developing lymphoma associated with tattoo exposure was strongest 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 for DLBCL seemed to be highest in individuals with 11 or more years between their first tattoo and the index year. Contrary to this, the risk for follicular lymphoma was elevated in that time frame and in individuals with 0-2 years between their first tattoo and the index year.¹

“It is important to remember that lymphoma is a rare disease and that our results apply at the group level. The results now need to be verified and investigated further in other studies and such research is ongoing,” Christel Nielsen, MSc, PhD, a researcher at Lund University who led the study, said in a news release.³

Surprisingly, a larger tattooed body surface was not associated with a greater risk of lymphoma compared to a small tattoo. There was also not a distinct difference in risk associated with different color schemes, despite the differences in the chemical composition of colored and black inks.¹

"People will likely want to continue to express their identity through tattoos, and therefore it is very important that we as a society can make sure that it is 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. eClinicalMedicine. 2024;72:102649. doi:10.1016/j.eclinm.2024.102649

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

3. ScienceDaily. Possible association between tattoos and lymphoma revealed. Lund University. Published May 24, 2024. Accessed July 3, 2024. https://www.sciencedaily.com/releases/2024/05/240524115341.htm