Tat’s All Folks!

By Peter Galvin, MD

I’ve never been a fan of tattoos, but they’ve been around since ancient times. In some cultures, tattoos have significant meaning. Recently, tattoos have grown increasingly popular as a means of self-expression, especially among younger people. It is estimated that about 32% of Americans have at least one tattoo, and about 22% have multiple tattoos. As tattoos have become more popular, the incidence of malignant lymphoma has increased by about 4% over the last 40 years. Is that just a coincidence, or is there a connection? According to a large study from Lund University in Sweden, which was published in “Lancet,” a prominent British medical journal, it’s no coincidence. The study found that those with at least one tattoo had a 21% higher risk of developing any type of lymphoma, after adjusting for other risk factors.

I believe that those who get tattoos don’t really know what is in tattoo inks. After getting a tattoo, the ink drains via the lymphatic system into local lymph nodes, where it remains, even if the tattoo is subsequently removed. The contents of tattoo inks are alarming. The pigments used in the inks contain multiple heavy metals plus known carcinogens like carbon black, synthetic organics (brightly colored azo chemicals), and formaldehyde (used as a preservative). The U.S. FDA considers the inks cosmetics, and so does not regulate them, but the European Union has started prohibiting certain pigments due to safety concerns.

Red pigments can contain cadmium sulfide, cadmium selenide, iron, or mercury. Green pigments can contain cobalt aluminum oxides or copper pthalocyanide. Pigments may also contain antimony, arsenic, beryllium, selenium, aluminum, titanium dioxide, or chromium. All these heavy metals can cause false positives in medical imaging studies, for example mammography. They may also cause local allergic skin reactions. The liquids used for inks may contain water, ethanol, methanol, or propylene glycol (antifreeze).

Interestingly, the Swedish study found that the risk of lymphoma from tattoo ink was not dose related. In other words, the tattoo size and number did not matter. The risk was the same whether the person had one tiny tattoo or tattoo sleeves. The study’s lead author stated “We do not know why this was the case. One can only speculate that a tattoo, regardless of size, triggers a low-grade inflammation in the body, which, in turn, can trigger cancer.” She added “It is important to make people aware that tattoos may have adverse health effects and that you should seek medical care if you have complaints that you associate with the tattoo.” Another study, published in 2022 in “Toxicology and Human Health” warned that toxic substances in tattoo ink “could pose toxicological risks to human health.” A study presented at the 2023 American Association for Cancer Research annual meeting identified a potential link between having three or more large tattoos and higher risks of blood cancers, myeloid cancers (bone marrow cancers), and lymphoma.

Certain ink colors, especially red and black, are associated with increased risk of skin cancers such as melanoma, basal cell carcinoma, and dermatofibrosarcoma protuberans. Hopefully this information will make people think twice about having these toxins injected into their body.

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