A study casts doubt on the increased risk of lymphoma in tattooed people

Tatouage et sur-risque de lymphome, une étude sème le doute

Intrigued by the popularity of tattoos and the increasing incidence of lymphoma, researchers have wondered about a potential increased risk of these malignant cancers in tattooed people. They observed a disturbing coincidence which will have to be confirmed by further work.

Tattooing has become very popular in France. Nearly one in five French people are tattooed, twice as many as at the start of the 2010s. The prevalence is 20% in Europe, according to the recent TABOO 2023 study. 32% of Americans are, and even 22% have several (56% of women between 18 and 29 years old). Most people get their first tattoo at a young age. However, tattoo ink and its constituents persist in the body for many decades, mainly in the lymph nodes.

Researchers, based on a large database of people who developed tattoos, found an increased risk of this form of lymph node cancer. Lymphoma is a malignant disease characterized by the excessive proliferation of B or T lymphocytes in the lymphatic system and its organs, such as the lymph nodes, liver, and spleen.

Tattoo ink can stain lymph nodes

The fact that some of the ink passes into the lymph nodes is well known, but not explored. “In tattooed individuals, the lymph nodes in the drainage area of ​​the tattoo exhibit coloration, similar to that of the axillary lymph nodes in cases of tattooing on the arm or shoulder, explains Dr Nicolas Kluger, dermatologist at Bichat hospital (Paris). The pigments migrate towards the lymph nodes. Certain immune cells (macrophages) absorb pigments present in the skin and transport them to the lymph nodes."

21% higher risk of lymphoma among tattooed people

"Until then, he continues, he had not increased risk of lymphomas in tattooed people." Swedish researchers carried out a so-called case-control study which has just been published. This is an analysis which compares a group of people suffering from a disease (the cases) to a group of people without the disease (the controls), in order to identify the factors of risk associated with the disease. In this case, they compared individuals from a control group to all individuals aged 20 to 60 who were diagnosed with malignant lymphoma in Sweden between 2007 and 2017, i.e. nearly 11,905 people. (records of the Swedish National Authority).

The authors commented on their results: "Nwe found that tattooed individuals had a 21% higher risk of overall malignant lymphoma than non-tattooed individuals, and that the association was stronger for diffuse large B-cell lymphoma and follicular lymphoma." The risk is increased when the tattoo is less than 2 years old at the time of lymphoma diagnosis (+81%) and more than 11 years old (+19%). No link emerges with the body surface covered by the tattoo, or its color.

So, tattoos, a risk factor for malignant lymphoma ?

Not so fast. Researchers explain: "Tattoo ink often contains carcinogenic chemicals, such as primary aromatic amines (in colored inks), polycyclic aromatic hydrocarbons (black inks ) and metals (nickel, cobalt…). The tattooing process triggers an immunological response that causes the tattoo ink to translocate from the injection site." However, nothing has yet been proven regarding the link with lymphomas. Case-control studies are particularly useful for identifying new risk factors. But to assert a causal link, this is not enough. "Our results suggest that tattoo exposure is associated with an increased risk of malignant lymphoma, write the authors. Additional epidemiological research is urgently needed to establish causality."

Already, the study highlights the importance of regulatory measures to control the chemical composition of tattoo ink.

To find out more about tattoos: Tattoos: what is the reality of the allergic risk ?