From ... in Biology — Jul 3, 2024

Tattoos May Increase Your Risk of Lymphoma, a Study Finds

Tattoos are becoming more commonplace nowadays.

According to a 2023 survey from Pew Research Center, at least a third of Americans have one or more tattoos, and the reasons are as unique as the people who get them. If you're considering getting a tattoo, no doubt you've spent considerable time going over the artistic appeal. It will stay on your skin forever, after all. However, have you thought about the health aspects of getting a tattoo as well? Most people may not even be aware that this procedure can pose a risk to their health. And according to published research, the newest one on the list is malignant lymphoma.

A Swedish study published in eClinicalMedicine investigated the potential link between tattoos and lymphoma. The researchers, hailing from Lund University, were particularly interested in studying the long-term effects of tattooing on human health, since there's limited information about this topic. After looking at 11,905 participants, the study authors identiﬁed 2,938 people who have been diagnosed with lymphoma when they were between 20 and 60 years old. They then matched these participants with another group consisting of the same age and gender, who didn't have cancer. After sending out more questionnaires to identify other factors that could contribute to cancer development, researchers determined that participants with at least one tattoo had a 21% higher risk of developing lymphoma compared to those who did not have any tattoos. However, they acknowledged certain limitations of the study, such as the role of the tattoo's size. According to lead researcher Christel Nielsen, their team initially hypothesized that the size of the tattoo could affect the risk of getting lymphoma. Therefore, participants with full-body tattoos would logically have a higher risk compared to someone who have a small, single tattoo. However, they discovered that this wasn't the case — in fact, the size didn't matter at all. In a news released published by Lund University, Nielsen commented: "We do not yet know why this was the case. One can only speculate that a tattoo, regardless of size, triggers a low-grade infiammation in the body, which in turn can trigger cancer. The picture is thus more complex than we initially thought."

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Malignant lymphoma is a type of cancer that affects your lymph nodes, which is part of the lymphatic system. This an essential part of your body's immune function as it helps protect against germs and diseases. As lymphoma begins to grow out of control, symptoms such as unexplained weight loss, fatigue, night sweats and chest pain begin to appear. Lymph nodes are located throughout your body, mainly in the abdomen, groin, pelvis, chest, underarms and neck. They contain immune system cells, acting as "ﬁlters" to ﬁght pathogens carried into them via lymph ﬂuid. When there's an infection, these nodes swell and get to work. However, certain substances — in this case, tattoo ink — may hamper the function of the lymph nodes. According to Nielsen: "We already know that when the tattoo ink is injected into the skin, the body interprets this as something foreign that should not be there and the immune system is activated. A large part of the ink is transported away from the skin, to the lymph nodes where it is deposited." This hypothesis is also observed in a study published in Chemical Research in Toxicology. According to the authors, "Pigments may accumulate in the lymph nodes or other organs as they are in direct contact with the skin tissue and lymphatic system." In turn, the pigments may cause the lymph nodes to swell. Upon closer inspection, it's easy to see why lymph nodes swell and stain after tattooing — they contain toxic ingredients.

The increased risk of lymphoma is not the only concern tied to getting a tattoo. The ink used may also cause organ failure, as noted in a study published in Analytical Chemistry, which investigated 54 tattoo inks from nine different brands sold in the U.S. In their analysis, researchers found that 45 inks contained discrepancies — the ingredients were different from the ones listed on the label.

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Fifteen samples tested positive for polyethylene glycol (PEG), a potential allergen that can damage your organs through repeated exposure. PEG is a petroleum-based substance used in various applications, such as solvents, softeners and thickeners in cosmetics. Medically, PEG is used as a laxative for constipation. Repeated exposure to PEG can eventually damage your organs, particularly the kidneys. In a study published in Endoscopy, researchers discovered that using PEG may cause acute renal failure, especially for patients who need to use it before a colonoscopy. PEG may also be carcinogenic. In an analysis by the David Suzuki Foundation, synthesizing PEG from petroleum creates detectable levels of ethylene oxide, which is classiﬁed as a "known human carcinogen" by the International Agency for Research on Cancer (IARC). PEG may also contain 1,4-dioxane, which is used in automotive coolants, chemical manufacturing and as a solvent for paper and other textiles. In a study published in Molecules, researchers discovered that a green tattoo ink sold "FOR ASIA MARKET ONLY" contained this toxic compound. 1,4-dioxane can cause eye, nose, throat and skin irritation, and has been linked to liver and kidney toxicity as well. In fact, its notorious reputation has reached legislators — in 2020, the state of New York passed a bill banning its use in personal care and household cleaning products.

Compounding the problem of tattoo inks is its use of iron oxide, which gives it a darker color. While many may suggest they're safe to use, a case report published in Virulence showed that when tattoo ink gets absorbed in your body, it can elevate your iron levels and possibly cause a misdiagnosis. In the study, a woman who had a severe case of anemia unexpectedly had high serum iron, which baﬄed her physicians — until they found out that she had gotten a large

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black tattoo on her left abdomen a week prior her doctor's appointment. The researchers noted: "Apparently iron oxide in the ink used for the tattoo was absorbed transcutaneously and led to high serum iron in the face of the other data, which suggested iron deficiency. We believe that this case report reinforces the imperative to always do a careful physical examination with any patient who has anemia, and also illustrates the potential toxicity of tattoo ink." As the Chemical Research in Toxicology study notes, around 1% to 4% of all tattoo inks contain iron oxide, which can pose serious risk to your health. According to the researchers: "Iron oxide formation has been associated with significant deleterious effects, such as infiammation, apoptosis, disruption of mitochondrial function, membrane changes, reactive oxygen species formation, increased micronucleus induction and chromosome condensation, depending on concentration, exposure time and cell type." It's no surprise that introducing excess iron into your body can eventually harm your health. For example, animal studies have shown that iron oxide nanoparticles may damage the membranes of endothelial cells by generating reactive oxygen species (ROS), harmful molecules that can cause signiﬁcant damage to cell structures. In a 2013 meta-analysis, researchers demonstrated that heightened iron levels are linked to a higher risk of cardiovascular disease. They emphasized a study showing that elevated ferritin levels raised men's risk of acute myocardial infarction two- to threefold. Elevated ferritin is also associated with a 2.9 times higher risk of death from cancer, tying back into the iron oxide present in tattoo ink.

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The best way to avoid the risk of iron overload from tattoos is not getting them in the ﬁrst place. However, if you already have one or several tattoos, you can still mitigate the risks of iron overload — and support a noble cause at the same time — by donating blood. Ideally, donate your blood two to four times a year. Adults typically have 10 pints of blood, and the standard donation amount is 1 pint. This means that every time you donate, you're giving away roughly 10% of your blood. If the thought of losing this much blood several times a year is uncomfortable for you, I suggest a phlebotomy in smaller amounts, once a month, using the schedule below. Men Postmenopausal Women Premenopausal Women 150 ml 100 ml 50 ml If you're already tattooed and would like to donate blood, there are some guidelines you need to follow. The American Red Cross says you can immediately give blood if the tattoo parlor follows the sanitation regulations set by your state. If not, you need to wait three months: "In most states, a tattoo is acceptable if the tattoo was applied by a state- regulated entity using sterile needles and ink that is not reused. The same goes for cosmetic tattoos (including microblading of eyebrows only): If they were applied in a licensed establishment in a regulated state using sterile needles and ink that is not reused, then they are acceptable. If you received a tattoo in a state that does not regulate tattoo facilities, then you must wait three months after it was applied. Currently, the only states that DO NOT regulate tattoo facilities are District of Columbia, Georgia, Idaho, Maryland, Massachusetts, New Hampshire, New York, Pennsylvania, Utah and Wyoming." The reason for the three-month period is due to concerns with hepatitis, which you can acquire after getting a tattoo. In fact, tattoos are a risk factor for hepatitis B and C.

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This is especially the case if the tattoo is done in an improvisational manner, and the environment and equipment aren't sterilized. If you have no tattoos, but recently had piercings, the same guidelines still apply: "Similarly, piercings are acceptable if the instruments used were single-use equipment and disposable (meaning both the gun and the earring cassette were disposable). You must wait three months if a piercing was performed using a reusable gun or any reusable instrument. It's also required that you wait three months if there is any question whether the instruments used were single-use equipment."

You can have your iron levels checked using a simple blood test called a serum ferritin test, which measures stored iron. I believe this is one of the most important tests that everyone needs to do on a regular basis as part of a preventive, proactive health screen. If you have tattoos, this test may be especially important. Aside from this, a gamma- glutamyl transpeptidase (GGT) test can also be used to measure excess free iron. What's the ideal iron level for optimal health? In my interview with Christy Sutton D.C., author of "The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health?", she recommends keeping ferritin levels below 100 nanograms per milliliter (ng/ml). A result above 100 ng/ml means you're either inﬂamed, have high iron or both. Studies referenced in Sutton's book suggest anything over 200 ng/ml is pathological. The higher your ferritin level, the shorter your lifespan. And as the studies have shown earlier, you're more likely at risk for heart disease and cancer. Remember, if your iron levels are high, donating blood two to four times a year is an effective way to lower them, while also contributing to society.

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Tattoos May Increase Your Risk of Lymphoma, a Study Finds

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