Do Tattoos Raise the Risk for Cancer?

Can tattoos give you cancer? A new study shows that pigments in tattoo ink migrate from the skin to the lymph nodes, leading to chronic enlargement. Although the long-term effects of this were not studied and are yet unknown, the findings have created quite a bit of buzz in the mainstream media, pointing to tattoos as a possible cause of cancer.

The results are too preliminary to suggest that tattoos can increase the risk for cancer, say the authors.

"Skin infections are a common side effect of getting a tattoo," explained study author Hiram Castillo-Michel, PhD, from the European Synchrotron Radiation Facility in Grenoble, France. "Granuloma formation and allergies are often reported to occur with tattooing, and these are health risks that can be linked to the tattoos very easily because they directly appear in the tattooed skin area."

Chronic health effects, such as cancer, are more complicated to track. "They usually do not emerge before years or decades after exposure and are thus difficult to link to tattoos or certain tattoo ingredients," Dr Castillo-Michel told Medscape Medical News. "Without epidemiological data that track large cohorts for decades and investigate whether people are tattooed or not, a connection between tattoo ingredients and chronic adverse effects can hardly be uncovered."

He added that this "also accounts for the pigments and toxic elements that we found in the lymph nodes in our study. The long-term health effects of this are unknown, so far."

The depositing of elements from tatoo ink in lymph nodes has never been investigated before. Because data on the exposure to toxic elements are yet unavailable, "people should be aware of the unknown risks that might come along with tattooing rather than presuming that the colors are safe," said Dr Castillo-Michel.

The findings were published online September 12 in Scientific Reports.

Tattoos have become increasingly mainstream. Tattoo-related health and safety regulations have focused primarily on regulations regarding hygiene and the prevention of infection.

The ink used to create a tattoo generally contains organic pigments but can also include nickel, chromium, manganese, cobalt, or titanium dioxide (TiO₂), which is the second most common ingredient used.

In this study, particles from both organic pigments and inorganic TiO ₂ were detected in skin and lymph nodes, as were several of the more toxic elements, such as nickel and chromium.

"Some of the elements we found, such as nickel and chromium, are categorized as carcinogenic and sensitizing substances by the Globally Harmonized System of Classification and Labelling of Chemicals," said first author Ines Schreiver, of the German Federal Institute for Risk Assessment, Berlin, Germany. "These substances potentially may harm the health of tattooed individuals."

She explained that to perform an appropriate risk assessment, further investigations on the average amounts of these compounds in the skin are needed. "This is necessary to estimate to what extent these elements will increase the risk of cancer over human lifetime," said Schreiver.

The deposit of these pigmented particles led to chronic enlargement of the lymph nodes, and exposure appears to be lifelong, she added.

Previously Observed in Lymph Nodes

Tattoos are created by depositing insoluble pigments into the dermal skin layer. For decades, enlarged lymph nodes have been observed in individuals with tattoos. The migration of tattoo ink to the regional nodes has also been observed in patients with breast cancer, melanoma, testicular seminoma, and vulvar squamous cell carcinoma.

As previously reported by Medscape Medical News, tattoo ink from 14 tattoos that extensively covered the legs of a cervical cancer patient migrated into the lymph nodes and was mistaken for metastatic disease. Initially diagnosed with stage 1B disease, her condition was upgraded, and 40 of the patient's lymph nodes were surgically removed.

Toxic Elements and Nanoparticles

In the current study, Schreiver and her colleagues analyzed tattooed human skin and tissue from regional lymph nodes that were obtained from four corpses. The investigators used synchrotron X-ray fluorescence techniques at both micro and nano scale.

The particles ranged in size in the human skin samples, but only the nanoparticles migrated into the lymph nodes.

A key goal of this analysis was to assess to what extent tattooing increases the proportion of toxic elements in the body. The authors found that levels of aluminum, chromium, iron, nickel, and copper were elevated in both skin and lymph node specimens.

In specimens from one of the donors, levels of cadmium and mercury were increased in the lymph nodes but not in the skin samples. These elements may have migrated from tattoos that were not used in this study, the authors note, or through other routes of exposure.

TiO₂, which was also found in skin and lymph node samples, is a white pigment commonly used to create varying shades of color in tattoos. It is also used in food additives, sunscreens, and paints. It has been associated with delayed healing and itching when used in tattoos, and the European Chemicals Agency recently declared that it is carcinogenic when inhaled.

"The size and degree of shading of the tattoo will determine the amount of ink injected into the body," said Dr Castillo-Michel. "Therefore, the amount of toxic substances will depend on the size of the tattoo and if a contaminated ink has been used."

The authors plan to continue investigating the burden of pigments and heavy metals on other, more distant internal organs and tissues, so that other potential sites of migration of the ingredients of tattoo ink can be identified.

"Biodistribution, metabolism, and a potential excretion of substances are key points necessary to assess the toxicity of compounds in tattoo inks," said Schreiver. "Especially when organic pigments are transported to the liver, a higher rate of metabolism can be expected. The toxicological properties of the reaction products are completely unknown so far."

The study was supported by the intramural research project at the German Federal Institute for Risk Assessment. The authors have disclosed no relevant financial relationships.

Sci Rep. Published online September 12, 2017. Full text

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