Background: Tattooing is increasing in popularity throughout western countries and is seen in approximately 32% of the United States. However, little is known about long-term health effects of tattooing. Some tattoo inks contain carcinogens, which can interact with solar radiation to produce potentially toxic compounds. Tattoo inks can also migrate to the lymphatic system and produce inflammatory and immune responses. In this study, we evaluated whether tattooing exposures were associated with risk of hematologic malignancies.

Methods: This population-based case-control study included 656 cases of hematologic malignancies (156 myeloid neoplasms and 500 lymphomas), ages 19-79 years, who were diagnosed between July 2019 and December 2021, and identified through the Utah Cancer Registry using rapid case ascertainment. Controls were selected from ~19,000 adult Utah residents who participated in the 2020 Utah Behavioral Risk Factor Surveillance System (BRFSS) statewide survey and frequency matched to cases in a 3:1 ratio on age, sex, race, and ethnicity. Telephone surveys collected data on number of tattoo sessions, number of large tattoos, age at first tattoo, and relevant covariates. We fit binary logistic regression models for general hematologic malignancies and multinomial logistic regression models for myeloid neoplasms and lymphomas, to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for each tattoo variable, adjusted for age, sex, race, ethnicity, education level, past cancer diagnosis (yes/no), and ever smoker (yes/no).

Results: There was no strong evidence that ever having received a tattoo versus never having received a tattoo was associated with risk of overall hematologic cancers (OR=1.01, 95% CI: [0.96-1.07]), myeloid neoplasms (1.12 [0.59-2.13]), or lymphomas (1.07 [0.77-1.49]). However, having three or more large tattoos, compared with never having received a tattoo, was suggestively associated with an increased risk of overall hematologic cancers (1.33 [0.69-2.47]). The effect estimate was strongest among myeloid neoplasms (1.73 [0.54-5.50]). Compared with never having received a tattoo, receiving a first tattoo before age 20 was associated with an elevated risk of myeloid neoplasms (2.00 [0.91-4.38]), and receiving a first tattoo at age 20 or older was associated with an elevated risk of lymphoma (1.24 [0.84-1.83]), though the estimates were imprecise.

Conclusion: We observed a potential association between having several large tattoos and risk of hematologic cancers, particularly myeloid neoplasms. The risk of myeloid neoplasms appeared to be strongest among individuals receiving tattoos at young age. If confirmed, these findings could inform public health messaging about the safety of tattoos.

Citation Format: Rachel D. McCarty, Britton Trabert, Morgan M. Millar, Benjamin Haaland, Laurie Grieshober, Mollie Barnard, Lindsay Collin, Jeffrey A. Gilreath, Paul J. Shami, Jennifer A. Doherty. Tattooing and risk of hematologic cancer: A population-based case-control study in Utah [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6471.