Is tattooing associated with an increased risk of cancer? A systematic review and meta-analysis.

BACKGROUND

Tattoo inks may contain carcinogenic compounds, and pigment migration to lymphatic tissues raises concerns regarding potential cancer risk. Epidemiological evidence remains inconclusive.

OBJECTIVES

To assess the association between tattoo exposure and the incidence of skin cancer and hematological malignancies.

METHODS

PubMed, Embase, and the Cochrane Library were searched from inception to January 2026 for cohort and case-control studies comparing cancer incidence in tattooed versus non-tattooed adults. Random-effects meta-analyses using restricted maximum-likelihood estimators were performed to pool odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was quantified using I2 statistics. Risk of bias was assessed using ROBINS-E, and certainty of evidence was evaluated with GRADE. Leave-one-out sensitivity analyses were conducted.

RESULTS

Seven observational studies including 140,841 participants were analyzed. Tattoo exposure was not associated with overall skin cancer (OR 0.92; 95%CI 0.83-1.04; I2 = 0%; p = 0.179). Stratified analyses by number of tattoo sessions showed no significant associations: one session (OR 1.08; 95%CI 0.55-2.12; I2 = 92.4%), two-to-three sessions (OR 0.90; 95%CI 0.62-1.32; I2 = 63.2%), and ≥ 4 sessions (OR 0.70; 95%CI 0.29-1.70; I2 = 88.5%). For hematological malignancies, pooled analysis showed no significant association (OR 1.02; 95%CI 0.78-1.32; I2 = 64.9%; p = 0.910). Subtype analyses were non-significant: non-Hodgkin lymphoma (OR 1.00; 95%CI 0.73-1.36; I2 = 3.7%), Hodgkin lymphoma (OR 1.19; 95%CI 0.59-2.40; I2 = 91.7%), diffuse large B-cell lymphoma (OR 0.90; 95%CI 0.57-1.44; I2 = 61.7%), T-cell lymphoma (OR 1.07; 95%CI 0.61-1.88; I2 = 0%), and follicular lymphoma (OR 0.99; 95%CI 0.72-1.36; I2 = 1.9%). Sensitivity analysis excluding one influential study rendered the association for overall hematological malignancies statistically significant (OR 1.20; 95%CI 1.05-1.39; I2 = 0%). Certainty of evidence ranged from low to moderate.

CONCLUSIONS

Tattoo exposure was not associated with increased skin cancer risk and showed no significant association with hematological malignancies in primary analyses. A significant association emerged only after sensitivity analysis, warranting cautious interpretation and further prospective investigation.