Project summary
CRABAT is a cohort study of about 13 000 tattooed individuals and 100 000 untattooed controls. It is the French partner study to Tattoo inK. CRABAT is integrated into the Consultants des Centres d’Examens de Santé (Constances) cohort (https://www.constances.fr/) of the French National Institute of Health and Medical Research (INSERM). Constances is the major epidemiological data source and research infrastructure contributing to the development of epidemiological research and surveillance, and providing information for public health purposes in France. Recruitment started in 2012, and Constances now has almost 220 000 volunteers, who are helping researchers to advance knowledge on health and participate in multiple research projects targeting major population health concerns.
Leveraging these resources, the CRABAT study aims to investigate a potential tattoo-induced cancer risk, as well as tattoo-related dermatological and immunological consequences. To attain these aims, longitudinal epidemiological data are collected via the EpiTAT exposure questionnaire, which is sent to all tattooed Constances participants regardless of age or sex. This detailed knowledge about exposure is needed because a potential health risk is likely to depend on many tattoo factors (e.g. colour, size, and age). The tattooed and untattooed cohort members will be followed up via record linkage to national health insurance data to compare their risk of developing first primary cancers and other relevant health effects. Cohort follow-up is planned for at least 20 years.
Justification
Long-term health consequences related to tattoos, in particular whether tattoo inks can cause cancer, is an under-researched field. This is worrying considering the rising population prevalence of tattoos, the potential presence of carcinogenic substances in inks, and their potential systemic distribution after intradermal injection. Although this new route of exposure to many known carcinogens is largely unexplored, toxicological analyses of tattoo inks and in vitro studies are emphasizing the need for epidemiological research on this worldwide trend.
Vision
To make an important contribution to public health through pioneering work in the field of epidemiological research on long-term health effects related to tattoos.
Goals
- To prospectively assess and re-assess tattoo-associated cancer risks at 5-year intervals starting in 2025 (i.e. 5 years after initial exposure information).
- To assess other potential tattoo-related health effects (e.g. immunological outcomes).
- To explore the burden of tattoo-associated viral infections in France and their potential impact on lymphomas.
- To provide a research framework for scientists in all fields who are interested in studying tattoo-related scientific questions.
- To contribute to an international data pooling project on tattoos and long-term health effects.
Target audience
Policy-makers, consumers, tattoo artists, and health professionals
This project is being developed under the leadership of IARC, led by Dr Milena Foerster and Dr Joachim Schüz in collaboration with Professor Khaled Ezzedine of Université Paris-Est Créteil. CRABAT receives funding from the French Institut national du Cancer (INCa). The CRABAT cohort recruits its participants from among the volunteers of the Constances epidemiological cohort, which is made up of a large sample of adults visiting the Social Security Health Examination Centres (for more information, see https://www.constances.fr/). We warmly thank the Principal Investigators Dr Marie Zins and Dr Marcel Goldberg as well as all participating Constances cohort volunteers for their support.
Project summary
Tattoo inK is a cohort study of about 18 000 tattooed individuals and 160 000 untattooed controls. It is the German partner study to CRABAT and is nested within the German National Cohort (NAKO). The study aims to investigate a potential tattoo-induced cancer risk, as well as tattoo-related dermatological and immunological consequences. To attain these aims, longitudinal epidemiological data are collected via the EpiTAT exposure questionnaire, which is sent to all tattooed NAKO participants regardless of age or sex. This detailed knowledge about exposure is needed because a potential health risk is likely to depend on many tattoo factors (e.g. colour, size, and age). The tattooed and untattooed cohort members will be followed up via record linkage to national cancer registry data to compare their risk of developing first primary cancers and other relevant health effects. Cohort follow-up is planned for at least 20 years.
Justification
Long-term health consequences related to tattoos, in particular whether tattoo inks can cause cancer, is an under-researched field. This is worrying considering the rising population prevalence of tattoos, the potential presence of carcinogenic substances in inks, and their potential systemic distribution after intradermal injection. Although this new route of exposure to many known carcinogens is largely unexplored, toxicological analyses of tattoo inks and in vitro studies are emphasizing the need for epidemiological research on this worldwide trend.
Vision
To make an important contribution to public health through pioneering work in the field of epidemiological research on long-term health effects related to tattoos.
Goals
- To prospectively assess and re-assess tattoo-associated cancer risks at 5-year intervals starting in 2024.
- To assess other potential tattoo-related health effects (e.g. immunological outcomes).
- To explore the burden of tattoo-associated viral infections in Germany and their potential impact on lymphomas.
- To provide a research framework for scientists in all fields who are interested in studying tattoo-related scientific questions.
- To contribute to an international data pooling project on tattoos and long-term health effects.
Target audience
Policy-makers, consumers, tattoo artists, and health professionals
This project is being developed under the leadership of the German Cancer Research Center (Principal Investigator: Dr Lena Koch-Gallenkamp) and IARC (Scientific Lead: Dr Milena Foerster). The core study team comprises Dr Joachim Schüz (Head of the Environment and Lifestyle Epidemiology Branch at IARC) and Dr Bernd Holleczek from the German Cancer Registry Network. Tattoo inK receives funding from the German Cancer Aid (Deutsche Krebshilfe [DKH]) and is embedded within the framework of the NAKO cohort. We warmly thank the Principal Investigators of all participating NAKO study centres as well as the NAKO participants for their support.
(Project closed)
Project summary
This validation study of a tattoo exposure questionnaire was conducted in winter 2021–2022 in Lyon, France. Almost 100 tattooed participants were recruited on social networks and invited to each complete one of three different preliminary versions of the Epidemiological Tattoo Assessment Tool (EpiTAT), which differed in their unit for measuring tattoo size, colour, and coverage, with hand surface area, credit card surface area, or body schemes of tattooed limbs as a unit of measurement. The study identified hand surface area as the most suitable unit of measurement and identified important measurement biases. The subjective self-estimation of tattoo size led to an overestimation of total tattoo surface area by almost 3-fold compared with validation measurements. The study also introduced ImageJ as a suitable tool for measuring tattoo surface area on photographs.
Justification
Exposure assessment is a cornerstone of environmental and occupational epidemiology and deserves particular attention in the planning and set-up of epidemiological studies. Misestimations of exposure are frequent and are known to produce errors, which often (but not always) could have been avoided through pilot studies dedicated to exposure assessment, such as this validation study of EpiTAT.
Vision
To ensure sound estimation of tattoo exposure in epidemiological research and identify biases.
Goals
- To provide a standardized questionnaire of tattoo exposure to be used in epidemiological studies worldwide to facilitate data pooling and ensure comparability of results.
- To identify a suitable and easy-to-apply unit of measurement for tattoo size.
- To identify and quantify exposure estimation biases to be considered in future studies.
Target audience
Researchers
This project was developed under the leadership of IARC (Principal Investigator: Dr Milena Foerster) and received no external funding. We warmly thank the study participants for their kind collaboration.
