Two years ago, when Gina Pozzi was 45, her annual mammograms suggested she had breast cancer, the disease that killed her mother at 47.

As well as showing a suspicious spot in Pozzi’s right breast, the x-rays revealed white spots in the lymph nodes in her armpits that looked like calcium deposits – possibly a sign that the cancer had spread to her. beyond its bosom.

“When cancer hits you in the lymph nodes, it is a game changer,” said Pozzi, who lives in Allentown. “This is what happened with my mother. The cancer came back and went to her lymph nodes.

Fortunately, Pozzi’s worst fears did not come true. Biopsies of her breast and lymph node tissue showed that she had an early stage, easily treatable breast tumor that had do not metastasis. The harmless stains were actually ink from an elaborate tattoo covering her right arm. His immune cells had swallowed up some of the pigment and then migrated to his lymph nodes.

To be clear, there is no evidence that tattoos increase the risk of breast cancer. And as Breastcancer.org explains, calcifications can be signs of harmless changes caused by breast injury or infection, fibrous cysts, or radiation therapy. The gold injections used to treat rheumatoid arthritis and even deodorants containing aluminum can also activate immune cells which act as garbage crushers as they move through the lymphatic system.

The problem, as Pozzi discovered, is that removing a metastatic cancer may require additional imaging and collection of tissue samples for laboratory analysis, as well as a week or two of waiting for them. results. Pozzi was completely unaware of the problem because state and federal regulators, the tattoo industry, breast cancer activists and social media devoted to body art mention little, if at all, that tattoos can make screening for breast cancer difficult.

Due to his family history, Pozzi began having mammograms in his twenties, decades before x-rays were recommended for women in general. In his thirties, Pozzi started getting a tattoo from one particular artist.

“I would have appreciated to know that there was a possibility that this would happen,” said Pozzi. “Would that have dissuaded me from getting a tattoo?” Probably not.”

Breast radiologists may be the only group to know about the problem, as many middle-aged women – in prime time to begin routine breast screening – now sport prominent tattoos on the breast. upper body. About 40% of Gen Xers, men and women between the ages of 41 and 56, have at least one tattoo, according to the Pew Research Center.

“I saw [tattoo pigment in lymph nodes] Many times. I think every radiologist has done it, ”said Susan L Summerton, radiologist at the University of Pennsylvania Health System. “The first case report was back in 2004. Now we see it probably a few times a month.”

In fact, this 2004 affair was not the first report, contrary to the belief of the New York City radiologists who published it. In 1981, the journal Radiology published “Tattoos simulating calcifications on xeroradiographs of the breast. “

Women without a family history or signs of cancer other than armpit lymph node deposits that are likely ink stains usually do not need biopsies, Summerton said. They often react with surprise or anxiety, which is why Summerton explains that when a tattoo needle pierces the skin, it causes a small wound; the body responds by sending white blood cells to close the wound and swallow up invaders such as germs or parasitic pigments.

It is not known if lymph nodes in other parts of the body of inked women – and men – have pigment spots because these nodes are not systematically x-rayed. “If you have a tattoo on your leg, there is no imaging of the groin lymph nodes,” Summerton said.

Eric Amicone, a tattoo artist for 30 years, was taken aback when a reporter asked him about ink and mammograms.

“This is the first time I’ve heard of it,” said Amicone, owner of Everlasting Art Tattoo in West Philadelphia. “And 60% of my clients are women.”

Amicone hypothesized that current tattoo inks are less likely to trigger lymph node deposits because the formulations do not rely on metals to create colors. “Now the inks are all natural and biodegradable,” he said.

It’s more complicated, according to an article published by the American Chemical Society. Historically, the pigments in tattoo inks were derived from minerals and heavy metals, many of which had known toxicities. For example, the black was made with iron oxide and the red tints were made with a mercury sulfide compound.

“Over the past 20 years, ink manufacturers have switched from mineral-based pigments to organic pigments,” the chemical company article explains. “More than 80% of the dyes used today are carbon-based.

But “organic” doesn’t necessarily mean natural or safe. For example, according to the article, carbon-based azo pigments, used to produce reds, yellows and oranges, are known to release carcinogenic compounds when they break down, especially when exposed to sunlight. . A number of tattoo pigments have been “originally developed for industrial applications, such as paints or textiles”.

The United States Food and Drug Administration considers tattoo inks to be cosmetics and takes regulatory action only if the agency identifies a safety concern. Tattoo parlors are regulated by local authorities.

Pozzi, who underwent a lumpectomy and radiation therapy to treat his cancer, found his longtime tattoo artist was vaguely aware of the mammogram problem, but no other clients have said they have experienced it.

“I’m not sure if it’s the tattoo artist’s responsibility or the doctors or others to educate women,” Pozzi said, noting that mastectomy patients who undergo breast reconstruction often get tattoos to recreate the nipple area.

“I don’t want to be an alarmist,” Pozzi said. “I just think women should have the information.”