Breast Implants Linked to Increased Risk of Developing Breast ALCL

By Mia Garchitorena
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A new study found that breast implants are linked to an increased risk of this rare type of cancer.

Researchers from various medical centers in The Netherlands analyzed a possible association between breast implants and the risk of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), a rare type of non-Hodgkin’s lymphoma, and sought to determine the relative and absolute risks. They found an increased relative risk between the two, but state that the absolute risk remains extremely low. The study was published in JAMA Oncology.

Breast implant. (Source: NCI)

The study authors used a large, Dutch population-based pathology registry to identify all patients who were diagnosed with non-Hodgkin lymphoma in the breast between 1990 and 2016. They then determined how many of those patients had breast implants by collecting their clinical data from their physicians, according to the study.

The researchers estimated the odds ratio of BIA-ALCL associated with breast implants and compared the prevalence between women with BIA-ALCL and women with other types of breast lymphoma.

“Cumulative risk of BIA-ALCL was derived from the age-specific prevalence of breast implants in Dutch women, estimated from an examination of 3000 chest x-rays and time trends from implant sales,” the authors wrote in the study.

According to the study, 43 patients were identified to have BIA-ALCL. Thirty-two of those patients had breast ipsilateral breast implants. Only one patient out of 143 women with other primary breast lymphomas had breast implants.

The prevalence of breast implants in women between the ages of 20 to 70 was 3.3%, the study found. The absolute risk of BIA-ALCL is 1 in 35,000 at age 50, 1 in 12,000 at age 70, and 1 in about 7,000 at 75 years in women with breast implants. 

“Our results emphasize the need for increased awareness among the public, medical professionals, and regulatory bodies, promotion of alternative cosmetic procedures, and alertness to signs and symptoms of breast-ALCL in women with implants,” the authors wrote.

In 2011, the U.S. Food and Drug Administration (FDA) found a possible association between breast implants and BIA-ALCL but had difficulty determining the exact number of confirmed cases because of a lack of world-wide reporting and global implant sales data.

As of February 1, 2017, the FDA has received a total of 359 medical device reports, which included nine deaths. There are currently six confirmed cases of BIA-ALCL among 17,656 women with Biocell textured implants. Most data suggests that BIA-ALCL occurs more frequently in patients who receive textured implants rather than smooth implants, the organization stated on their website.

In an accompanying editorial commentary, reconstructive surgeon Colleen McCarthy, MD, and medical oncologist Steven Horwitz, MD from Memorial Sloan Cancer Center in New York sought to better understand the relative and absolute risks by analyzing other studies on BIA-ALCL. They found that there is a growing body of evidence that suggests a greater risk of BIA-ALCL with macrotextured implants, which are not commonly used in the U.S., compared with microtextured implants. The reason for this may have to do with the larger surface area on macrotextured implants, which can bring on greater bacterial contamination.

“In the meantime, it is essential that we continue to systematically capture the critical data elements needed to evaluate both the risk and nature of BIA-ALCL,” they said. They urge clinicians to report all confirmed cases of BIA-ALCL to the PROFILE registry and the FDA.