Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast

Authors: De Boer, M et. al.

Source: JAMA Oncol. doi:10.1001/jamaoncol.2017.4510

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Questions have been asked about the health hazards of breast implants over the years. At one point, silicone implants were banned from use in the United States. Associations have been made between silicone implants and breast cancer, autoimmune diseases and connective tissue disorders. However, scientific studies have not proven any of these relationships.

The authors first published a report in 2008 that showed an increased risk of breast ALCL among women with breast implants. They noted that, since 2008, the number of cases of breast ALCL among women with breast implants has risen. However, the number still remains so low (just 173 patients) that there have been no updated studies about the incidence.

The authors accessed a Dutch national health records database to readdress the topic. Women with breast ALCL and women with other types of breast lymphomas were identified. These women’s records were reviewed to determine if they had ipsilateral (same side as the lymphoma) breast implants.  ALCL was identified in 47 women with implants. Just over 40 (43) of these women had documentation that the ALCL originated in the breast with the implant.

Using this data as well as information from other data sources, women with breast implants were 400 times more likely to develop breast ALCL compared to women without breast implants. For women with implants, the group predicted an absolute risk of 29 implant associated cases of breast ALCL per 1 million women at age 50. This risk rose to 82 cases per 1 million women at age 70. This translated to a risk of 1 per 35,000 women at age 50 and 1 per 12,000 women at age 75. It appeared that the macrotextured (as opposed to microtextured or smooth) implants were most frequently associated with breast ALCL. However, the numbers in the study were too small to support an association between duration of implant, implant type and development of breast ALCL.

The investigators concluded that silicone breast implants appear to be a cause of breast ALCL. Reasons may include local inflammatory responses, implant-specific bacteria or substances derived from implant production. Although the numbers are convincing, the authors note that there is no record of the prevalence of breast implants before 2016. They had to extrapolate this information for this current study. If the actual number of women with implants over a longer period of time were known, the risk of implant associated breast ALCL may be quite different.

This study raises the possibility of an association between breast implants and breast ALCL. The actual risk may be lower than observed here, but the rarity of the disease makes it difficult to provide a more accurate estimate. This information should be carefully considered as a woman contemplates breast reconstruction options.