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

Abstract

Importance: Breast implants are among the most commonly used medical devices. Since 2008, the number of women with breast implants diagnosed with anaplastic large-cell lymphoma in the breast (breast-ALCL) has increased, and several reports have suggested an association between breast implants and risk of breast-ALCL. However, relative and absolute risks of breast-ALCL in women with implants are still unknown, precluding evidence-based counseling about implants.

Objective: To determine relative and absolute risks of breast-ALCL in women with breast implants.

Design, setting, and participants: Through the population-based nationwide Dutch pathology registry we identified all patients diagnosed with primary non-Hodgkin lymphoma in the breast between 1990 and 2016 and retrieved clinical data, including breast implant status, from the treating physicians. We estimated the odds ratio (OR) of ALCL associated with breast implants in a case-control design, comparing implant prevalence between women with breast-ALCL and women with other types of breast lymphoma. Cumulative risk of breast-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.

Main outcomes and measures: Relative and absolute risks of breast-ALCL in women with breast implants.

Results: Among 43 patients with breast-ALCL (median age, 59 years), 32 had ipsilateral breast implants, compared with 1 among 146 women with other primary breast lymphomas (OR, 421.8; 95% CI, 52.6-3385.2). Implants among breast-ALCL cases were more often macrotextured (23 macrotextured of 28 total implants of known type, 82%) than expected (49 193 sold macrotextured implants of total sold 109 449 between 2010 and 2015, 45%) based on sales data (P < .001). The estimated prevalence of breast implants in women aged 20 to 70 years was 3.3%. Cumulative risks of breast-ALCL in women with implants were 29 per million at 50 years and 82 per million at 70 years. The number of women with implants needed to cause 1 breast-ALCL case before age 75 years was 6920.

Conclusions and relevance: Breast implants are associated with increased risk of breast-ALCL, but the absolute risk remains small. 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.

Figure.. Cumulative Risk of Breast-ALCL per Attained Age in 1 Million Women in the General Population and With Breast Implants

ALCL Indicates anaplastic large-cell lymphoma. Cumulative risk of breast-ALCL in the general female population was calculated using the number of breast-ALCL cases without breast implants from the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands, and the age-specific size of the female Dutch population from 1990 to 2016 per age category. Cumulative risk of breast-ALCL associated with breast implants was calculated using the number of breast-ALCL cases with breast implants and the cumulative number of women with breast implants in the Netherlands from 1965 to 2016 per age category. ^aThe sensitivity analysis for cumulative risk of breast-ALCL in women with breast implants was calculated by multiplying the background incidence of breast-ALCL without implants in the general female population with the OR for breast-ALCL in women with breast implants from the case-control study.