Anaplastic large-cell lymphoma risk with breast implants determined
medwireNews: Silicone-filled breast implants are associated with a high relative risk for developing anaplastic large-cell lymphoma in the breast (breast-ALCL), but the absolute risk remains low, confirms a population-based study.
Among 43 women with breast-ALCL and 146 with non-ALCL non-Hodgkin lymphoma of the breast, drawn from the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA), a respective 32 and one had an ipsilateral breast implant, while one of the controls had an implant in the contralateral breast.
This equated to a significant 421.8-fold increased risk for women with versus without breast implants, which the study authors believe “is highly suggestive of a direct or indirect causal role of the breast implant.”
However, the absolute risk for breast-ALCL was low – with one case for every 35,000 women with implants at age 50 years, one in 12,000 at 70 years, and one in 7000 at 75 years.
Researcher Daphne de Jong (VU University Medical Center, Amsterdam, the Netherlands) and team also calculated the number needed to harm, finding that 6920 women would need to have a breast implant for one case of breast-ALCL to develop before the age of 75 years.
“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,” they write in JAMA Oncology.
The investigators note that various underlying causes for such an association have been suggested; for instance, “a local inflammatory response, elicited by silicone-derived products or specific bacterial species adherent to the prosthesis surface (biofilm) may play a role,” as may “[t]oxic products related to the production of breast implants.”
Of the 28 participants with breast-ALCL for whom the implant type was known, the majority (82%) had macrotextured implants. By contrast, sales data from 2010–2015 showed that macrotextured implants have only 45% of the Dutch market share, indicating a possible increased risk with this implant type, which has also been suggested by previous case reports, say de Jong et al.
Once again the underlying mechanism remains unclear, but the authors of a related commentary highlight one hypothesis, namely that “the larger surface area of a macrotextured implant allows for greater bacterial contamination.”
Colleen McCarthy and Steven Horwitz (both from Memorial Sloan Kettering Cancer Center, New York, USA) add that “it is essential that we continue to systematically capture the critical data elements needed to evaluate both the risk and nature of [breast implant-associated]-ALCL.”
And they conclude: “The relative scarcity of knowledge and experience with breast-ALCL worldwide creates a unique need for all stakeholders to participate and cooperate. It is only with this type of cooperation that questions may turn into answers.”
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