Breast Implant-associated Anaplastic Large Cell Lymphoma Incidence

Abstract

Objective: This study sought to estimate the incidence and incidence rate of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) at a high-volume single institution, which enables vigorous long-term follow-up and implant tracking for more accurate estimates. Summary Background Data: The reported incidence of BIA-ALCL is highly variable, ranging from 1 in 355 to 1 in 30,000 patients, demonstrating a need for more accurate estimates. Methods: All patients who underwent implant-based breast reconstruction from 1991 to 2017 were retrospectively identified. The incidence and incidence rate of BIA-ALCL were estimated per patient and per implant. A time-to-event analysis was performed using the Kaplan–Meier estimator and life table. Results: During the 26-year study period, 9373 patients underwent reconstruction with 16,065 implants, of which 9589 (59.7%) were textured. Eleven patients were diagnosed with BIA-ALCL, all of whom had a history of textured implants. The overall incidence of BIA-ALCL was 1.79 per 1000 patients (1 in 559) with textured implants and 1.15 per 1000 textured implants (1 in 871), with a median time to diagnosis of 10.3 years (range, 6.4–15.5 yrs). Time-to-event analysis demonstrated a BIA-ALCL cumulative incidence of 0 at up to 6 years, increasing to 4.4 per 1000 patients at 10 to 12 years and 9.4 per 1000 patients at 14 to 16 years, although a sensitivity analysis showed loss to follow-up may have skewed these estimates. Conclusions: BIA-ALCL incidence and incidence rates may be higher than previous epidemiological estimates, with incidence increasing over time, particularly in patients exposed to textured implants for longer than 10 years.

New Data on the Epidemiology of Breast Implant- Associated Anaplastic Large Cell Lymphoma

“…Regarding the surgeons' preferences for a certain type of surface of breast implants, Nelson et al (18) noted that between 1991 and 2009, in the Memorial Sloan Kettering Cancer Center in the United States, textured implants by far exceeded smooth implants. Since 2009, a balance between the two types of implants was noticed, and after 2011, surgeons preferred smooth implants over textured implants (18). A multinational survey conducted in Europe and published in 2020 showed that most surgeons (70%) prefer textured implants and that only 29% of those who changed their preferences in terms of the implant surface and manufacturing company did so to prevent the occurrence of BIA-ALCL (28).…”

“…The average exposure time was 10.26 (range: 6.4-15.5) years. The overall incidence of BIA-ALCL was 1.79 per 1000 patients with textured implants (1:559) and 1.15 per 1,000 textured implants (1: 871) -the difference is caused by the fact that several patients were exposed to more than one implant in their lifetime(18). After analyzing a cohort of 3,546 patients who also benefited fromTable 1.…”

ALK-Negative Anaplastic Large Cell Lymphoma: Current Concepts and Molecular Pathogenesis of a Heterogeneous Group of Large T-Cell Lymphomas

“…The incidence of this lymphoma is difficult to calculate. In the U.S. its incidence has been estimated at 1 in 6120 women with breast implants per year, and 1 in 4120 women with textured breast implants per year, with a cumulative incidence of 3.31 per 1000 breast implants between 14 and 16 years after surgery [ 150 ].…”

Breast Implant Safety: an Overview of Current Regulations and Screening Guidelines

“…14 Current estimates of lifetime risk for BIA-ALCL in patients with textured implants range from 1-in-559 to 1-in-355. 15,16 When screening for BIA-ALCL, the primary care provider should ask the patient about texturing of the implant, the manufacturer of the implant, and the duration of implant placement. 17 On physical exam, BIA-ALCL commonly presents as new breast swelling or fluid collection 7-10 years after implant insertion, but it can also present as a new mass or capsular contracture.…”