Research has found that people with breast implants have a risk of developing breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is not breast cancer; it is a type of non-Hodgkin lymphoma. Anaplastic large cell lymphoma (ALCL) is a rare cancer of the immune system. In most cases, BIA-ALCL is found in the scar tissue and fluid near the implant, but in some cases, it can spread throughout the body.
The U.S. Food and Drug Administration (FDA) first reported the link between ALCL and breast implants in 2011. The FDA has recently revised its estimate of how many women develop BIA-ALCL. Originally, it was thought to be 1 in 30,000 women. Now, the estimate is a range of 1 in between 3,817 to 30,000 women. BIA-ALCL is most often found in patients with textured breast implants.1,2
The reporting of this type of cancer was so low that it was nearly impossible to identify patient risk factors. The need for better information gathering through worldwide organizations was indicated. This included medical registries, as well as breast implant sales and registration data.
Prior to receiving breast implants, you should always discuss your personal situation with a physician and discuss possible risks. Breast implants come in a variety of shapes and sized and in multiple materials. Those approved in the U.S. can be filled with either saline or with silicone gel and can have either smooth or textured surfaces. BIA-ALCL occurs more frequently in breast implants with textured rather than smooth surfaces. The material inside the implant did not appear to have an impact on developing this kind of lymphoma.3
It is important to follow your physician’s instructions about how to monitor your breasts on a post-operative and ongoing basis. If you experience any new or changing symptoms that are not consistent with the healing process, including those that happen years later, consult your physician for further evaluation.
Diagnosis and treatment of BIA-ALCL
In recent years, the incidence of BIA-ALCL has been on the rise. It is frequently identified in patients undergoing implant revision operations. About half of the reported lymphoma cases were diagnosed approximately 7-8 years post-implantation.1 Pathology tests on a sample of the seroma fluid (fluid collection around the implant), any mass, or the capsule can often confirm a diagnosis. Additional imaging studies may be requested. Treatment generally involves the surgical removal of the implant and the capsule surrounding the implant. For some, subsequent treatment with chemotherapy and radiation will be necessary.
Reporting of BIA-ALCL
BIA-ALCL is no longer considered very rare. The incidence rate has gone up due to the availability of better information, an increase in reporting, and physician education. Cases of BIA-ALCL can be reported to MedWatch, the FDA Safety Information and Adverse Event Reporting program, and the PROFILE registry.1,2
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Updated March 21, 2018. FDA website. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm. Accessed online April 21, 2018.
Breast implant-associated lymphoma more common than originally predicted. Published March 29, 2018. https://www.healio.com/hematology-oncology/lymphoma/news/online/%7B92d99dc2-1bb1-4835-8c4a-3da058212b28%7D/breast-implant-associated-lymphoma-more-common-than-originally-predicted. Accessed online April 22, 2018.
FDA Updates Warning on Link Between Textured Breast Implants and Rare Cancer. BreastCancer.Org website. http://www.breastcancer.org/research-news/fda-updates-on-textured-implants-and-cancer. Accessed online April 23, 2018.