Anaplastic Large-Cell Lymphoma in Women With Breast Implants

Daphne de Jong, MD, PhD; Wies L. E. Vasmel, MD, PhD; Jan Paul de Boer, MD, PhD; Gideon Verhave, MD; Ellis Barbé, MD; Mariel K. Casparie, MD, PhD; Flora E. van Leeuwen, PhD

JAMA. 2008; 300(17): 2030-2035.

Context  Recently, we identified 2 patients with anaplastic large T-cell lymphoma (ALCL) negative for tyrosine kinase anaplastic lymphoma kinase (ALK-negative) in the fibrous capsule of silicone breast prostheses, placed for cosmetic reasons. Similar cases have been reported in the literature. Although an increased risk of ALCL in patients with breast prostheses has been speculated, no studies have been conducted so far.

Objective  To determine whether ALCL risk is associated with breast prostheses.

Design  A search for all patients with lymphoma in the breast diagnosed in the Netherlands between 1990 and 2006 was performed through the population-based nationwide pathology database. Subsequently, we performed an individually matched case-control study. Conditional logistic regression analysis was performed to estimate the relative risk of ALCL associated with breast prostheses.

Setting and Patients  Eleven patients with breast ALCL were identified in the registry. For each case patient with ALCL in the breast, we selected 1 to 5 controls with other lymphomas in the breast, matched on age and year of diagnosis. For all cases and controls (n = 35), pathological and clinical information was obtained with special emphasis on the presence of a breast prosthesis.

Main Outcome Measure  Association between breast implants and ALCL of the breast.

Results  The 11 patients with ALCL of the breast were diagnosed between 1994 and 2006 at a median age of 40 years (range, 24-68 years). In 5 of these patients, bilateral silicone breast prostheses had been placed 1 to 23 years before diagnosis. All received prostheses for cosmetic reasons. Lymphoma classes of 35 eligible control patients were 12 diffuse large B-cell lymphomas, including 1 T-cell rich B-cell lymphoma; 5 Burkitt lymphomas; 10 mucosa-associated lymphoid tissue–type lymphoma; 3 follicular lymphomas; 3 peripheral T-cell lymphomas; and 2 indolent B-cell lymphomas, unclassified. One of 35 control patients had a breast implant placed before diagnosis of lymphoma. The odds ratio for ALCL associated with breast prostheses was 18.2 (95% confidence interval, 2.1-156.8).

Conclusions  These preliminary findings suggest an association between silicone breast prostheses and ALCL, although the absolute risk is exceedingly low due to the rare occurrence of ALCL of the breast (11 cases in the Netherlands in 17 years). These findings require confirmation in other studies.

Author Affiliations: Departments of Pathology (Dr de Jong), Hematology (Dr de Boer), and Epidemiology (Dr van Leeuwen), the Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Internal Medicine (Drs Vasmel and Verhave), Department of Pathology (Dr Barbé), St Lucas-Andreas Hospital, Amsterdam, the Netherlands; and The Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands (PALGA, Pathologisch Anatomisch Landelijk Geautomatiseerd Archief), Utrecht, the Netherlands (Dr Casparie).