1. Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast
- Author
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Marc B. I. Lobbes, Flora E. van Leeuwen, Hinne A. Rakhorst, René R. W. J. van der Hulst, Mintsje de Boer, Lucy I. H. Overbeek, Michael Hauptmann, Caroline A H Klazen, Daphne de Jong, Arthur Sernee, Nathalie J. Hijmering, Jan de Boer, Promovendi ODB, Plastische Chirurgie (PLC), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Plastische Chirurgie (3), Epidemiology and Data Science, APH - Quality of Care, CCA - Cancer Treatment and quality of life, Pathology, VU University medical center, AGEM - Re-generation and cancer of the digestive system, and Amsterdam Neuroscience - Cellular & Molecular Mechanisms
- Subjects
Adult ,Risk ,Cancer Research ,medicine.medical_specialty ,Breast Implants ,Population ,Breast Neoplasms ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,hemic and lymphatic diseases ,medicine ,Humans ,RECONSTRUCTION ,education ,skin and connective tissue diseases ,Anaplastic large-cell lymphoma ,Breast Implantation ,Aged ,Netherlands ,education.field_of_study ,business.industry ,Large cell ,Absolute risk reduction ,Case-control study ,WOMEN ,US EPIDEMIOLOGY ,Odds ratio ,Middle Aged ,medicine.disease ,Lymphoma ,Oncology ,030220 oncology & carcinogenesis ,Case-Control Studies ,Lymphoma, Large-Cell, Anaplastic ,Female ,Implant ,Disease Susceptibility ,business - 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.
- Published
- 2018
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