ALCL is an extremely rare subtype of non-Hodgkin’s lymphoma (not breast cancer) that can affect different tissues, including the breast. It has been reported in women with and without breast implants and population-based studies estimate an overall incidence of between 0.1 and 0.3 per 100,000 women. The French National Cancer Institute reported 18 cases in women with implants with an incidence of 0.7-1.17 per 100,000ii. However, even this small risk may be of concern to women with breast implants.
ALCL was first described in 1985 but only classified as a distinct disease in 1994. The first case of ALCL that was associated with breast implants was reported in 1997, however, there are no prospective epidemiological studies linking ALCL with breast implants and a causative link has not been established. In 2011 the FDA released a notice about a possible association between breast implants and ALCLiii. T
BIA-ALCL is a lymphoma and not cancer of the breast tissue. When breast implants are placed in the body, they are inserted behind the breast tissue or under the chest muscle. Over time, a fibrous scar called a capsule develops around the implant, separating it from the rest of the breast. In women with breast implants, the ALCL was generally found adjacent to the implant itself and contained within the fibrous capsule.
The commonest presenting symptom for breast-implant associated ALCL is the formation of a delayed unilateral seroma, not usually associated with any other manifestations. Only occasionally was it associated with tenderness, a lump or capsular contraction. Cases have been reported in the absence of a peri- prosthetic fluid collection in association with capsular contraction or a mass or as a cutaneous nodule. Where ALCL is associated with breast implants, CD30- positive cytokeratin-negative malignant cells are found infiltrating the periprosthetic capsule on histological analysis, or in the aspirated fluid collection surrounding the implant. Both saline and silicone filled implants have been identified in case reports.
Since the initial MHRA medical device alert in the UK in 2011 only fourteen cases of Anaplastic Large Cell Lymphoma (ALCL) have been reported (correct at March 2016).
It should be noted that ALCL is extremely rare and treatable by excision of the capsule and adjunctive treatment on the recommendation of the appropriate MDT. This is evidenced in particular by a recent paper. ‘Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients’ (reference 1) concluded that: “most patients with breast implant-associated ALCL, who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.”
The MHRA currently advises no change to current practice and all patients should be advised that ALCL is a very rare condition.
ABS and BAPRAS maintain that until further evidence is presented, there is no need to routinely remove breast implants as a matter of course. We continue to advise that any women with breast implants who experience any sudden unexplained changes, lumps or swelling should speak to their surgeon.
1- Breast implants and anaplastic large-cell lymphoma: a danish population-based cohort study
Vase MØ, Friis S, Bautz A, Bendix K, Sørensen HT, d’Amore F.
Cancer Epidemiol Biomarkers Prev. 2013 Nov;22(11):2126-9. doi: 10.1158/1055-9965.EPI-13-0633. Epub 2013 Aug 16.
PMID: 23956025 [PubMed – in process]
* Guidance from ABS (Association of Breast surgery, UK) and BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons), UK
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