Incidence of lymphoma subtype linked to breast implants rises rapidly in US
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Age-adjusted incidence of anaplastic large-cell lymphoma of the breast rapidly increased in the U.S. between 2000 and 2018, according to a research letter published in JAMA Oncology.
The rate appeared consistent with what has been observed in Australia, the Netherlands and New Zealand, researchers noted.
Rationale and methods
Approximately 3% of breast lymphomas in the U.S. are anaplastic large-cell lymphoma of the breast — a rare malignancy identified as a potential adverse effect of breast implants, according to study background.
“Anaplastic large-cell lymphoma was first described in 1997 and only in 2011 did the FDA issue a safety communication cautioning about a possible association between breast implants and anaplastic large-cell lymphoma,” Connor J. Kinslow, MD, radiation oncology resident at Columbia University Irving Medical Center, told Healio. “Despite widespread attention during the past decade, it has been difficult for researchers to assess how many cases have been diagnosed and what the true risk is after breast implant.”
Researchers used the SEER database to determine crude and age-adjusted incidence rates of pathologically confirmed primary breast anaplastic large-cell lymphoma diagnosed in women between Jan. 1, 2000, and Dec. 31, 2018.
They additionally conducted a sensitivity analysis that included mature T-cell lymphoma cases not otherwise specified; used the crude annual incidence rates in 5-year age categories to calculate cumulative risk; calculated trends in age-adjusted incidence using a linear regression model with Pearson correlation; and compared coverage of anaplastic large-cell lymphoma in SEER and National Program of Cancer Registries with cases reported to the FDA for external validation.
Key findings
Results showed an age-adjusted incidence rate of primary breast anaplastic large-cell lymphoma of 8.1 (95% CI, 6.3-10.2) per 100 million persons per year, for a cumulative lifetime risk of 7.5 per 100 million persons at age 79 years.
The age-adjusted incidence rate increased throughout time, from 3.2 (95% CI, 1.4-6.3) between 2000 and 2005 to 4.4 (95% CI, 2.2-7.7) between 2006 and 2011 and 14.5 (95% CI, 10.8-19.3) between 2012 and 2018 (P < .001). Researchers observed similar trends when they included cases of T-cell lymphoma not otherwise specified in the analysis, for a rate of 19.6 (95% CI, 15.1-24.9) per 100 million persons per year between 2012 and 2018.
Moreover, researchers identified an estimated 353 cases of breast anaplastic large-cell lymphoma diagnosed through 2017 in the SEER database and 310 cases in SEER/National Program of Cancer Registries data, compared with 333 cases reported to the FDA during a similar time period.
Implications
Kinslow said he expects more cases of breast anaplastic large-cell lymphoma to be diagnosed in the coming years.
“Previous risk estimates of anaplastic large-cell lymphoma vary widely, prompting different responses from regulatory authorities around the world. For example, Australia has banned the use of specific implant models, while the U.S. has mandated black box labels on all implants, and other government agencies are yet to pass formal legislation,” he said. “Our results imply that previous studies have underestimated the risk [for] developing anaplastic large-cell lymphoma after implantation, which warrants continued surveillance of this disease and may influence regulatory policies.”
The updated risk estimates in this study should improve the accuracy of future epidemiological studies on the topic, Kinslow added.
“Our group is currently using these numbers to investigate the risk [for] anaplastic large-cell lymphoma in specific populations at risk, including women who have undergone reconstructive vs. cosmetic breast implantation,” he said.
For more information:
Connor J. Kinslow, MD, can be reached at cjk2151@cumc.columbia.edu.
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