Risk for lymphoma after postmastectomy breast implant reconstruction ‘still extremely low’
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Women who underwent implant reconstruction after mastectomy for breast cancer or ductal carcinoma in situ had a significantly increased relative risk for anaplastic large cell lymphoma, according to findings published in JAMA Network Open.
However, the absolute risk is “still extremely low” and should not dissuade women from considering implant reconstruction, researchers noted.
Background
Most women diagnosed with breast cancer and ductal carcinoma in situ undergo local curative surgery, such as mastectomy with implant-based reconstruction, according to study background. Both national and regulatory guidelines recommend candidates for reconstruction be counseled regarding the association of breast implants with anaplastic large cell lymphoma (ALCL).
“Breast ALCL is believed to be caused by chronic inflammation that develops in the capsule around certain textured implants, which causes lymphocyte proliferation that can sometimes progress to become malignant,” Connor J. Kinslow, MD, radiation oncology resident at Columbia University and first author on the study, told Healio. “It was previously unknown if women with a history of breast cancer or carcinoma in situ were at higher risk [for] ALCL compared with women who receive cosmetic implantation.”
Methodology
Kinslow and colleagues used the SEER 17 database to identify 56,784 women (median age range, 50-54 years; interquartile range, 40-59) who received cancer-directed mastectomy with implant reconstruction following diagnosis of a tumor within the breast between 2000 and 2018.
The sample population included 84% white women, 8% Black women and 7% Asian or Pacific Islander women. Among all women, 72% had invasive disease and 18% had in situ disease.
Researchers assessed patients for pathologically confirmed primary breast ALCL until end of study, loss to follow-up or death. They utilized multiple primary-standardized incidence ratios (SIRs) to compare the number of observed and expected cases diagnosed based on incidence rates from the general U.S. population of women, adjusting for age, race and year of diagnosis.
Median follow-up was 81 months (range, 46-125), and more than 15,000 women had follow-up of 10 years or longer.
Results
Five cases of breast ALCL occurred during 421,223 person-years. Researchers reported significantly higher incidence rates after postmastectomy implant reconstruction, with an observed rate of 11.9 per million persons per year vs. an expected rate of 0.3 per million persons per year (SIR, 40.9; 95% CI, 13.1-95.5).
One not otherwise specified T-cell lymphoma also was diagnosed, with an excess risk of 13.8 cases per million per year and SIR of 34.8 (95% CI: 12.8-75.8).
“To put this in context, for women who receive implantation after mastectomy, the risk [for] subsequent ALCL is much lower than the risk of breast cancer recurrence or a new breast cancer,” Kinslow said.
Next steps
Researchers noted study limitations, such as failure to account for implant removal or exchanges, a potentially long latency time to ALCL development after implantation, and likely underestimation of true risk.
Although the data should not prevent women from pursuing breast implant reconstruction, Kinslow said physicians and patients should discuss the risk for ALCL after reconstruction.
“This current study, as well as our recent study — which showed that the rate of ALCL is rapidly increasing in the U.S. — indicate the continued need for surveillance and evaluation of legislation by government and regulatory bodies,” Kinslow said. “Women who are concerned about the risk for ALCL should discuss this with their plastic surgeons before implantation.”
For more information:
Connor J. Kinslow, MD, can be reached at cjk2151@cumc.columbia.edu.
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Kinslow CJ, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.43396.
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