Post-mastectomy Breast Implants Not Found to Increase Risk for Rare Lymphoma

The risk of developing a rare form of lymphoma following breast reconstruction surgery in breast cancer survivors is extremely low, according to a study by researchers from Columbia University and published in JAMA Network Open.

The study authors noted that the incidence of anaplastic large-cell lymphoma (ALCL) has grown since 2008. It has been hypothesized that this increase is because of the growing use of textured breast implants. As a result, patients with breast cancer who received a mastectomy may be concerned that the benefits of getting reconstructive implants are not worth the risk of developing a secondary cancer.

The new study is the first to examine rates of ALCL in breast cancer survivors who received breast implants following a mastectomy, according to the authors. The study found that just 12 cases of ALCL are projected to occur per 1 million women undergoing reconstructive surgery each year.

“The risk of developing ALCL is actually much lower than the risk of experiencing a relapse of breast cancer,” lead study author Connor J. Kinslow, MD, said in a press release. “Based on our findings, we do not believe that women should be dissuaded from having implant-based breast reconstruction after mastectomy solely due to the risk of ALCL.”

The investigators said they designed the study to provide accurate information on the risk of ALCL for women considering reconstructive surgery. They used a national cancer registry to identify 57,000 women who received a mastectomy with implant reconstruction for breast cancer or ductal carcinoma in situ between 2000 and 2018, with a median follow-up time of 7 years.

Approximately 16,000 women were followed for at least 10 years. Participants were assessed for pathologically confirmed primary breast ALCL through December 2019 until death, loss to follow-up, or end of study, with a latency exclusion period of 2 months from diagnosis.

The investigators found that women who underwent post-mastectomy breast reconstruction do not have a greater risk of ALCL compared with women in general, with 0.3 cases expected per 1 million each year in the general population, according to the study.

“Although the relative risk is significantly increased, the absolute risk remains extremely low,” the study authors wrote. “Furthermore, our risk estimates are within the range of reported literature for cosmetic or reconstructive implants. Breast implant–associated ALCL was not readily diagnosed in practice before 2008. The risk of ALCL will likely increase with longer follow-up, as the incidence rate is rapidly increasing in the US.”

The investigators emphasized that ALCL is a rare form of cancer.

“Among the 57,000 women in the study, only 5 cases of ALCL were diagnosed over the combined 421,000 years of follow-up,” said study lead David Horowitz, MD, assistant professor of radiation oncology at Columbia University Vagelos College of Physicians and Surgeons, in a press release.

The investigators said that the results indicate that women should not be dissuaded from pursuing implant-based reconstruction solely because of the risk for ALCL. They added that certain brands of macrotextured implants with high-surface-area have been associated with higher rates of ALCL, but these may be avoided based on regulatory guidelines and clinical discretion.

“Women who have had one cancer are understandably nervous about having a second,” Kinslow said in a press release. “But that shouldn’t necessarily put them off from having reconstructive implants. For many women, breast reconstruction after mastectomy is extremely important to quality of life, and women should feel comfortable going ahead with implants without adding to the psychological burdens that come with a breast cancer diagnosis.”

Reference

Kinslow CJ, DeStephano DM, Rohde CH, et al. Risk of Anaplastic Large Cell Lymphoma Following Postmastectomy Implant Reconstruction in Women With Breast Cancer and Ductal Carcinoma in Situ. JAMA Netw Open. 2022;5(11):e2243396. doi:10.1001/jamanetworkopen.2022.43396