To the Editor De Boer et al1 calculate a 1:6920 lifetime risk of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) in Dutch patients. The authors report that 82% of affected patients had macrotextured implants and 45% of all implants sold in the Netherlands from 2010 through 2015 were macrotextured (P < .001).1 Despite this significant comparison, de Boer et al1 do not find an association between implant type and BIA-ALCL risk.1 The authors recognize that their study is limited by the fact that almost no smooth implants are inserted in the Netherlands.1
Swanson E. Risk of Breast Implant–Associated Anaplastic Large Cell Lymphoma. JAMA Oncol. 2018;4(10):1434. doi:10.1001/jamaoncol.2018.2616
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