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Original Investigation
March 2018

Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast

Author Affiliations
  • 1Plastic, Reconstructive and Hand-Surgery, Maastricht University Medical Centre, School for Oncology and Developmental Biology, Maastricht, the Netherlands
  • 2Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
  • 3Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands
  • 4Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
  • 5Department of Pathology, VU University Medical Centre, Amsterdam, the Netherlands
  • 6Department of Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
  • 7Department of Radiology and Nuclear Medicine, Maastricht University, Maastricht University Medical Centre, Maastricht, the Netherlands
  • 8Plastic, Reconstructive and Hand-Surgery, Maastricht, University Medical Centre, School of Nutrition and Translational, Research in Metabolism, Maastricht, the Netherlands
  • 9Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuis Groep Twente/Medisch Spectrum Twente, Enschede, the Netherlands
JAMA Oncol. 2018;4(3):335-341. doi:10.1001/jamaoncol.2017.4510
Key Points

Question  What are the relative and absolute risks of breast anaplastic large-cell lymphoma (ALCL) in women with breast implants?

Findings  In this population-based, case-control study, we identified 32 patients with primary breast-ALCL with ipsilateral breast implants. Relative risk for breast-ALCL in women with breast implants was 421.8 and absolute cumulative risk was 29 per million at age 50 years and 82 per million at age 70 years.

Meaning  Breast implants were associated with an increased relative risk of breast-ALCL, although the absolute risk remains small; the results suggest a need for increased clinical awareness, comprehensive registration of implants and complications, and stimulation of alternative cosmetic/reconstructive procedures.


Importance  Breast implants are among the most commonly used medical devices. Since 2008, the number of women with breast implants diagnosed with anaplastic large-cell lymphoma in the breast (breast-ALCL) has increased, and several reports have suggested an association between breast implants and risk of breast-ALCL. However, relative and absolute risks of breast-ALCL in women with implants are still unknown, precluding evidence-based counseling about implants.

Objective  To determine relative and absolute risks of breast-ALCL in women with breast implants.

Design, Setting, and Participants  Through the population-based nationwide Dutch pathology registry we identified all patients diagnosed with primary non-Hodgkin lymphoma in the breast between 1990 and 2016 and retrieved clinical data, including breast implant status, from the treating physicians. We estimated the odds ratio (OR) of ALCL associated with breast implants in a case-control design, comparing implant prevalence between women with breast-ALCL and women with other types of breast lymphoma. Cumulative risk of breast-ALCL was derived from the age-specific prevalence of breast implants in Dutch women, estimated from an examination of 3000 chest x-rays and time trends from implant sales.

Main Outcomes and Measures  Relative and absolute risks of breast-ALCL in women with breast implants.

Results  Among 43 patients with breast-ALCL (median age, 59 years), 32 had ipsilateral breast implants, compared with 1 among 146 women with other primary breast lymphomas (OR, 421.8; 95% CI, 52.6-3385.2). Implants among breast-ALCL cases were more often macrotextured (23 macrotextured of 28 total implants of known type, 82%) than expected (49 193 sold macrotextured implants of total sold 109 449 between 2010 and 2015, 45%) based on sales data (P < .001). The estimated prevalence of breast implants in women aged 20 to 70 years was 3.3%. Cumulative risks of breast-ALCL in women with implants were 29 per million at 50 years and 82 per million at 70 years. The number of women with implants needed to cause 1 breast-ALCL case before age 75 years was 6920.

Conclusions and Relevance  Breast implants are associated with increased risk of breast-ALCL, but the absolute risk remains small. Our results emphasize the need for increased awareness among the public, medical professionals, and regulatory bodies, promotion of alternative cosmetic procedures, and alertness to signs and symptoms of breast-ALCL in women with implants.