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Anaplastic large-cell lymphoma in women with breast implants.
JAMA. 2008 Nov 05; 300(17):2030-5.JAMA

Abstract

CONTEXT

Recently, we identified 2 patients with anaplastic large T-cell lymphoma (ALCL) negative for tyrosine kinase anaplastic lymphoma kinase (ALK-negative) in the fibrous capsule of silicone breast prostheses, placed for cosmetic reasons. Similar cases have been reported in the literature. Although an increased risk of ALCL in patients with breast prostheses has been speculated, no studies have been conducted so far.

OBJECTIVE

To determine whether ALCL risk is associated with breast prostheses.

DESIGN

A search for all patients with lymphoma in the breast diagnosed in The Netherlands between 1990 and 2006 was performed through the population-based nationwide pathology database. Subsequently, we performed an individually matched case-control study. Conditional logistic regression analysis was performed to estimate the relative risk of ALCL associated with breast prostheses.

SETTING AND PATIENTS

Eleven patients with breast ALCL were identified in the registry. For each case patient with ALCL in the breast, we selected 1 to 5 controls with other lymphomas in the breast, matched on age and year of diagnosis. For all cases and controls (n = 35), pathological and clinical information was obtained with special emphasis on the presence of a breast prosthesis.

MAIN OUTCOME MEASURE

Association between breast implants and ALCL of the breast.

RESULTS

The 11 patients with ALCL of the breast were diagnosed between 1994 and 2006 at a median age of 40 years (range, 24-68 years). In 5 of these patients, bilateral silicone breast prostheses had been placed 1 to 23 years before diagnosis. All received prostheses for cosmetic reasons. Lymphoma classes of 35 eligible control patients were 12 diffuse large B-cell lymphomas, including 1 T-cell rich B-cell lymphoma; 5 Burkitt lymphomas; 10 mucosa-associated lymphoid tissue-type lymphoma; 3 follicular lymphomas; 3 peripheral T-cell lymphomas; and 2 indolent B-cell lymphomas, unclassified. One of 35 control patients had a breast implant placed before diagnosis of lymphoma. The odds ratio for ALCL associated with breast prostheses was 18.2 (95% confidence interval, 2.1-156.8).

CONCLUSIONS

These preliminary findings suggest an association between silicone breast prostheses and ALCL, although the absolute risk is exceedingly low due to the rare occurrence of ALCL of the breast (11 cases in The Netherlands in 17 years). These findings require confirmation in other studies.

Authors+Show Affiliations

Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands. d.d.jong@nki.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18984890

Citation

de Jong, Daphne, et al. "Anaplastic Large-cell Lymphoma in Women With Breast Implants." JAMA, vol. 300, no. 17, 2008, pp. 2030-5.
de Jong D, Vasmel WL, de Boer JP, et al. Anaplastic large-cell lymphoma in women with breast implants. JAMA. 2008;300(17):2030-5.
de Jong, D., Vasmel, W. L., de Boer, J. P., Verhave, G., Barbé, E., Casparie, M. K., & van Leeuwen, F. E. (2008). Anaplastic large-cell lymphoma in women with breast implants. JAMA, 300(17), 2030-5. https://doi.org/10.1001/jama.2008.585
de Jong D, et al. Anaplastic Large-cell Lymphoma in Women With Breast Implants. JAMA. 2008 Nov 5;300(17):2030-5. PubMed PMID: 18984890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anaplastic large-cell lymphoma in women with breast implants. AU - de Jong,Daphne, AU - Vasmel,Wies L E, AU - de Boer,Jan Paul, AU - Verhave,Gideon, AU - Barbé,Ellis, AU - Casparie,Mariel K, AU - van Leeuwen,Flora E, PY - 2008/11/6/pubmed PY - 2008/11/11/medline PY - 2008/11/6/entrez SP - 2030 EP - 5 JF - JAMA JO - JAMA VL - 300 IS - 17 N2 - CONTEXT: Recently, we identified 2 patients with anaplastic large T-cell lymphoma (ALCL) negative for tyrosine kinase anaplastic lymphoma kinase (ALK-negative) in the fibrous capsule of silicone breast prostheses, placed for cosmetic reasons. Similar cases have been reported in the literature. Although an increased risk of ALCL in patients with breast prostheses has been speculated, no studies have been conducted so far. OBJECTIVE: To determine whether ALCL risk is associated with breast prostheses. DESIGN: A search for all patients with lymphoma in the breast diagnosed in The Netherlands between 1990 and 2006 was performed through the population-based nationwide pathology database. Subsequently, we performed an individually matched case-control study. Conditional logistic regression analysis was performed to estimate the relative risk of ALCL associated with breast prostheses. SETTING AND PATIENTS: Eleven patients with breast ALCL were identified in the registry. For each case patient with ALCL in the breast, we selected 1 to 5 controls with other lymphomas in the breast, matched on age and year of diagnosis. For all cases and controls (n = 35), pathological and clinical information was obtained with special emphasis on the presence of a breast prosthesis. MAIN OUTCOME MEASURE: Association between breast implants and ALCL of the breast. RESULTS: The 11 patients with ALCL of the breast were diagnosed between 1994 and 2006 at a median age of 40 years (range, 24-68 years). In 5 of these patients, bilateral silicone breast prostheses had been placed 1 to 23 years before diagnosis. All received prostheses for cosmetic reasons. Lymphoma classes of 35 eligible control patients were 12 diffuse large B-cell lymphomas, including 1 T-cell rich B-cell lymphoma; 5 Burkitt lymphomas; 10 mucosa-associated lymphoid tissue-type lymphoma; 3 follicular lymphomas; 3 peripheral T-cell lymphomas; and 2 indolent B-cell lymphomas, unclassified. One of 35 control patients had a breast implant placed before diagnosis of lymphoma. The odds ratio for ALCL associated with breast prostheses was 18.2 (95% confidence interval, 2.1-156.8). CONCLUSIONS: These preliminary findings suggest an association between silicone breast prostheses and ALCL, although the absolute risk is exceedingly low due to the rare occurrence of ALCL of the breast (11 cases in The Netherlands in 17 years). These findings require confirmation in other studies. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/18984890/abstract/Anaplastic_large_cell_lymphoma_in_women_with_breast_implants_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2008.585 DB - PRIME DP - Unbound Medicine ER -