Epidemiology of Anaplastic Large Cell Lymphoma Associated with Breast Implants: a quantitative analysis
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University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Via Enrico Albanese, 31, Italy
University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Italy
University of Palermo
A.O.U.P. Paolo Giaccone, Italy
Sapienza University of Rome, Department of Clinical and Molecular Medicine, Italy
University of Palermo, Economics, Business and Statistics, Italy
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1491
Background and Objective:
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare non-Hodgkin T-cell lymphoma arising in patients with breast reconstruction post-mastectomy or undergoing cosmetic-additive mammoplasty. Due to widespread use of implantations for cosmetic purposes, BIA-ALCL cases are expected to increase. We aimed at investigating main characteristics of the disease and factors predicting BIA-ALCL onset in patients with and without implant replacement.

A quantitative analysis was performed on cases extracted from primary studies published until April 2022 and searched in PubMed, Scopus and Google-Scholar databases, using “Breast-Implant” AND/OR “Associated” AND/OR “Anaplastic-Large-Cell-Lymphoma”. Statistical significance was verified by Student-T test for continuous variables, while Fisher’s exact test was applied for qualitative variables. Cox model with time-dependent covariates was applied to estimate BIA-ALCL’s onset time.

232 patients with BIA-ALCL (mean age at diagnosis: 55 years-old; mean time to disease onset from first implant: 10.3 years) were extracted from 52 selected studies. Patients with cosmetic implants were younger than patients with post-mastectomy implants but no difference was showed for median time to onset. Patients with implant replacement were significantly older than patients without previous replacement at the diagnosis, having a median time to diagnosis since first implant of 13 years (7 years in patients without replacement). Hazard of developing BIA-ALCL resulted significantly lower inpatients having a previous implant replacement as compared to patients who did not (HR= 0.03; 95%CI: 0.005-0.19; p-value= <0.01).

Exposure time to prosthesis, regardless of the age at implant and any possible condition associated with the disease, may play a role in BIA-ALCL induction. We provided evidence to be suggested for a proper information on breast implant use and for updating follow-up guidelines. Linkage between prosthetic implants registries and population-based cancer registries will help to better estimate the epidemiological impact over time of both BIA-ALCL and other lymphomas.

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