The incidence of anaplastic large cell lymphoma (ALCL) has surged in recent years—possibly because of the growing use of textured breast implants. Considering this trend, some patients with breast cancer who undergo mastectomy may wonder if the benefits of getting reconstructive implants are worth the risk of developing a second cancer. A recent study published as a research letter by Kinslow et al in JAMA Network Open found that the risk of developing ALCL after reconstructive surgery is extremely low: each year, about 12 cases are expected to occur per 1 million women who have had reconstructive surgery.
“The risk of developing ALCL is actually much lower than the risk of experiencing a relapse of breast cancer,” said lead author Connor J. Kinslow, MD, a resident in radiation oncology at the Columbia University Vagelos College of Physicians and Surgeons. “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 recent study was designed to provide women with accurate information about risk, and is the first to look at rates of ALCL in breast cancer survivors who have had breast implants after mastectomy.
The researchers used the Surveillance, Epidemiology, and End Results (SEER) 17 database to identify 57,000 women who had undergone mastectomy with implant reconstruction for breast cancer or ductal carcinoma in situ between 2000 and 2018. The median follow-up time was 7 years, and roughly 16,000 women were followed for at least 10 years.
Though the study found that women who have had postmastectomy breast implants do have a higher risk of ALCL than women in general (each year, 0.3 cases are expected per million in the general population), “It should be noted that ALCL is a rare cancer,” said study leader David Horowitz, MD, Assistant Professor of Radiation Oncology at Columbia University Vagelos College of Physicians and Surgeons. “Among the 57,000 women in the study, only 5 cases of ALCL were diagnosed over the combined 421,000 years of follow-up.”
“Women who have had one cancer are understandably nervous about having a second,” Dr. Kinslow said. “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.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
