title: Anaplastic large-cell lymphoma in women with breast implants.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.affiliation: Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands. d.d.jong@nki.nl
authors.forename: Daphne
authors.initials: D
authors.lastname: de Jong
authors.forename: Wies L E
authors.initials: WL
authors.lastname: Vasmel
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: de Boer
authors.forename: Gideon
authors.initials: G
authors.lastname: Verhave
authors.forename: Ellis
authors.initials: E
authors.lastname: Barbé
authors.forename: Mariel K
authors.initials: MK
authors.lastname: Casparie
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D017728:Lymphoma, Large-Cell, Anaplastic / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012306:Risk; D020034:Silicone Gels / Q000009:adverse effects*
chemical_list: D020034:Silicone Gels