title: Anaplastic large T-cell lymphoma and breast implants: a review of the literature.
abstract: BACKGROUND
  Anecdotal reports and one case-control study suggested an association, without evidence of causation, between breast implants and anaplastic lymphoma kinase-negative anaplastic large T-cell lymphoma (ALCL), a rare non-Hodgkin's lymphoma. This review summarizes the published evidence, including case reports and epidemiologic studies.
  
  
  METHODS
  A PubMed search limited to English language articles was conducted using the search terms "breast implant" and "lymphoma," "primary T-cell breast lymphoma," or "breast implant and ALCL" to identify all published cases of breast-associated ALCL.
  
  
  RESULTS
  A total of 18 publications were retrieved describing 27 cases of ALCL in breast implant recipients. Breast-associated ALCL occurred in women with and without implants. Approximately 78 percent of cases (21 of 27) were CD30 anaplastic lymphoma kinase-negative, with an indolent clinical course. Both saline- and silicone-filled devices were identified; however, implant style and surface texture were largely unreported. The tumor stage at diagnosis was I in 16 of 27, II or higher in seven of 27, or unreported in four of 27. No prospective epidemiologic study has linked implants and ALCL; however, a single case-control study in Dutch women reported increased odds of association between ALCL and implants, and an estimated frequency of one in 1 million women with and without breast implants.
  
  
  CONCLUSIONS
  An association, without evidence of causation, was reported between breast implants and ALCL. Further study is required to confirm this association. Breast-associated ALCL occurred rarely in women with and without breast implants and had a primarily indolent clinical course, which may provoke a revision of the World Health Organization nomenclature for lymphoma; however, aggressive clinical behavior was also reported. The cases of ALCL were not confined to a specific type of implant.
  
  
  METHODS
  Risk, V.
authors.affiliation: Eugene, Ore.; Washington, D.C., Irvine, Calif.; and Dallas, Texas From the Jewell Plastic Surgery Center; Georgetown University Hospital; Global Safety & Epidemiology and Medical Affairs, Allergan, Inc.; and the University of Texas Southwestern Medical Center.
authors.forename: Mark
authors.initials: M
authors.lastname: Jewell
authors.forename: Scott L
authors.initials: SL
authors.lastname: Spear
authors.forename: Joan
authors.initials: J
authors.lastname: Largent
authors.forename: Michael G
authors.initials: MG
authors.lastname: Oefelein
authors.forename: William P
authors.initials: WP
authors.lastname: Adams
mesh_terms: D000368:Aged; D000077548:Anaplastic Lymphoma Kinase; D014408:Biomarkers, Tumor / Q000032:analysis; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D015984:Causality; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011474:Prosthesis Design; D020794:Receptor Protein-Tyrosine Kinases / Q000032:analysis; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases