by Collett, David J.;
Rakhorst, Hinne; Lennox, Peter; Magnusson, Mark; Cooter, Rodney; Deva, Anand K.
Background: With
breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) now
accepted as a unique (iatrogenic) subtype of ALCL directly associated with
textured breast implants, we are now at a point where a sound epidemiologic
profile and risk estimate are required. The aim of this article is to provide a
comprehensive and up-to-date global review of the available epidemiologic data
and literature relating to the incidence, risk, and prevalence of BIA-ALCL. Methods: All current literature
relating to the epidemiology of BIA-ALCL was reviewed. Barriers relating to
sound epidemiologic study were identified, and trends relating to geographical
distribution, prevalence of breast implants, and implant characteristics were
analyzed. Results: Significant barriers exist to the accurate estimate of both
the number of women with implants (denominator) and the number of cases of
BIA-ALCL (numerator), including poor registries, underreporting, lack of
awareness, cosmetic tourism, and fear of litigation. The incidence and risk of
BIA-ALCL have increased dramatically from initial reports of 1 per million to
current estimates of 1/2,832, and is largely dependant on the “population”
(implant type and characteristics) examined and increased awareness of the
disease.
Conclusions:
Although many barriers stand in the way of calculating accurate estimates of
the incidence and risk of developing BIA-ALCL, steady progress, international
registries, and collegiality between research teams are for the first time
allowing early estimates. Most striking is the exponential rise in incidence
over the last decade, which can largely be explained by the increasingly
specific implant subtypes examined—driven by our understanding of the pathologic
mechanism of the disease. High-textured high-surface area implants (grade 4
surface) carry the highest risk of BIA-ALCL (1/2,832).
