What is BIA-ALCL?
Anaplastic Large Cell Lymphoma (ALCL) is a rare form of cancer of the immune system. Experts now agree that women with breast implants are more likely to develop ALCL1. Since it will develop in the breast area, it is called Breast Implant Associated-ALCL (BIA-ALCL). Usually, this cancer develops in the scar tissue (capsule) that forms around a breast implant2. Sometimes this cancer can be found in the lymph nodes. If it’s not treated quickly, it can be fatal.
How can breast implants cause cancer? Why didn’t my doctor mention it?
Scientists are trying to figure out why ALCL forms near breast implants. Many experts believe that cancer may develop in response to chronic inflammation caused by bacteria3. Most cases of BIA-ALCL have been reported in women with textured implants, which provide a better surface for bacteria to grow.
The apparent link between ALCL and breast implants was published by cancer experts in 2009. It wasn’t until 2011 that the Food and Drug Administration (FDA) warned the public, and it wasn’t until 2013 that cancer researchers published an article in a medical journal stating that breast implants could cause ALCL. By 2016, BIA-ALCL was widely recognized by cancer experts, but not all oncologists are aware of it. Many breast cancer survivors are upset to realize that their “cautious” choice to have a mastectomy with implants rather than a lumpectomy puts them at risk of developing ALCL.
Is BIA-ALCL really rare?
The U.S. Food and Drug Administration (FDA) says that it has received 359 reports of ALCL, including 9 deaths, in women with breast implants. They say that since millions of women have breast implants, BIA-ALCL must be very rare. However, the Australian version of the FDA (called the Therapeutic Goods Administration) estimates that between 1 in 1,000 and 1 in 10,000 women with breast implants will develop ALCL4.
More than 300,000 women get breast implant surgery every year. If the Australian estimates are correct, about 30-300 of those women will develop ALCL every year. However, many experts believe that ALCL is underreported and therefore the chance of developing ALCL from breast implants is likely higher than the current estimates. Although awareness of BIA-ALCL is increasing, many doctors are still unaware of the risks and symptoms.
How will I know if I have BIA-ALCL?
All women with breast implants should be seeing a doctor regularly to check for any problems. If you experience redness or swelling near your implants you should see a doctor immediately. A swollen breast is usually an infection, but the fluid around your implants should be tested for ALCL as well.
Although a swollen breast is the most common symptom of BIA-ALCL, not all women with BIA-ALCL have noticeable swelling. Some women with BIA-ALCL reported feeling a lump near their implant or capsular contracture. If you find a lump, see your doctor immediately to check for breast cancer or ALCL. If you have capsular contracture, keep in mind that it could be a sign of BIA-ALCL, even though it probably isn’t.
How can I prevent BIA-ALCL?
You can’t prevent ALCL if you have breast implants. However, you can watch out for warning signs mentioned and have regular checkups with a doctor who knows about BIA-ALCL and other risks associated with breast implants.
What is the treatment for BIA-ALCL?
ALCL is treated by removing the implant and all of the surrounding scar tissue. This procedure is called a total capsulectomy, or an “en bloc” removal. This is done to make sure any cancer cells in the tissue are removed.
If any of your lymph nodes are found to have ALCL, they will also be removed.
If the cancer is found later and has spread, you may need to be treated with chemotherapy or radiation therapy.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
- FDA, Center for Devices and Radiological Health. (2017). Breast Implants – Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Retrieved from https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm
- Swerdlow, S. H., Campo, E., Pileri, S. A., Harris, N. L., Stein, H., Siebert, R., et al. (2016). The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 127, 2375-2390. doi:10.1182/blood-2016-01-643569
- Kadin, M. E., Deva, A., Xu, H., Morgan, J., Khare, P., Macleod, R. A., Epstein, A. L., et al. (2016). Biomarkers Provide Clues to Early Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthetic Surgery Journal, 36(7), 773-781. doi:10.1093/asj/sjw023
- Therapeutic Goods Administration. (2017). Breast implants and anaplastic large cell lymphoma. Retrieved from https://www.tga.gov.au/alert/breast-implants-and-anaplastic-large-cell-lymphoma