The number of cases of anaplastic large cell lymphoma (ALCL) linked to breast implants has hit an all-time high, with reports earlier this month that more than 150 patients have now been diagnosed. ALCL is a rare type of cancer of the immune system that is estimated to affect one in 500,000 women. It typically appears in the lymph nodes, skin, soft tissue, lungs or liver.

Silicone breast implants have been the subject of controversy since the late 1980s and early 1990s, when thousands of women with silicone implants reported a variety of ailments, including autoimmune disease and a variety of other systemic illnesses. For many years, women were assured that breast implants did not cause breast cancer or any other type of cancer but evidence has slowly emerged that there may be a possible link with ALCL.

There are reports that ALCL had sometimes been found to develop in the breast area of women with breast implants. This initial evidence was dismissed but, over time, the amount of data in the scientific community of a possible association between ALCL and breast cancer has increased. With growing evidence that breast implants could cause this very rare cancer of the immune system, the US Food and Drugs Administration (FDA) embarked on a review in 2011 of the available data to assess the association.

Based on the published case studies and epidemiological research, the FDA concluded that there is a possible association between breast implants and ALCL, although it is extremely rare. The FDA found that women with breast implants may have a very small but increased risk of developing this disease in the scar capsule adjacent to the implant. However, based on the information available at the time, it was not possible to confirm with statistical certainty that breast implants caused ALCL and it was not possible to identify a type of implant (silicone versus saline) or a reason for implant (reconstruction versus aesthetic augmentation) associated with a smaller or greater risk.

Following its review, the FDA released a number of recommendations to health care providers. It advised that the possibility of ALCL should be considered in a patient with late onset, persistent peri-implant seroma. In some cases, patients presented with capsular contracture or masses adjacent to the breast implant. The FDA advised that doctors who have a patient with suspected ALCL should refer her to an appropriate specialist for evaluation and all confirmed cases of ALCL in women with breast implants should be reported to the FDA.

As ALCL is so rare and most often identified in patients with late onset of symptoms such as pain, lumps, swelling, or asymmetry, it is unlikely that increased screening of asymptomatic patients would change their clinical outcomes. The FDA does not recommend prophylactic breast implant removal in patients without symptoms or other abnormality.  The prognosis varies according with the type of ALCL. Breast implant-related ALCL has an excellent prognosis when the lymphoma is confined to the fluid or to the capsule surrounding the breast implant. The tumour can be recurrent and grow as a mass around the implant capsule or can extend to regional lymph nodes if not properly treated.

On 25 May 2014, The Mail on Sunday reported that there are now more than 150 women who have been diagnosed with cancer related to implants. Elise Bevan, a clinical negligence solicitor at Penningtons Manches LLP, said: “It is extremely worrying that the number of incidences of breast implant-related ALCL has risen sharply since the first reported case. Most of the women affected have been treated by having surgery to remove the implants followed by a course of chemotherapy or radiotherapy but there have been three women who have sadly not survived this rare type of cancer.

“Although the number of women who have been affected remains low, it is important to raise the awareness of the possible association between ALCL and breast implants when advising patients about surgery so that the signs and symptoms can be spotted early leading to a greater chance of successful treatment. The reports are that all women with breast implant-related ALCL have had capsular contracture, which is a common post-surgical complication. Therefore, it is important that you should seek medical advice if you have any worrying symptoms and all women considering breast implants should be warned of the risk of the association with ALCL.”