BRCA1/2 impact on the development of implant-associated lymphoma in women with breast cancer and textured implants.

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a type of T-cell lymphoma arising near textured breast implants. In a Dutch population, a higher prevalence of BRCA1/2 was found in BIA-ALCL. We analyzed the risk of BIA-ALCL occurrence related to BRCA in a large population of women with implants followed after breast cancer (BC) mastectomy. We compared the prevalence of BRCA1/2 between women from a large cohort of patients with BC who did and did not develop BIA-ALCL after reconstruction with textured implants. Hazard ratios (HRs) of developing BIA-ALCL were estimated using Cox regression. We also conducted a case-control study. Of 520 patients with BC tested for BRCA, the age-adjusted rate of developing BIA-ALCL for women with BRCA was 16 times the rate of BIA-ALCL among women without BRCA (95% confidence interval [CI], 3.6-76.1; P < .0003). Carrying bilateral implants (HR, 3.9; 95% CI, 0.4-32.7), chemotherapy (HR, 0.95; 95% CI, 0.2-4.2), and radiotherapy (HR, 0.37; 95% CI, 0.04-3.1) were not associated with BIA-ALCL. We also conducted a case-control study with 13 BIA-ALCL patients matched 1:3 with 39 controls. We used a complete enumeration of Bernoulli probability to rule out a nonassociation of BRCA with BIA-ALCL (P = .0002). In this study, we defined the role of BRCA1/2 mutations as a risk factor in developing BIA-ALCL in patients with BC. These results will help women undergoing breast reconstruction or with textured implants in place.