Non-Hodgkins lymphoma (NHL) has been in the news a great deal lately because of its link to the herbicide Roundup. Anaplastic Large Cell Lymphoma (ALCL) is a rare variant of the same disease that most often affects children and young adult males. However, in recent years, medical researchers have discovered links between ALCL and textured breast implants. It has even given ALCL its own identifying prefix: BIA, meaning “Breast Implant Associated”.
Like NHL, ALCL attacks the white blood cells known as T-cells (so-called because they originate in the thymus, the primary organ of the lymphatic system). However, ALCL results from the mutation of a specific gene, causing T-cells to produce excess amounts of a protein known as anaplastic lymphoma kinase (ALK1).
Initial symptoms usually consist of a painless, but noticeable swelling in the lymph nodes (for example, the armpit, groin, or neck). This may be followed by a loss of appetite, generalized fatigue, fever, and night sweats. An accurate diagnosis requires the analysis of an enlarged lymph node in order to determine if lymphoma cells are present.
Textured Breast Implants
This variety of breast implants have a rough, pebbled surface that is comparable to sandpaper. The purpose is to prevent the implants from falling out of place and causing the breast to appear unnatural, as can occur with typical smooth-surfaced implants. This roughened surface causes irritation on the inner surfaces of the surgically-made implant pocket. This, in turn, makes the surface of the implant adhere to the tissues, holding them in place.
The ALCL Connection
Scientists are not altogether sure why textured implants increase the risk of ALCL. Current theories suggest that it may have to do with the inflammation that results in the formation of the scar tissue, which in turn holds the implants in place. It is also possible that bacterial contamination at the surgical site may play a role, as well as a family history of lymphoma. As of February 2019, there have been nearly 700 cases of BIA-ALCL identified across the world. The risk of an implant patient developing ALCL as the result of a breast implant range between 1 in 4000 and 1 in 30,000, according to estimates from the FDA. However, Australian researchers have found evidence to suggest that the risk may be as high as 1 in 1,000.
Early Detection is Key
The good news is that with early diagnosis, BIA-ALCL is highly treatable, often by surgery alone. Of the 700 or so cases identified so far, fewer than 10 have been fatal. Stage 1 ALCL can be treated by removal of the implant and affected tissues. However, if the disease has progressed beyond that stage, chemotherapy and radiation treatments may be required.