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

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 BC patients 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, age-adjusted rate of developing BIA-ALCL for women with BRCA was 16 times the rate of BIA-ALCL among women without BRCA (HR 95% C.I. 3.6, 76.1, p < 0.0003). Carrying bilateral implants (HR 3.9, 95% C.I. 0.4, 32.7), chemotherapy (HR 0.95, 95% C.I. 0.2, 4.2), radiation therapy (HR 0.37, 95% C.I. 0.04, 3.1) were not associated with BIA-ALCL. We also conducted a case-control study with 13 BIA-ALCL cases matched 1:3 with 39 controls. We used a complete enumeration of Bernoulli probability to rule out a non-association of BRCA with BIA-ALCL (p=0.0002). In this study, We define 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.