Patients with breast implants are at risk of developing squamous cell carcinoma (SCC) and various types of lymphoma in the capsules around the implants, according to the US Food and Drug Administration (FDA).

These cancers appear to be rare, but patients and clinicians should be aware of the risk, according to the FDA. 

The agency issued a safety alert in September that warned about these emerging cases of breast implant-associated SCC (BIA-SCC) and lymphomas other than breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL).1

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The FDA had received 10 medical device reports of BIA-SCC and 12 reports of non-BIA-ALCL implant-associated lymphomas. The agency conducted a preliminary literature review and identified fewer than 20 cases of BIA-SCC and fewer than 30 cases of non-BIA-ALCL implant-associated lymphomas. 

Based on the available data, some of these patients experienced pain, swelling, lumps, or changes in the skin years after undergoing breast implant surgery.1 In a 2021 case report by Goldberg et al, for example, 2 patients had received implants more than 10 years prior to detection of BIA-SCC.2 A previous review revealed an average time of 23.2 years from the initial breast augmentation to BIA-SCC diagnosis.3 

“Regarding BIA-SCC, the most recent information that has emerged suggests that it can exhibit highly invasive properties, including spread to lymph nodes and local tissues as well as distant sites, including muscle and bone,” said Merisa L. Piper, MD, assistant professor of surgery at the University of California, San Francisco. 

Across case studies, the prognosis for BIA-SCC has been poor overall.4 

Lymphomas Other Than BIA-ALCL

The FDA noted that the types of lymphoma referred to in the recent safety alert differ from BIA-ALCL, which the FDA first recognized in 2011.5 As of June 2022, approximately 389 suspected and confirmed cases of BIA-ALCL had been documented in the US.6 The mean period of time between implant surgery and diagnosis of BIA-ALCL is approximately 10 years.

“BIA-ALCL is typically an indolent CD30-positive, ALK-negative peripheral T-cell lymphoma,” explained David M. Euhus, MD, a professor of surgery and oncology at Johns Hopkins Medicine in Baltimore, Maryland. “The recent reports have included a variety of different lymphoma types, but most have been EBV-positive large B-cell lymphomas.” 

A 2021 case series revealed several differences between BIA-ALCL and EBV-positive large B-cell lymphomas in patients with breast implants.7 The EBV-positive large B-cell lymphomas had a thicker capsule and a more prominent layering pattern of neoplastic cells. They were also more likely to have foamy histiocytes, lymphoid aggregates in the outer aspects of the capsule, and calcification or necrosis on the luminal side of the capsule. 

Another difference between BIA-ALCL and other implant-associated lymphomas is that BIA-ALCL most frequently occurs in patients with textured breast implants, but the other lymphomas do not.1,4-5 The other implant-associated lymphomas have occurred with both smooth and textured implants as well as with both silicone and saline implants. 

There is insufficient evidence at present to determine whether some types of implants are associated with a greater risk of BIA-SCC or non-BIA-ALCL lymphoma compared with other types, according to the FDA.8 

This article originally appeared on Cancer Therapy Advisor