LETTER TO THE EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2024 - Universidad Ricardo Palma10.25176/RFMH.v24i1.6425
ANAPLASTIC LARGE CELL LYMPHOMA ASSOCIATED TO BREAST IMPLANTS IN LATIN AMERICA
LINFOMA ANAPLÁSICO DE CÉLULAS GRANDES ASOCIADO A IMPLANTES MAMARIOS EN LATINOAMÉRICA
Gianella F. Ugarte
1,a
Carlos Noriega-Baella
1,b
1 Instituto de Investigaciones en Ciencias Biomédicas. Universidad Ricardo Palma. Lima, Perú
a Medical Student
a Surgeon
Dear Editor,
After reading the 2023 publication by Manjarres A. et al. in your esteemed journal on cancer and breast
implants, I would like to contribute additional data regarding breast implant-associated anaplastic
large-cell lymphoma (BIA-ALCL) in Latin America. This work highlights the lack of knowledge and evidence
in Latin American countries, a crucial aspect given the classification of BIA-ALCL as a new pathological
entity by the World Health Organization in 2016 (1).
BIA-ALCL is a rare T-Cell Non-Hodgkin's lymphoma, uncommonly linked to an increased risk due to the use
of breast implants, especially textured ones (2). Additional factors, such
as bacteria, chronic irritation, and genetic predisposition, have also been identified as contributors
(3).
Although breast implant registries have been established in various countries, like the PROFILE in the
U.S. (4), the incidence of BIA-ALCL remains limited. In Spain, there is also
a breast implant registry called the Spanish Breast Implant Registry. From 1997 to 2018, significant
studies on BIA-ALCL have been conducted, such as that by Miranda RN et al. (5).
According to the systematic review by Torres A et al., there were 118 cases, in which the majority were
women, and 3% were men at birth. In 77% of the cases, race was not recorded: 19% were described as
White, Caucasian, or European; 3% as Latino; and one case as African American. The highest prevalence
was in the U.S. with 39%, followed by the United Kingdom and Spain; each with 9%. In Latin America,
there were three cases in Brazil and one in Mexico (6).
In 2020, the CDC issued a warning about implants, reflecting significant advancements in the medical
literature. Despite this, more than 10 million people globally have textured implants (7).
According to the study by the Ibero-Latin-American Federation of Plastic Surgery (FILACP, by its Spanish
acronym) Implant Registry Committee, there is evidence of a transition to smooth breast implants instead
of textured ones among Latin American plastic surgeons. The proportion of textured implants decreased
from 85.1% in 2016 to 53.8% in 2020, while smooth ones increased from 12.7% in 2016 to 42% in 2020. This
possibly relates to concerns about the risk of BIA-ALCL. As of April 2020, 106 cases of BIA-ALCL were
registered in nine countries of the FILACP: Argentina, Chile, Colombia, Spain, Mexico, Panama, Portugal,
and Venezuela; Brazil was the most affected with 28 cases (8).
Although it is a rare complication, it should be considered that in Latin America, particularly in
Brazil, many breast augmentation surgeries are performed (9). In Chile,
cases have been reported suggesting that BIA-ALCL should be considered as a differential diagnosis in
patients with periprosthetic seroma or capsular tumors; cytological study of the periprosthetic effusion
is useful for an early diagnosis of BIA-ALCL (10). Moreover, in Panama,
cases of BIA-ALCL have been documented in patients with textured prostheses, and a study in Mexico, with
a population of 87 cases, found eight cases with textured breast implants, supporting the theory of its
presence in Latin American countries (12).
In Peru, this issue is addressed following the safety communication of technovigilance No. 002-2019,
highlighting the risk of developing BIA-ALCL, regardless of the texture or type of filling of the breast
implants, approximately 11 years after surgery. It is considered a lymphoproliferative disorder
associated with the periprosthetic capsule. Awareness of the symptoms has been raised, but
epidemiological literature in the country is lacking (13).
In conclusion, the evidence suggests that BIA-ALCL represents a challenge in Latin America, underscoring
the need for further research and awareness in the region to improve the understanding and management of
this pathological entity.
Authorship contributions:
Gianella F. Ugarte participated in conceptualization, research, methodology, resources, and
writing of the original draft. Carlos Noriega Baella participated in conceptualization,
research, methodology, resources, and writing of the original draft.
Financing:
Self-financed
Declaration of conflict of interest:
The authors declare no conflict of interest.
Recevied:
March 12, 2024
Approved:
March 16, 2024
Correspondence author:
Gianella Fernanda Ugarte Farfán
Address:
Jirón Ismael Bielich 799, Apt. 40, Santiago de Surco, Lima, Peru
Phone:
(+51) 943105400
E-mail:
gianellaugartefarfan@gmail.com
Article published by the Journal of the faculty of Human Medicine of the Ricardo Palma University. It is an open access article, distributed under the terms of the Creatvie Commons license: Creative Commons Attribution 4.0 International, CC BY 4.0 (https://creativecommons.org/licenses/by/1.0/), that allows non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited. For commercial use, please contact revista.medicina@urp.edu.pe.
