Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): review of epidemiology and prevalence assessment in Europe

Background: Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) epidemiological studies focus on incidence and risk estimates. Objectives: The aim of this manuscript is to perform a thorough review of scientific literature, and provide an accurate estimate of BIA-ALCL prevalence in Europe. Methods: For the review, we searched PubMed, Web of Science, SCOPUS, and Google Scholar databases to identify publications regarding BIA-ALCL epidemiology. Research was conducted between November 2019 and August 2020. European prevalence was assessed as the ratio between pathology-confirmed cases and breast implant-bearing individuals. The Committee on Device Safety and Development (CDSD) collected data from National Plastic Surgery Societies, Health Authorities, and Disease-Specific Registries to calculate the numerator. The denominator was estimated combining European demographic data with scientific reports. Results: Our research identified 507 manuscripts: 106 were excluded for not being relevant to BIA-ALCL. From the remaining 401 manuscripts, we selected 35 that discussed epidemiology and 12 reviews. CDSD reported 420 cases in Europe, with an overall prevalence of 1:13,745 cases in the European Union counting 28 members (EU-28). Countries, where specific measures have been implemented to tackle BIA-ALCL, account for 61% of EU-28 population and actively reported 382 cases with an overall prevalence of 1:9,121. Conclusion: Countries where specific measures have been implemented show a higher prevalence of BIA-ALCL compared to mean European value, suggesting that they improve the detection of the condition and reduce underreporting that affects the numerator value. Other nations should adopt projections based on those measures to avoid underestimating how widespread BIA-ALCL is.