The Micromort Concept and its Applicability to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Risk Assessment

I read with interest the article by Sieber and Adams about the micromort concept and its applicability to anaplastic large cell lymphoma (ALCL) risk assessment.¹ While I concur with the conclusions of the article, I wish to point out some issues with the source data in Table 1 for risks associated with common activities. I recently attempted to locate the original reference for the micromort concept and this proved challenging. The only reference from Ronald Howard listed in PubMed is from 1989.² A 1979 article by Richard Wilson in Technology Review³ is the first appearance of the table of lifestyle risks that I could locate. The author's methodology in drafting the table appears to have simply taken averages such as the number of deaths from alcoholic cirrhosis and national average drinking, and deriving risk of a single drink from that. More sophisticated analysis shows a J-shaped curve for alcohol, especially wine, with lower risk at moderate consumption.⁴ The risk we run is missing more nuanced aspects of risk for ALCL by not factoring in the positive aspects of breast implant use. For example, there is some evidence that breast cancer survival is improved with reconstruction⁵; breast implants may have their own J-shaped curve. So while micromort analysis offers a reassuring perspective on the ALCL situation, we need to be cautious about citing outdated and poorly documented data on comparative risk.