Nine deaths have been reported to the US Food and Drug Administration, stemming from a rare cancer that is associated with breast implants.

The extremely rare cancer, called anaplastic large cell lymphoma (ALCL) affects cells in the immune system and can be found around the breast implant. It can be found in the skin or lymph nodes, and is not a type of breast cancer.

“All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants,” the FDA reported.

On Tuesday, the FDA issued an update on its understanding of breast implant-associated ALCL cases.

The agency has received 359 reports of possible breast implant-associated cancer cases as of February 1. But the exact number of cases “remains difficult to determine due to significant limitations in world-wide reporting and lack of global implant sales data,