Recently the New York Times published an article about a rare cancer that has been linked to breast implants, breast implant associated anaplastic large cell lymphoma (BIA-ALCL) a rare type of non-Hodgkins lymphoma. Reports were also published on the NPR website, Allure Magazine, Vogue Magazine, Medscape, USA Today and Fortune Magazine to name a few. The news is presented with a somewhat ominous tone by some of the news sources while others are written with a grain of salt approach. These articles cite a recent FDA report that states that there have been 9 deaths from BI-ALCL, that the majority of the cases were associated with textured implants, but also states that BIA-ALCL is rare and that for those patients with breast implants there is no need to change their routine medical care and follow up.
Over 300,00 women had breast implants placed last year for cosmetic or reconstructive reasons. So many of these women may be thinking what is my risk of getting cancer? Should I have these implants removed?
In NPR’s article they report that the rate of ALCL is 65 times higher in women with implants, than women without implants. For perspective, men have a 2:1 increased chance of getting ALCL, and the International Non-Hodgkin’s Lymphoma Classification Project determined out of 1403 cases of reported Non-Hodgkin’s Lymphoma there were only 33 cases of ALCL [Ma].
Allure Magazine writes that women should not be concerned. In their interview with Dr. Laurie A. Casas from University of Chicago’s Pritzker School of Medicine, Dr. Casas clarifies the FDA report by stating that breast implants do not cause BIA-ALCL, the data instead suggests that “BIA-ALCL can occur in patients following breast implant surgery with textured implants more often than smooth.”
There is a different tone in the articles published in medical journals and reports from the FDA compared to many of the articles published in newspapers and magazines. At this time there is no recommendation from the scientific community to remove implants or take any extreme measures to alter one’s regular course of treatment.
Since the FDA’s last report in 2011 the World Health Organization reported that BIA-ALCL can develop following the placement of breast implants. What has not been determined is the exact number of cases that occur in all women with breast implants worldwide. As of February of 2017, 359 reports of BIA-ALCL were reported to the FDA; 231 of the reports accounted for whether the implant surface was textured (203) or round (28). The average time from implant placement to diagnosis was 10.7 years [Doren].
At this time the FDA has concluded that women with breast implants have a slightly higher risk of developing ALCL than women who don’t have breast implants.
At first glance this information may seem daunting and worrisome, feel free to contact Northwestern Medical Group to ask your surgeon any questions. The risk of contracting BIA-ALCL if you have textured breast implants is 1 in 30,000 and the risk of dying from BIA-ALCL is around 1 in 1,000,000. Although, reading a statistic about one’s risk can sometimes be confusing. To put things in perspective, it is more likely to die from a dog bite or drowning in the bathtub than dying from BIA-ALCL.
If you are looking for more information about BI-ALCL there are some recent publications that can help to illuminate some of the issues. In a recent MD Anderson study “United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma,” the researchers performed an extensive literature review to gain information about this elusive disease [Doren]. In this study they analyzed the different types of implant texturing to determine if there was a difference in the risk. There are two types of texturing: salt loss and negative imprint stamping. They found that the incidence rate of BIA-ALCL with salt loss implants was 1.87 per 1,000,000 person years and with negative imprint stamping 3.3 per 10,000,000 person years [Doren].
Another article from MD Anderson titled “Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant–Associated Anaplastic Large-Cell Lymphoma” the authors evaluate the efficacy of different treatments for BIA-ALCL [Clemens]. In this study they found that patient’s whose lymphoma was localized to the fibrous capsule surrounding the implant had better event free survival than those where the lymphoma had spread beyond the capsule. They also found that those patients who had a complete surgical excision had a better overall survival, than those who underwent capsulectomy, chemotherapy, or radiation therapy.
It is important to follow your breast surgeon’s instructions on how to monitor the breast implant after surgery. BIA-ALCL is a very rare disease and at this time the FDA is not recommending women make any changes. If you have any questions or notice any changes in your breast call Dr. Kim who is happy to answer any of your questions.
Clemens, M. W., Medeiros, L. J., Butler, C. E., Hunt, K. K., Fanale, M. A., Horwitz, S., … & Parkash, V. (2015). Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant–Associated Anaplastic Large-Cell Lymphoma. Journal of Clinical Oncology, 34(2), 160-168.
Doren, E. L., Miranda, R. N., Selber, J. C., Garvey, P. B., Liu, J., Medeiros, L. J., … & Clemens, M. W. (2016). United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plastic and Reconstructive Surgery–Global Open, 4(9S), 93-94.
Edgar, Jolene. “That Scary News About Breast Implants Causing Cancer? It Isn’t What It Seems.” Allure Magazine. N.p., 27 Mar. 2017. Web. 30 Mar. 2017.
Hersher, Rebecca. “Breast Implants Linked To Rare Blood Cancer In Small Proportion Of Women.” NPR. NPR, 22 Mar. 2017. Web. 31 Mar. 2017.
Ma, H., & Abdul-Hay, M. (2016). T-cell lymphomas, a challenging disease: types, treatments, and future. International Journal of Clinical Oncology, 1-34.
“Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).” Medical Devices. U.S. Food and Drug Administration, 23 Mar. 2017. Web. 30 Mar. 2017.