Diana Zuckerman, PhD, National Center for Health Research
In 2015, plastic surgeons who have been well known for defending the safety of breast implants published a study of 173 women with cancer of the immune system caused by breast implants. 1 The study was paid for by a plastic surgery medical association and written by plastic surgeons who have defended the safety of breast implants for decades.
ALCL (Anaplastic Large Cell Lymphoma) develops near a breast implant but is not breast cancer – it is a cancer of the immune system. The authors of this study point out that the first silicone breast implant was implanted in 1962 and the first publicly reported case of ALCL in a woman with silicone breast implants was in 1997. The authors reviewed 37 medical articles reporting on 79 patients and collected information about an additional 94 women with ALCL caused by breast implants.
Physicians first identified these 173 women with ALCL based on either seromas (a collection of fluid under the skin), a mass attached to the scar capsule surrounding the implant, a tumor that eroded through the skin, in a lymph node near the breast, or discovered during surgery to replace a breast implant. Whether the women had silicone gel or saline breast implants didn’t seem to make a difference, but many of the women had at least one textured breast implant. Cosmetic augmentation patients and women who had breast implants to reconstruct their breasts after undergoing a mastectomy were both at risk of developing ALCL because of their implants. Of the women whose ALCL spread outside of their scar capsule surrounding the implant, about half died from ALCL.
The authors pointed out that ALCL can be difficult to diagnose. Although the fluid and scar capsule usually appear abnormal, they sometimes look normal. The authors recommend “that all fluid and capsule tissue from patients with seromas” should be tested for ALCL. They point out that if the tumor is inside the capsule, removing both implants and the capsules may be the only treatment necessary. However, if the tumor has developed just outside the capsule, chemotherapy with or without radiation is needed and usually effective. Unfortunately, aggressive ALCL that has spread beyond the scar capsule area is usually fatal, regardless of treatment.
In March 2017, the U.S. Food and Drug Administration (FDA) reported that it had received 359 reports of ALCL among women with breast implants. Unfortunately, many cases of ALCL are not reported to the FDA. The FDA’s announcement came after the World Health Organization (WHO) officially recognized “breast implant associated ALCL (BIA-ALCL)” in 2016. In 2014, the National Comprehensive Cancer Network (NCCN) has also released a worldwide oncology standard for surgeons and oncologists to test for and diagnose the disease.
Read the original study summary here.
To read more about what you need to know about ALCL, click here.