For the past six months headlines like the one above have been peppering the news, social media and the internet, raising questions about cancer risks of breast implants. Congress and the FDA even weighed in with hearings and press releases, as well as letters alerting health practitioners to be on the lookout. What is all the fuss about and how worried do women with implants need to be?
The issue in question is a rare form of lymphoma called Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) that has been described in women with breast implants, most clearly with textured implants (the data is unclear regarding smooth implants). First reported in 1997, and first defined by the World Health Organization in 2016, BIA-ALCL is a very rare form of lymphoma, a form of cancer that starts in the T cells of the immune system (not the breast itself), in women with textured breast implants.
As of September 2018, there have been 457 confirmed cases in the United States. For perspective, in 2018 close to 400,000 women got breast implants in the US – approximately 300,000 for elective augmentation and 100,00 for breast reconstruction(1). This cancer is very rare, estimated at 1 in 3,800 to 1 in 30,000 women with implants (same odds as being hit by lighting in your lifetime, less likely than getting killed in a car crash in 50 years of driving) (2). In more than 70% of cases, surgical removal of the implant and the capsule around it is curative, and no further treatment is needed. If the disease is extensive, or involves lymph nodes, further treatment would be indicated. Either way prognosis is excellent with only nine reported deaths in the 457 patients with the confirmed diagnosis (21 reported deaths worldwide) or a 98% 5-year survival rate.
For women with implants who are concerned about this, the most important information are signs and symptoms to watch for. Because this is so rare, there is no recommendation that women with textured implants have them prophylactically removed. Rather, the FDA recommends patients and physicians know the warning signs.
BIA-ALCL has been identified on average 10 years after implants were placed, in women who suddenly developed signs of an inflamed breast: rapid swelling, redness and a seroma (fluid collection) around the implant years after surgery was complete. (Note: seroma fluid around the implant at the time of surgical placement is common and to be expected; of concern is a seroma that forms years after the implants were placed). Diagnosis suspected when imaging shows a fluid collection around the implant. The diagnosis is made by testing fluid and tissue from the capsule around the implant and the laboratory should be alerted that BIA-ALCL is suspected. The patient should then be referred to a medical center with experience dealing with BIA-ALCL and her case reported to the FDA who is tracking these cases. As stated above, surgery will likely be curative.
In summary, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a very rare form of lymphoma related to breast implants, usually 10 or so years after the implants were placed. The risk seems to be higher in women with textured implants than smooth. This condition is so rare, there are no recommendations to date to remove the implants. Women should however know the warning signs: a breast that suddenly appears inflamed, enlarged, red and swollen. The good news is most women with BIA-ALCL caught early are cured by surgery.
Additional resources:
- 2018 National Plastic Surgery Statistics, American Society of Plastic Surgeons, accessed online at https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-report-2018.pdf
- https://www.foxnews.com/health/breast-implants-linked-rare-cancer-fda-declines-ban
- https://www.nbcnews.com/health/womens-health/blindsided-women-speak-out-about-breast-implant-illnesses-fda-hearing-n987141
- Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
- https://www.fda.gov/medical-devices/breast-implants/questions-and-answers-about-breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl
