Possible Explanations For Findings
The finding of later stage tumors at diagnosis of breast cancer in women with implants can be explained by multiple mechanisms, the first being that both silicone and saline implants create radio-opaque shadows on mammograms, which impair the visualization of breast tissue.65 The amount of parenchymal breast tissue obscured at mammography by the implant is known to be between 22% and 83%.66 Insufficient compression of the breast to visualize the parenchyma and the production of implant related artifacts on the film can also make interpretation of mammographic examinations difficult in women with augmented breasts.2829 Additionally, capsular contracture, which develops in about 15-20% of women with implants, has been shown to reduce mammographic sensitivity by 30-50%.65 Furthermore, specific characteristics of breast implants might affect the detection of breast cancer.67 Specifically, implants placed under the breast glands , because of their proximity with breast tissue, are suspected to obstruct mammographic visualization of the breast more than those with submuscular placement.433 However, to date, only one study has been able to evaluate the stage distribution of breast cancer according to implant placement.1834 Results from this study were inconclusive.
Breast Sarcomas And Other Tumors
Another rare fibrous tumor that can infiltrate extensively into surrounding structures but does not metastasize is classified by the term “desmoid.” reported their experience with 22 cases of breast desmoids. One of these cases was associated with saline implants that had been in place for several years. Four other cases of desmoids in association with breast implants have been reported . reviewed the literature and found less than 75 other cases of desmoids reported in women without breast implants. The relation of these tumors to previous trauma, scars from previous surgery, fibroadenomas and fibrocystic disease was noted. Desmoids occur rarely there is no evidence of an increase in frequency, and they are apparently associated with fibrosis, which occurs in the breast in conditions other than implantation. It is possible that a desmoid could occur very rarely in association with the fibrotic response that forms the around a breast implant, but there is no evidence to conclude that this occurs with increased frequency in the presence of silicone breast implants.
Epidemiological studies reported by , , ,and , discussed earlier, have not observed significant numbers of myeloma cases in women with breast implants. The committee concludes that evidence for an association between silicone breast implants and multiple myeloma or MGUS is insufficient.
Do Breast Implants Affect Breast Cancer Risk
| In the United States, plastic surgeons performed 334,052 breast augmentations in 2004. That’s up 19 percent from 280,401 in 2003, and more than a tripling from 101,176 in 1997. Breast augmentation is now more popular than nose reshaping, according to these figures, the latest available from the American Society for Aesthetic Plastic Surgery. |
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Should My Implants Be Removed Even Though I Have No Symptoms
Medical experts do not recommend removing your breast implants if you do not have symptoms of BIA ALCL, even if your implants are no longer supplied in Australia. This is because BIA ALCL is a rare cancer with excellent cure rates if it is detected early.
The risk of developing BIA ALCL is lower than the risks associated with an anaesthetic and surgery. The complication rate of revision surgery involving implant removal or replacement is also higher with each revision procedure.
Generally, breast implants are not lifetime devices, regardless of breast implant associated cancer. Typically they are removed after 10-15 years. The longer you have the implant, the more likely it will need to be removed. Common reasons for removal are contracture or movement of the implant.
Breast implant associated cancer is rare, but the risk is higher with certain types of breast implants. If you do not remember whether your implants are smooth or textured, or what brand they are, your surgeon or the clinic that holds your operation record should be able to advise you on these details.
It is best to discuss with your surgeon what they would recommend in their clinical opinion given the type of implant you have and the benefits versus risks of removal of implants in a healthy person with no symptoms. You can also discuss a plan for regular check ups. You can seek a second opinion to help you decide on options, or if you are unsure or concerned about the advice you receive from your surgeon.
Reporting Of Confirmed Cases
The U.S. Food and Drug Administration specifically recommends that all confirmed cases be reported to the PROFILE registry. The PROFILE registry is a joint effort of the FDA and ASPS/PSF. If you have been diagnosed with BIA-ALCL, please ensure your physician has reported the case to the PROFILE registry for tracking of cases. Information reported to PROFILE is updated with the FDA on a monthly basis. While PROFILE is a physician reporting system, if you would like to report your case directly, you may contact PSF who can get you in contact with a physician willing and able to report your case.
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What Are The Cancer Risk Reduction Options For Women Who Are At Increased Risk Of Breast Cancer But Not At The Highest Risk
Risk-reducing surgery is not considered an appropriate cancer prevention option for women who are not at the highest risk of breast cancer . However, some women who are not at very high risk of breast cancer but are, nonetheless, considered as being at increased risk of the disease may choose to use drugs to reduce their risk.
Health care providers use several types of tools, called risk assessment models, to estimate the risk of breast cancer for women who do not have a deleterious mutation in BRCA1, BRCA2, or another gene associated with breast cancer risk. One widely used tool is the Breast Cancer Risk Assessment Tool , a computer model that takes a number of factors into account in estimating the risks of breast cancer over the next 5 years and up to age 90 years . Women who have an estimated 5-year risk of 1.67 percent or higher are classified as “high-risk,” which means that they have a higher than average risk of developing breast cancer. This high-risk cutoff is widely used in research studies and in clinical counseling.
Who Should A Woman Talk To When Considering Surgery To Reduce Her Risk Of Breast Cancer
The decision to have any surgery to reduce the risk of breast cancer is a major one. A woman who is at high risk of breast cancer may wish to get a second opinion on risk-reducing surgery as well as on alternatives to surgery. For more information on getting a second opinion, see NCI’s Finding Health Care Services page.
A woman who is considering prophylactic mastectomy may also want to talk with a surgeon who specializes in breast reconstruction. Other health care professionals, including a breast health specialist, medical social worker, or cancer clinical psychologist or psychiatrist, can also help a woman consider her options for reducing her risk of breast cancer.
Many factors beyond the risk of disease itself may influence a womanâs decision about whether to undergo risk-reducing surgery. For example, for women who have been diagnosed with cancer in one breast, these factors can include distress about the possibility of having to go through cancer treatment a second time and the worry and inconvenience associated with long-term breast surveillance . For this reason, women who are considering risk-reducing surgery may want to talk with other women who have considered or had the procedure. Support groups can help connect women with others who have had similar cancer experiences. The searchable NCI database National Organizations That Offer Cancer-Related Services has listings for many support groups.
Selected References
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Old Breast Implants And Cancer Risks
There is a link between old breast implants and a cancer called breast implant-associated large cell lymphoma, or BIA-ALCL. BIA-ALCL develops in the scar tissue between the breasts and the implants. The longer the breast implants are in, the higher the risk of BIA-ALCL development. There are steps women can take to stay safe.
Breast Implant Safety: A Decades
Since the 1960s, implants have been used to restore the look and shape of the breasts after a mastectomy and for cosmetic breast enlargement . Theyve grown in popularity in recent years despite the fact that for decades there have been heated debates over their safety. In 2018, more than 101,000 breast reconstruction procedures were performed in the U.S., and 82% of them used implants. In addition, more than 313,000 breast implant surgeries were performed for cosmetic augmentation. 3
Some breast cancer patients more than 18,000 in 2018 chose reconstruction using their own tissue rather than implants. 3 Women who opt for autologous surgery tend to have higher long-term satisfaction with their reconstruction. But autologous surgery is less common because fewer plastic surgeons have experience with it, its a more complex surgery with a longer recovery time, and some women arent candidates, usually because they dont have enough extra tissue.
Plastic surgeons are supposed to carefully go over the risks and benefits of a reconstruction procedure, and the alternative treatment options, with a patient before the surgery takes place. Recently, a number of women who got breast reconstruction with implants have raised concerns about whether they received enough information from their doctors about newly emerging risks before they agreed to the surgery.
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Women: Breast Implants And Cancer Risk
In about 90% of breast cancer cases, women find a breast lumpthemselves. So, check your breasts regularly. If you have implants, payextra attention to how your new breasts look and feel.
Have breast implants? Or thinking of getting implants? You may be worried theyll make it hard for your doctor to detect and treat breast cancer.
No need for concern, says Therese Bevers, M.D., medical director of MD Andersons Cancer Prevention Center. Just take the extra precautions listed below.
Get familiar with your new breasts
In about 90% of breast cancer cases, women find a breast lump themselves. So, check your breasts regularly. Its one of the best ways to detect breast cancer early.
If you have implants, pay extra attention to how your new breasts look and feel.
Itll take a while to get used to your new breasts because theyll have a different texture. Theyll also have new folds or dimples, Bevers says.
But after you get comfortable with your new breasts, you shouldnt have any problems noticing changes.
Women with implants can sometimes even notice changes more easily than women without implants, Bevers says. Implants tend to push the natural breast tissue closer to the surface of the breast, making a lump easier to feel.
Take extra screening steps
Most women, including those with breast implants, should start annual mammograms at age 40.
Worried that flattening your breasts during the exam will damage your implants? That rarely happens, Clemens says.
Helping Your Ob/gyn Identify Alcl
Dr. Agarwal: Right. So patients who’ve had breast implants can present to their physician, OB/GYN, general family physician, or their plastic surgeon with a variety of different complaints. The breast is swollen, it’s become more painful, or they feel a mass. The most common presentation is fluid around the implant. And about 86 percent to 90 percent of patients who’ve had this ALCL presented with what we call an effusion or a seroma around the implant.
Dr. Jones: Was it years after their implant or . . . it must have been years because cancer doesn’t happen in a day.
Dr. Agarwal: Right. So the average time to presentation of the 400 to 500 patients that have had this has been 8 to 10 years after the breast implant has gone in.
Dr. Jones: Right. So if it’s 400 in the U.S., that means the vast majority of plastic surgeons, OB/GYNs, primary care docs, nurse practitioners have never seen this, have never heard of it. But if a patient comes with a new complaint some years after the breast implant should be pretty stable, they should know enough to say, “That’s not normal.”
Dr. Agarwal: That’s correct. Again, to put it in a little bit of context, as you mentioned in your opening, there are about 300,000 to 500,000 breast implants that are placed annually in the United States. It’s believed that worldwide there are about 35 million women who have textured implants, and it’s believed worldwide about 1.5 million implants are placed annually.
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What Should You Do If You Have Implants
Talk to your doctor. Most experts donât recommend removing textured implants just because of their link to ALCL. But if you do have textured implants and youâre concerned, talk with your doctor.
Itâs important to watch for the signs of ALCL. It can show up anywhere in your body. But most women with breast implants get it near scar tissue where their implants are.
Check your breasts regularly for:
- New swelling
- Lumps or other changes in the shape of your breast
- Pain in or near your breast thatâs regular or constant
- A skin rash near your breast
- Hardening in your breast or new scar tissue
Also look for:
- Hair loss
- Exhaustion, which can be a sign of a weak immune system
These can be signs that you have ALCL. But they can also be signs of other things, like a ruptured implant. Thatâs why itâs important to see your doctor right away if you notice changes in your breasts.
ALCL is usually curable, especially when itâs found early. To find out if you have ALCL, a doctor will do a needle biopsy and an imaging test, such as an ultrasound or mammogram. Early treatment usually involves removing the implant and any tissue that has cancer.
Show Sources
Mayo Clinic: âIs There Any Connection Between Breast Implants and Cancer? And If So, How Serious is the Risk?â âNon-Hodgkinâs Lymphoma.â
M.D. Anderson Cancer Center: âWomen: Breast implants and Cancer Risk,â âImplant-Associated Anaplastic Large Cell Lymphoma.â
How Do I Spot The Symptoms
It is important to know the symptoms of breast implant associated cancer. The most common symptom is swelling of a breast caused by fluid build-up around the implant, but in some cases it may appear as a lump in the breast or armpit.
As this is a rare disease, changes in your breast are unlikely to be breast implant associated cancer. For example, swelling immediately after your breast implant surgery is normal. But you should raise all concerns with your surgeon, including the possibility of breast implant associated cancer. If the surgeon or clinic which performed your original implant operation is no longer available, you should see your GP for referral to another surgeon.
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Breast Implants Are Not Lifetime Devices
The longer you have breast implants, the greater the chances are that you will develop complications, some of which will require more surgery.
The life of breast implants varies by person and cannot be predicted. That means everyone with breast implants may need additional surgeries, but no one can predict when. Patients can also request additional surgeries to modify the size or shape of their breasts.
Breast Implants Linked To A Rare Cancer: How Big Is The Risk
5 January 18
Women with breast implants are at increased risk of developing a rare type of cancer of the immune system, but the overall chance of getting this cancer from implants is very low, according to a new study from the Netherlands.
The study provides one of the most precise estimates to date of the risk for women with breast implants of developing this cancer, which is called anaplastic large cell lymphoma , the researchers said. ALCL is not breast cancer rather, it is a type of lymphoma, which is a cancer of the immune system cells. When it occurs in women with breast implants, the cancer typically appears in the scar tissue around the implant.
In the new study, the researchers estimated that, for women who get breast implants, the risk of developing ALCL in the breast is 1 in 35,000 at age 50, 1 in 12,000 at age 70, and 1 in 7,000 at age 75.
Although the risk is low, the researchers recommended that women considering breast implants for cosmetic or reconstructive purposes should be counseled about the risk of ALCL, as well as the symptoms of the disease.
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What Is The Prognosis Of Bia
The is generally good since it is considered to be highly treatable. As with most cancers, the key is in early detection.
BIA-ALCL is usually treated successfully with surgery to remove the implant and surrounding scar tissue. Some patients also receive treatment with chemotherapy and radiation therapy.
According to the National Institutes of Health , the 5-year survival rate of BIA-ALCL is 89%. Patients who were diagnosed with Stage 1 BIA-ALCL almost always survive.
However, this cancer is harder to treat and might become incurable if it spreads. Sadly, in these cases, BIA-ALCL can be fatal. As of January 2020, the FDA reported 36 deaths due to BIA-ALCL.
Brands Linked With Cancer After Breast Implants
As part of an FDA request, Allergan recalled its manufactured implants in July of 2019. The recall came after reports of 573 cases of BIA-ALCL, 481 of which were reported to involve Allergan breast implants.
It was also reported that over three dozen other countries had banned these implants due to the risk of BIA-ALCL.
If you are concerned about developing BIA-ALCL or breast cancer after breast implants, talk to your health care providers. From there, you and your medical team can develop a plan to minimize your risks of cancer.
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