Frederick Locke, MD, Medical Oncologist, Vice Chair and Associate Member in the Department of Blood and Marrow Transplant and Cellular Immunotherapy at the Moffitt Cancer Center, discusses the correlation between breast implants and lymphoma.
Interview conducted by Ivanhoe Broadcast News in June 2017.
What is the connection with the implants and cancer?
Dr. Locke: The FDA recently updated their data on breast implant-associated lymphoma or specifically breast implant-associated anaplastic large T-cell lymphoma. This is a very rare lymphoma that can occur in people who have not had breast implants, however it occurs more frequently in women with breast implants.
Is it a certain kind of implants?
Dr. Locke: The FDA recently reported on 359 cases from their registry. It’s important to know that there were only nine deaths due to this lymphoma, out of those 359 cases; as far as lymphomas go it’s relevantly nonaggressive in most of these cases. When the FDA looked at whether it was associated with silicone or saline implants there was not much of a difference, it was about equal. 60 percent silicone, 40 percent saline implants. In addition, they looked at the texture of the implant, that can either be a smooth surface or it can have sort of a textured or dimpled appearance. And more of the cases, actually 90 percent of the cases, of breast implant-associated lymphoma were associated with these textured implants.
Has there ever been an issue like this up to this point with implants?
Dr. Locke: This is not a new association, we’ve known about this association between anaplastic large cell lymphoma and breast implants. Again, the FDA recently updated their data so that we have a clearer picture about the associations. Again there was no clear association with saline or silicon. The update also now includes data about the texture of the implants. In 90 percent of the cases where information was available on the texture of the implant, it was a textured or dimpled implant.
That’s new information from yesterday?
Dr. Locke: Well not only did the FDA recently report on this larger number of 359 cases. The National Comprehensive Cancer Center Network (NCCN) issued guidelines on what to look out for and how to manage this sort of lymphoma, breast implant-associated lymphoma. What’s important for women who do have breast implants to know, is that the chance of them developing this lymphoma is very, very low. At most about one in 30 thousand women who have breast implants could expect to develop this breast implant-associated lymphoma. Neither the FDA nor the National Comprehensive Cancer Center Network is recommending that women have their breast implants removed because of this information. It’s something that is important for not only women with breast implants to be aware of, but their physicians to be aware of. Because the symptoms often come on years after the breast implants are surgically placed. In fact, on average it’s almost ten years after the implants are placed that this lymphoma is diagnosed. Typically it presents as a fluid filled area around the breast implant or hardening of the breast implant. Sometimes a lump or bump along the side of the implant. The latest recommendations are that if there is a fluid-filled area around the breast implant; that needs to be tested and sent to a pathologist to make sure that it’s not due to breast implant-associated lymphoma. Again, it’s important for women with breast implants, their primary care physicians and their plastic surgeons to be aware that this can occur.
Testing the fluid is that the CD 30 tests?
Dr. Locke: Anaplastic large cell lymphoma typically has a marker on the surface of the cells. That’s called CD 30 and in fact there’s a treatment, a relatively new cancer treatment, that targets CD 30 and that’s the latest recommendation by the NCCN. To use this special targeted agent for women who developed breast lymphoma if the lymphoma is not not cured by simple surgical removal of the breast implant. In most cases simple removal of the breast implant and the capsule around it can get rid of the lymphoma. It’s relatively rare that it spreads to other areas of the body and if so it can be treated with this targeted agent. Brentuximab Vendotin it’s called. In fact, Stacy Boone has one of, if not the most aggressive case, that been reported. It was spread throughout her body and was not responding to the therapies that we had available at the time. Stacy underwent a donor stem cell transplant, which is not the typical. In fact, I think it’s important to realize that often breast implant-associated lymphoma acts less aggressively then if that same lymphoma were to develop in someone without breast implants.
This is not like you’re taking a big risk if you have breast implants you might not want to go down that road?
Dr. Locke: No one is recommending that women who have the breast implants, have them removed because of this information. It’s just important to understand the risks and if there is a change; hardening of the breast implant, collection of the fluid or something that’s noticed, that it be brought to a physician’s attention and also for that physician to be aware that this is possible.
It won’t be compared to like smoking, don’t smoke because it causes cancer, now don’t get breast implants because it could cause cancer?
Dr. Locke: Almost 400 thousand women a year, in the United States, are having breast implants placed. Whether it be for cosmetic reasons or following surgery for breast cancer or other reasons, that’s always an individual choice. The risks are very small of developing breast implant-associated lymphoma. It’s just important to understand those risks. Again, no one’s recommending that woman with breast implants have them removed. In the latest statistics, the numbers that we have suggest that women with breast implants have about a one in 30 thousand chance of developing this breast implant-associated lymphoma. It’s a relatively small chance and again, most of the cases are associated with these textured breast implants rather than a smooth breast implant.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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