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Amid increasing concerns worldwide about reported cases of breast lymphoma linked to textured breast implants, researchers from Finland indicate that the problems are likely under-diagnosed, and warn that further studies are needed to confirm the best treatment plans.
In a report published last week in the European Journal of Surgical Oncology, researchers took a closer look at a rare type of cancer known as breast implant analplastic large cell lymphoma (BI-ALCL), following the first confirmed diagnosis in Finland.
While most cases of the non-Hodgkins lymphoma developing in breast tissue around the artificial implant can be treated with surgical removal of the breast, researchers indicate that some women have experienced more severe problems and the cancer can become life-threatening.
The report comes as doctors and health officials continue to learn more about the link between analplastic large cell lymphoma and breast implants, which was first detected in 1997, but has been diagnosed with increasing frequency in recent years.
Earlier this year, the FDA issued warnings about breast lymphoma risks, indicating that the agency was aware of at least 359 reports involving women diagnosed with the cancer, including at least nine deaths.
After Australia’s Therapeutic Goods Administration (TGA) launched an effort to monitor for cases of anaplastic large cell lymphoma (ALCL) from breast implants, the number of identified cases in that country more than doubled, increasing the level of concern among doctors and patients worldwide.
There is little known about the underlying cause of the breast lymphoma problems, but investigators have noted that the risk seems higher among women with breast implants that have a textured surface, which may be causing chronic inflammation and immune system reactions, leading to the development of lymphoma in the fluid around the breast implant.
In this new study, researchers from Finland looked at the disease from diagnosis to treatment, warning that it may be more deadly in some cases than doctors expect.
“BI-ALCL is an anaplastic lymphoma kinase-negative T-cell lymphoma that has a distinctively different clinical course than other breast lymphomas or ALCLs,” the study notes. “Diagnosis is based on aspiration of the effusion around the implant and CD30 positivity of the sample. Every periprosthetic effusion after breast augmentation or reconstruction using implants should be considered as potential BI-ALCL until proven otherwise.”
In most cases, simply removing the implant seems to be an effective cure for the breast implant lymphoma, which sets it apart from other forms of ALCL, which have about a 40% survival rate. However, there are rare cases where researchers say it could be deadly, and those require more research.
“Most patients have an excellent prognosis when complete removal of the capsule and prosthesis with negative margins is achieved surgically,” they wrote. “Some patients, however, develop infiltrative disease with a potentially life-threatening clinical course. Treatment planning regarding the extent of surgery and role of adjuvant therapy, especially in advanced cases, requires further investigation.”
The authors warn that determining the number of actual cases and developing a reliable diagnosis may be difficult, as not all laboratories are equipped to perform lymphoma diagnostics, and not all cases are reported in the medical literature. They also note that it has not yet been made clear if there have been misdiagnoses or if the cancer may progress at a later date even after the implant is removed.
Due to increasing concerns about the risks, health officials have made efforts to raise awareness among doctors, not only encouraging them to discuss the benefits and risks before breast augmentation or reconstructive surgery, but also to be on the look out for signs or symptoms of breast lymphoma among women during the years after surgery.
Symptoms of the cancer linked to breast implants may first appear as pain or a lump in the breast or armpit, typically occurring after the surgical incision has fully healed, with most cases diagnosed 8 to 10 years after the breast implants are received.
Researchers said their findings raise questions about whether breast implant surgery is even ethical.
“The growing body of evidence for BI-ALCL has raised ethical concerns regarding aesthetic augmentations and breast reconstruction with implants. So far, the risk of developing a malignant tumor related to breast implants seems low, but the risk is still real and for those affected, the outcome is disastrous,” they concluded. “It is reasonable to question whether breast augmentation with implants that may predispose the patient to malignant neoplasm can be considered ethical, and if so, should surgeons move toward choosing a smooth implant in the face of recent evidence pointing toward textured implants as a potential main causative factor? At the very least, informed consent should include the risk of developing BI-ALCL, and the patients must be educated about the signs and symptoms of the disease.”
As medical experts continue to evaluate the best ways to diagnose and treat the cancer, a number of product liability lawyers are reviewing potential breast implant lymphoma lawsuits for women nationwide, pursuing potential claims against the manufacturers of certain devices that may contain dangerous design defects and inadequate warnings.