The number of cases of anaplastic large cell lymphoma (ALCL) linked to breast implants hit an all-time high last year. ALCL is a type of cancer involving cells of the immune system which typically appears in the lymph nodes, skin, soft tissue, lungs or liver. On rare occasions, however, it has appeared in the breast and, according to latest research led by Dr. Suzanne Turner of the University of Cambridge in the UK, almost all cases of breast ALCL have occurred in patients who have had breast augmentation, with the tumors always developing in the scar tissue surrounding the implant.
The US Food and Drugs Administration (FDA) released a number of recommendations to health care providers that included what to look out for and when to refer patients for further evaluation. Earlier this year, France's National Cancer Institute found a "clear link" between silicone implants and ALCL. Breast implants in France will now carry a warning of the potential link.
ALCL is rare and the association with breast implants is still relatively unknown. It is estimated that between five and 10 million women have breast implants and only 71 cases potentially linked to ALCL have been reported. But just because it is rare does not mean its underlying mechanisms should not be investigated.
The main symptoms of ALCL in women with breast implants are persistent swelling or pain in the vicinity of the breast implant. These symptoms were noted to occur after the surgical incision had healed, often years after implant placement. Evidence of fluid collection (seroma) around the breast implant has been observed and some patients have reported that a palpable mass or capsular contracture (thick and noticeable scar capsule around the implant) were present.
The FDA advised that the possibility of ALCL should be considered in a patient with late onset, persistent peri-implant seroma. In some cases, patients presented with capsular contracture or masses adjacent to the breast implant. The FDA advised that doctors who have a patient with suspected ALCL should refer her to an appropriate specialist for evaluation and all confirmed cases of ALCL in women with breast implants should be reported.
ALCL is treatable. Most patients with breast implant-associated ALCL who had the disease confined within the fibrous capsule achieved complete remission. An effective treatment for these patients is simply to remove the breast implant and the surrounding tissue but patients who present with a mass have a more aggressive clinical course, justifying chemotherapy or radiotherapy.
Elise Bevan, a solicitor in the clinical negligence team at Penningtons Manches said: “We have recently been instructed by Mrs X who presented on seven occasions to her surgeon with persistent seroma over a period of four years. The cause of the seroma was not evaluated and, earlier this year, Mrs X developed a hard mass adjacent to the implant in her left breast. It has since been confirmed that she has ALCL. The breast implant has been removed and she now requires chemotherapy.
“We have been instructed to investigate whether earlier assessments should have been undertaken and whether this would have meant that treatment would have been limited to removal of the breast implant without any need for chemotherapy. Although the number of women who have been affected remains low, it is important to raise the awareness of the possible association between ALCL and breast implants when advising patients about surgery so that the signs and symptoms can be spotted early giving a greater chance of successful treatment.”