Breast implant risk ‘underestimated’
Warning from experts as survivor relives ordeal that left her fearing she ‘wouldn’t live to see’ her children grow up
THE number of women at risk of blood cancer triggered by the most commonly used type of breast implant in Ireland has been ‘hugely underestimated’, a world expert has warned.
Research has suggested implants with a textured silicon surface, which are the most commonly used type in Ireland, trigger a cancer called BIAALCL. One American plastic surgeon said this cancer is rare but he fears numbers have been ‘hugely underestimated’.
This cancer has been found in 173 women around the world, with 11 of those women in Britain.
THE number of women at risk of a blood cancer – which is triggered by the most popular type of breast implant in Ireland – has been ‘hugely underestimated’, a world authority on the newly emerging disease has warned.
American plastic surgeon Professor Mark Clemens, who has been tracking cases since the first were reported in 2011, said that while the disease is ‘still very rare’, the true incidence is ten times higher than women are often told.
Breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL, has been identified in 173 patients worldwide.
However, the numbers currently being seen ‘could be just the tip of the iceberg’, according to one UK breast surgeon who has treated three women with the disease in the past year.
BIA-ALCL is not breast cancer, but rather a type of ALCL: a cancer that develops in the lymphatic fluid – which is part of the immune system, and can circulate throughout the body forming solid tumours. Women in their mid-30s to over-60s have been affected, and problems are typically seen at least four years after the implant operation.
One patient struck down with the illness is 30-year-old Charlotte Fouracres, who claims she was not warned about the risk when she had an augmentation in April 2012 to take her from a B cup to a D.
Last July, the teacher, from Colchester, Essex, southeast England, discovered a lump the ‘size of a 5p piece’ at the top of her right breast, near the cleavage, and sought medical advice. The mother of four was referred by her GP to a breast-screening centre. Experts performed an ultrasound scan and needle biopsy, which confirmed ALCL. She started chemotherapy immediately, but the treatment failed to halt the disease.
After four months, scans revealed her tumour had spread to her chest wall and was inoperable.
Charlotte said: ‘My right breast was swollen, felt burning hot and I had developed a red, itchy rash. I became unable to raise my right arm to brush my hair or teeth and could no longer cook or drive. I felt absolutely lost, with no control over my body. I had to contemplate the unthinkable – that I might not see my children grow up.’
With her disease progressing at an alarming rate, Charlotte’s doctors sought specialist help. She was referred to consultant breast surgeon Fiona MacNeill at the Royal Marsden NHS Foundation Trust, a cancer centre in London.
Dr MacNeill, who had treated two other patients with BIAALCL, said: ‘It’s a new cancer, so many doctors don’t recognise it when they see it. To diagnose BIA-ALCL as distinct from ALCL, specific tests have to be carried out. Although Charlotte was put on the correct treatment for regular ALCL, it is possible the BIA-ALCL does not respond well to the type of chemotherapy used to treat the more common form.’
Charlotte was then given seven cycles of a biological therapy drug called brentuximab, which mimics immune-system antibodies that attack and destroy tumour cells. ‘This new drug was amazing,’ said Dr MacNeill. ‘The disease melted away in front of our eyes.’
This was followed by surgery in April to remove Charlotte’s implants, and she has been told she has no remaining cancer.
She said: ‘I suppose I had the boob job to boost my self-esteem. Now, looking back, maybe having smaller breasts wasn’t such a bad thing after all.’
In most cases of BIA-ALCL, women are successfully treated with surgery alone, but chemotherapy and radiotherapy may also be needed. There has been growing concern in the medical community about BIA-ALCL
since 2011, when America’s Food and Drug Administration, the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), and the World Health Organisation issued alerts to doctors urging them to report cases.
Implants with a textured surface – the most common type in Ireland – are under particular scrutiny.
Ireland’s Health Products Regulatory Authority said it ‘does not collect specific data relating to the number and type of breast implants sold in Ireland’. It added: ‘The HPRA understands that textured breast implants are used more commonly than smooth implants in Ireland.
‘The HPRA is aware of this issue (ALCL) and is monitoring this closely in conjunction with the MHRA and other European regulatory colleagues.’
Prof Clemens, who has studied the disease in depth, believes the true scale of the risk of being affected by BIA-ALCL has been underestimated. He said: ‘A figure of one in 500,000 has been quoted, but this is a huge underestimate.
‘It does not take into account that it takes on average ten years after an implant for symptoms to occur. Given this, the actual number is one in 50,000.’
Dr MacNeill agreed, saying: ‘Because of the length of time it take for the disease to show, and because many doctors are not aware of it, women may have gone undiagnosed. It is rare, but there is the worry that the numbers we have seen so far are just the tip of the iceberg... Low risk does not equal no risk, and patients must be advised as such.’
Earlier this month, French health authorities confirmed a ‘clearly established link’ between implants and the development of BIA-ALCL. A watchdog, the ANSM, ordered manufacturers to prove the safety of their products or face them being banned.
The ANSM says it is vital that research is done into how silicone prostheses interact with body tissues to ‘reduce the risk (of cancer) as much as possible’.
Some research has suggested bacteria on the outer shell introduced during implantation leads to immune system changes that trigger the cancer. However, this is not proven.