Knowledge is Power

The FDA, New York Times, Fox News, and others have recently reported on rare lymphatic cancers linked to breast implants. These articles have left many women with concerns about whether they are at risk, and many have been asking what they can do to protect themselves. Simply stated: you can do a lot! In fact, the very steps you should take to protect yourself from this rare disease are even more likely to keep you safe from your greatest risk: carcinoma (not lymphoma) of the breast.  The exact number of women in the U.S. who have implants is not known. But a good estimate holds that approximately 2-5 million women currently have implants, and many more have had them removed. The FDA has released 240 MDR’s (medical device reports) of patients with a rare cancer: anaplastic large-cell lymphoma. Out of those cases, 9 deaths have been reported. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm481899.htmLymphoma is always included in the differential diagnosis of all breast tumors; although rare, they can occur at any age. So it is not so surprising that the presence of a large foreign body (implant), could be linked to, and even increase, the rare likelihood for certain types of lymphomas to grow in the breast. Because lymphomas are diagnosed more commonly in women with textured implants, and because the abnormal cells are most commonly found in the fluid around the implant, the evidence seems to suggest that the cause may well be due to low-level chronic infection or colonization of bacteria around the implant.  Although this type of cancer is very rare, there are things you can do to protect your implants and yourself: from lymphoma, and also from the more likely risk of breast carcinoma. 1) Antibiotic Prophylaxis:  Women with implants should consider taking prophylactic, or preventative, antibiotics when they undergo teeth cleaning and/or oral surgery. We know that teeth cleaning can dislodge bacteria into the blood stream; when these bacteria circulate in the blood, bacteria can colonize nonliving implanted objects, including breast implants. Even if an actual infection does not occur, the presence of bacteria around the implant could stimulate hyperactivity in the immune system’s response and lead to lymphomas. 2)Self-Exam:   Examine your breasts monthly, approximately 3-5 days after the end of your menstrual cycle, when your breasts are at their least tender. The timing is important, because breast tissue becomes very lumpy right before and during menses. Record your findings each month, including information about breast symmetry, changes in thickness, and any lumps or bumps you notice. The more often you examine yourself, the more aware you will be of any changes in your breast tissue. Draw a simple picture of what you feel, and check any areas of concern during subsequent self-exams. Refresh your memory each month as to what was there last month, and note if there is still a nodule or thick area that concerned you previously.   Be sure to report any persistent or increasing asymmetries, swelling, thickenings, or nodules to your physician and your plastic surgeon. 3) Automated Whole Breast Ultrasound: Consider Automated Whole Breast Ultrasound (AWBUS) as a tool for routine breast cancer screening, and to look for seromas around your implant. AWBUS is a great option if you cannot tolerate mammography, have dense breast tissue, or fear damage to your implants and therefore have tended to avoid screening altogether.  Finally, keep in mind that your risk for a lymphoma related to implants is likely less than 1 in 20,000, but your risk for breast cancer is 1 in 10. Protect yourself from both with a thoughtful and thorough cancer-screening regimen.