Prognosis and Survival Rate for Women with BIA-ALCL
Breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL, is an extremely rare cancer. Often, symptoms of the cancer start showing eight to 10 years after women have had breast implant surgery. The cancer usually begins in the scar tissue capsule that surrounds the implant.
For a majority of women who develop breast implant-associated ALCL, the outcomes are favorable. Typically, ALCL spreads slowly. Like all lymphomas, however, it can become aggressive if it goes untreated. Once ALCL spreads beyond the implant capsule and involves the lymph nodes, it can become especially dangerous.
The overall survival rate for women with breast implant-associated ALCL is 89 percent at 5 years. However, prognosis always depends on the “stage” of the cancer at the time it is diagnosed. Doctors use the term “stage” when describing how far a cancer has spread and how dangerous it is. Stages range from 1 (mostly contained) to 4 (cancer has spread a lot).
The survival rate for women who receive complete treatment while the cancer is in stage 1 is nearly 100 percent. After a successful operation, there is also a very small chance of the cancer returning.
If the cancer is stage 2 or worse—which often means it has spread beyond the capsule—then risks are higher and the necessary treatments will be more intense. Additionally, one study showed that patients with stage 4 breast implant-associated ALCL have a 14.3 percent chance of another disease event following surgery.
What Are the Chances of Developing BIA-ALCL?
Here are the quick facts about the number of women affected:
- Approximately 1 in 500,000 women is diagnosed with ALCL.
- Estimates of how many women may develop BIA-ALCL range from 3,817 to 30,000.
- The FDA has received 414 medical device reports involving BIA-ALCL, including 9 fatalities.
Despite its rarity, scientists have not been able to say for certain that there is a “safe” or “safest” breast implant in regard to BIA-ALCL.
There have been reports of BIA-ALCL related to:
- Reconstructive and cosmetic surgeries
- Saline and silicone implants
- Original and replacement implants
- Implants with textured and smooth surfaces
Implants with a textured surface account for more reports than implants with smooth surfaces, though it is not yet fully understood why this is the case. More research is being done to help women better understand the risks involved with breast implants, to recognize and respond to symptoms and to ensure that companies manufacture safer products.
Common BIA-ALCL Procedures
Once BIA-ALCL has been detected, the typical treatment involves surgically removing the implant and the tissue surrounding it. Known as the “capsule,” the scar tissue that forms around the implant is part of the immune system’s natural response to a foreign object being placed inside of it.
In many cases, BIA-ALCL develops in the fluid buildup between the implant and the capsule. Sometimes, the cancer develops or spreads into the scar tissue. As long as the the cancer is caught early, it is not likely to spread beyond the capsule. If this is the case, then explant surgery will be performed.
Explant surgery (capsulectomy) removes both the implant and the capsule from the body. For women with stage 1 BIA-ALCL, a complete and successful explant surgery will usually get rid of the cancer without the need of other treatments.
Even if the BIA-ALCL is confined to one breast implant, women may consider removing the other implant. This is because 4.6 percent of women with BIA-ALCL have demonstrated incidental lymphoma in the opposite breast.
Advanced BIA-ALCL May Call for Additional Procedures
If BIA-ALCL remains undiagnosed for too long, or if it is particularly aggressive, the cancer may have spread beyond the capsule. In these cases, explant surgery may not be enough to fully remove the disease. This is why doctors screen nearby lymphatic tissue in addition to the capsule during testing for BIA-ALCL.
In cases where the cancer has affected the lymph nodes or spread to other sites outside the capsule, women may need to undergo more invasive treatments.
Additional treatment options include:
- Chemotherapy: Also known as “chemo,” chemotherapy is a treatment doctors use to control a cancer that has spread. Chemotherapy drugs are designed to attack cancer cells and prevent their rapid growth. The treatment also harms healthy cells, which means there are a number of side effects.
- Radiotherapy: Also known as radiation therapy, radiotherapy uses X-rays and other high-energy beams to shrink and destroy cancer. Radiotherapy can target cancer cells better than chemotherapy, which affects the entire body. However, it will still damage healthy cells in the process.
Common Side Effects of Chemotherapy and Radiotherapy
While chemotherapy and radiotherapy can be effective, they come with a host of side effects. Many side effects will go away after treatment, but some will linger for the rest of a person’s life.
Side effects of chemotherapy include:
- Hair loss
- Increased risk of infection
- Fatigue
- Constipation
- Diarrhea
- Nausea
- Vomiting
- Mouth sores
- Issues with memory and focus
- Mood changes
- Fertility problems
- Lower white blood cell count (neutropenia)
- Lower red blood cell count (anemia)
- Lower platelet count (thrombocytopenia)
Though it may not affect the entire body like chemotherapy, radiotherapy still has a range of side effects to be aware of.
Side effects of radiotherapy include:
- Skin reactions and damage (temporary or lasting)
- Fatigue
- Swelling caused by buildup of lymph node fluid (lymphoedema)
- Swelling or pain in the breast
- Change in shape of breast
- Hair loss
- Sore throat
Although many of these effects will go away over time, radiotherapy may leave other lasting damage in the treatment area.
Lasting effects of radiotherapy include:
- Nerve damage
- Weakening of the bones
With these risks in mind, women of childbearing age should be tested for pregnancy before undergoing any type of cancer treatment.
Take Control of the Fight Against Breast Implant Cancer
The risk of developing breast implant-associated ALCL is very small, but there is no way to rule out the possibility for any woman with breast implants. Without displaying symptoms of BIA-ALCL, the Food and Drug Administration (FDA) does not advise any change in the routine medical care and checkups that follow any implant surgery. Women showing symptoms of BIA-ALCL are advised to talk with their doctor immediately.
In the event that BIA-ALCL is diagnosed, it should be treated immediately to increase the odds of a favorable outcome. Treatment will almost certainly involve the surgical removal of the breast implant and the surrounding capsule. If the disease has spread to different parts of the body, however, there may be other, more difficult treatments on the horizon.
A majority of the women diagnosed with BIA-ALCL survive and return to their healthy and productive lives. The road through treatment and recovery will demand a lot from patients and their families. Finding the support you need during this time is an essential—but often overlooked—tool for beating cancer both physically and mentally.
