Getting Tested for Cancer When You Have Breast Implants
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is very rare, but any woman who has breast implants should know the steps to follow should symptoms start to appear. Symptoms of BIA-ALCL generally manifest eight to 10 years after breast implant surgery.
There is still a lot to learn about BIA-ALCL and the fight against cancer is unique for every woman. That said, doctors have developed a fairly standard strategy for diagnosing and treating various types of ALCL. The specific approach will depend on the individual.
Diagnosis and treatment generally involve:
- Initial Diagnosis: Doctors will collect relevant cell, tissue or fluid samples from the body to determine whether or not a woman has BIA-ALCL. If the tests are positive, the patient will undergo additional testing.
- Staging Workup: Once BIA-ALCL has been confirmed in the body, additional tests are conducted to determine the exact nature of the cancer and how far it has spread. With this information, doctors develop a blueprint for removing or shrinking the cancer.
- Disease Surveillance: After the cancer has been removed, doctors will recommend tests and scans to be performed to make sure the cancer remains in remission.
Due to the rarity of BIA-ALCL, the FDA recommends that women who are not showing signs or symptoms carry on with their routine cancer screenings, such as mammograms. Women who are displaying symptoms are strongly encouraged to talk to their physician immediately because BIA-ALCL cannot be diagnosed through routine screenings.
Initial Tests to Determine Presence of Breast Implant Cancer
The most common symptoms of BIA-ALCL are pain, swelling or lumps near the implant that appear later than one year after the surgery. The cancer is most commonly discovered in the scar tissue that surrounds the implant (known as the “capsule”) or in fluid that has built up between the implant and the capsule (known as “seroma”).
During the initial testing, an ultrasound is used to evaluate key areas near the implant, including the capsule, seroma and nearby lymph nodes. If an ultrasound does not provide enough information, doctors may recommend magnetic resonance imaging (MRI) or positron emission tomography (PET) scans.
Ultrasounds are usually successful at pinpointing the seroma so that doctors can collect fresh fluid. They also help doctors locate suspicious masses in the scar tissue, samples of which are then collected in a procedure known as tissue biopsy. The lymph nodes closest to the implant are also observed, because BIA-ALCL can often spread through them.
The seroma fluid and any suspicious masses that were collected are then analyzed to determine the presence of BIA-ALCL.
Expected tests will include:
- Immunohistochemistry: Also known as immunostaining, this helps doctors identify abnormal cells, like cancer cells. It is also used to tell the difference between various types of cancer.
- Flow Cytometry: This is a laser-based technology that enables doctors to analyze particular characteristics of cells or particles. Through these tests, doctors are looking to find microscopic warning signs. For BIA-ALCL, they are looking for the presence of a certain protein known as CD30.
If BIA-ALCL is ruled out, then patients who are presenting symptoms are directed to a plastic surgeon who will help them with non-cancerous lumps or excess fluid buildup. If the presence of BIA-ALCL is confirmed, the patient will begin a new set of tests. The case is also reported to a registry maintained by the American Society of Plastic Surgeons (ASPS).
Workup and Cancer Staging
After breast implant-associated ALCL has been identified in the body, there are several tests that doctors will run to get a better understanding of the cancer and how much it has spread. They call this phase “workup and staging.”
Lab work will likely include:
- Complete Blood Count (CBC): this test evaluates overall health. With regards to lymphoma, which affects white blood cells, a CBC will alert doctors to abnormal cells.
- Comprehensive Metabolic Panel (CMP): this is another blood test that measures your blood sugar level as well as kidney and liver functions.
- Lactate Dehydrogenase (LDH): LDH is a substance the body creates to turn sugar into energy. If there are abnormally high levels of LDH in the bloodstream, it indicates serious cell damage.
- HIV and Hepatitis B Testing: Because lymphoma attacks the immune system, a person is at increased risk of viral infection. This test will most certainly be done if the doctors are considering chemotherapy or radiotherapy as part of treatment.
- PET Scan: this is one of the best ways that doctors can pinpoint tumors and track the spread of the cancer.
Cell samples from bone marrow may also require testing, but only in very select cases. Other tests may be ordered, too. By the end of the staging workup, doctors have will have a clear picture of how far the cancer has spread, as well as what needs to be done to increase the odds of a favorable outcome.
Disease Surveillance After Treatment
Data shows that treatment of BIA-ALCL is very effective and outcomes are favorable for the vast majority of women. To be safe, however, doctors will recommend follow-up physical exams every three to six months for the first two years after surgery. After that, it is up to the doctor to order additional tests and scans.
If BIA-ALCL is diagnosed before it has spread beyond the capsule, studies show that there is almost no chance that the cancer will return. In a small number of more advanced cases of BIA-ALCL, patients have experienced additional issues.
Diagnosing and Treating Breast Implant Cancer Is a Team Effort
It takes a team of highly trained specialists to diagnose and treat BIA-ALCL. Oncologists, radiologists, pathologists, hematopathologists and other specialists and technicians will need to be involved. Good communication is essential, as lab work may need to be sent for a second or even third opinion.
Early diagnosis of any cancer is the key to successful treatment. Be sure to stay up to date with check-ups and to be diligent in self-examinations. When BIA-ALCL is diagnosed, it is usually because a woman first sought help for symptoms she discovered herself.
Some traditional tests and routine cancer screenings, such as mammograms, may not be helpful in diagnosing BIA-ALCL. This is not because the breast implants “hide” the cancer, but because only very specific tests are able to find the microscopic evidence of BIA-ALCL.
If you or a loved one is showing symptoms of BIA-ALCL more than one year after surgery, getting the area around the breast implant tested is the only way to know for sure what you are up against. If you test positive for BIA-ALCL, there is a clear course of action. Make sure you have the support you need to give yourself the best chance of returning to a healthy life.
Lastly, it is important to note that breast implant cancer is a disease that is caused by the implants themselves. While getting implants was a choice for some woman, cancer was not.
The Breast Implant Cancer Advocates of our organization are here to help you on your journey toward a brighter future.