Breast Implants That May Cause Cancer– The FDA’s Meeting About Safety Concerns

“On March 25-26, 2019, the FDA plans to convene a meeting of the General and Plastic Surgery Devices Panel at the FDA's Headquarters in Silver Spring, Maryland, to discuss a range of topics concerning the benefit-risk profile of breast implants. The FDA plans to publish a Federal Register notice and agenda on the FDA's Advisory Committee Calendar webpage 15 days in advance of the meeting,” says the FDA website.

This comes after the FDA issued the warning letters to Mentor Worldwide LLC in Irvine, California, and Sientra, Inc. in Santa Barbara, California for failure to conduct what’s called a post-approval study on the long term safety and risks of their silicone gel breast implants. A post-approval study provides additional information on products which are already on the market.

"Post-approval requirements are critical to ensuring the safety and effectiveness of the medical products we regulate and we'll continue to hold manufacturers accountable when they fail to fulfill these obligations," said FDA Commissioner Scott Gottlieb, M.D.

In its letters, the FDA noted a number of problems with the two companies’ post-approval studies. The FDA's letter to Mentor Worldwide said that the company didn’t enroll enough patients in their post-approval safety study, and had poor follow-up rates with patients who they did enroll. They also had significant data inconsistencies including missing race and ethnicity information. The FDA's letter to Sientra also noted poor follow-up rates with patients. The FDA says it wants both companies to reply within 15 business days with details about how these violations will be corrected.

The Companies Respond to the FDA’s Warning Letters 

Mentor Worldwide LLC said that it was disappointed with the FDA’s decision to issue a warning letter, even though the company has tried to address post-approval study requirements with the FDA. “A number of the details cited in the Warning Letter are incorrect and incomplete and we look forward to the opportunity to further discuss these discrepancies and next steps with the FDA,” the company said in statement, according to NBC News.

Sientra, Inc. replied that it would attempt to rectify the issue. “Sientra takes this matter seriously and will take all necessary steps to address the topic of the warning letter issued by the FDA.”

FDA’s Advisory on Breast Implants and Cancer Risk

This news comes after the Food and Drug Administration issued a broad-based advisory about breast implants and cancer risk. In the advisory, the FDA said that it had received reports of 660 cases in which women who received breast implants subsequently developed a rare form of lymphoma.

The blood cancer that implants may cause, called Breast Implant-Associated Anaplastic Large Cell Lymphoma or BIA-ALCL, is a type of non-Hodgkins lymphoma and is completely distinct from breast cancer. It is rare, and symptoms include pain, redness and swelling around the implant and breast area.

The Food and Drug Administrationresponsible for regulating medications and medical deviceshas acknowledged that it has known of a potential relationship between breast implants and increased risk of ALCL since 2011. Now they've updated that information.

"After a thorough data analysis, we are reporting that, as of September 2018, the agency has received a total of 660 total medical device reports regarding BIA-ALCL cases since 2010," the report said. "Of the 660 MDRs, our in-depth analysis suggests that there are 457 unique cases of BIA-ALCL, including 9 patient deaths," the report continued. "MDR" stands for Medical Device Reports, so there's been an increase in the number of reports the FDA has received about instances of the disease.

"We understand that the information presented shows an increase of 246 new MDRs since last year," said the FDA. "These types of increases in the MDRs are to be expected and may include past cases that were not previously reported to the FDA. The increased number of MDRs contributes to our evolving understanding of BIA-ALCL and represents a more thorough and comprehensive analysis."

"In addition, it is difficult to determine the total number of cases or estimate risk from the MDR reporting system due to potential under-reporting of events, possible duplicate reporting, and lack of data about the exact number of breast implants," the FDA warned.

Breast Cancer Risk Tied To Allergan

Previously, the issues the FDA highlighted were tied to one specific brand. At the end of 2018, Allergan, a leading global biopharmaceutical company, suspended its sales of textured breast implants and tissue expanders, and withdrew its supply from all European markets. "The withdrawal decision follows a compulsory recall request from Agence Nationale de Sécurité du Médicament (ANSM), the French regulatory authority. The suspension of sales stems from the expiration of the company's CE Mark for these products," Allergan announced at the time.

While getting breast implants certainly does not mean you'll definitely get this type of lymphoma, it's a dangerous illness for those who do get it. "ALCL is rare, but for those who get ALCL from their breast implants, it is very frightening and potentially fatal," says Diana Zuckerman, PhD, President of the National Center for Health Research.

In an interview conducted prior to recent news, Dr. Andrea Pusic, Chief of Plastic Surgery at Brigham and Women's Hospital, told SurvivorNet that breast implants are generally considered safebut they do require monitoring by a doctor. The FDA also states that breast implants are "not lifetime devices," and that the longer a patient has them, the more likely they are to rupture or experience other complications.

Dr. Andrea Pusic answers the question: “Are breast implants dangerous?”

With regards to the safety of implants, Dr. Darrick Antell, a private practice plastic surgeon in New York City, cites the rarity of these instances as part of the reason implants are not excessively dangerous. "Textured surface implants have rarely been noted to develop ALCL, at a rate of 1 in 30,000I would even recommend them to a family member," he says. "Multiple leading institutions from around the world have shown them to be safe."

But, as Dr. Zuckerman urges, it's important to discuss the risk with your doctor before getting implants, because some women felt blindsided and uninformed about the disease possibility. "We know women who, when they developed ALCL, felt betrayed because their doctors hadn't warned them of the risks."

Breast implants also have the possibility of causing other health or physical issues. These issues have not been fully studied, but Zuckerman and the NCHR recently released a paper that discusses some of the possible side effects.

Increased Risk of Breast Implant Related Cancer For Some Populations

The risks that come with implants are real for all women, Dr. Zuckerman tells SurvivorNet, but these risks increase with a personal or family history of autoimmune or connective tissue symptoms or diseases. They can happen soon after getting implants or years later, and are especially likely when a silicone gel implant breaksmost likely after three years. Another issue is that leaking silicone can migrate into the lymph nodes, and, "from there, the silicone can get into the lungs, liver, or other organs." Broken saline implants, she continues, offer less risk when they leak, but can cause health issues from the silicone shell, other chemicals, as well as from bacteria, fungus and mold issues that develop over time.

This isn't the first time instance of concern regarding breast implants and potential health risks. Throughout the 1980s and early 1990s, silicone manufacturer, Dow Corning was named in a number of class-action lawsuits claiming that their breast implants were the cause of a number of health issues.

In 1992, the FDA mandated that silicone implants be removed from the market, but they were re-introduced in 2006 following stricter regulations around tracking patients for at least 10 years after their surgeries. However, because monitoring the implants and patients with them is not always thorough nor properly reported, it is difficult to know for sure what side effects implants are having in the long term.

The best idea, as always, is to discuss all the possible risks and benefits of implants with your doctor before any procedures, and be on alert for any symptoms that indicate a medical issue, suggests Dr. Zuckerman. "If a woman with implants starts to have any of the autoimmune symptoms that we've described in our report, she should consider having her implants removed."

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