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Breast Implants and Anaplastic Large Cell Lymphoma

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Breast Implants and Anaplastic Large Cell Lymphoma

Group says implant risk downplayed

When talking to patients about a rare type of cancer linked to breast implants, plastic surgeons should call it "a condition" and avoid using the words cancer, tumor, disease or malignancy, the president of the American Society of Plastic Surgeons advised members during an online seminar on Feb. 3.

The comments, by Dr. Phil Haeck, the society president, were made public this week by Public Citizen’s Health Research Group, an advocacy group in Washington. the group wrote to the Food and Drug Administration, characterizing the advice as part of a misinformation campaign devised to play down the risks of implants.

The surgeons’ group said Public Citizen had taken Haeck’s remarks out of context. he was discussing a possible link between the implants and anaplastic large-cell lymphoma or ALCL, a cancer that involves the immune system. the group said, "Haeck’s extemporaneous remarks were well understood by physicians present to mean that the type of ALCL that has been observed in possible association with breast implants does not appear to have the malignant course of classic ALCL which is a systemic disease."

The events grew out of an announcement in January by the FDA that breast implants might cause a small but significant increase in the lymphoma, which is rare but treatable. it is not breast cancer. but in the cases linked to implants, the lymphoma grew in the breast, usually in the capsule of scar tissue around the implant. Though some evidence suggests that the lymphoma associated with implants might be less aggressive than the more common form of the disease, that evidence is not conclusive, said Dr. William Maisel, the chief scientist and deputy director for science in the Center for Devices and Radiological Health at the Food and Drug Administration.

In January, the FDA said it knew of about 60 cases worldwide, a tiny number compared with the 5 million to 10 million women who have implants. but even that small number appears to be an excess of cases when compared with the usual incidence in the breast of this type of lymphoma in women who do not have implants: 3 in 100 million.

The online seminar, about an hour long, was available only to members of the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery. about 600 members logged in. A plastic surgeon who saw the session made a transcript of portions of it and sent it to Public Citizen. the new York Times viewed the seminar and verified that Haeck did advise the audience to call the lymphoma a "condition" when talking to patients "rather than disturb them by saying this is a cancer, this is a malignancy."

EARLY BALDING TIED TO PROSTATE CANCER

Men who go bald in their early 20s have a doubled risk of developing prostate cancer, but those who lose hair in their 30s and 40s apparently are not at greater risk, French researchers reported last week. the findings suggest that men who lose their hair very early in life might benefit from increased screening.

Because the same male hormones that are involved in hair growth also play a role in prostate cancer, researchers have been tantalized by possible links between balding and prostate cancer. but past studies have yielded conflicting results or none at all.

Dr. Philippe Giraud, a professor of radiation oncology at Paris Descartes University, and Dr. Michael Yassa, a radiation oncologist who is now at the University of Montreal, studied 388 men being treated for prostate cancer and 281 healthy men, questioning them about their history of hair loss. They reported in the Annals of Oncology that 37 of the men with prostate cancer had some balding at age 20, but only 14 of the healthy men had had balding at that age. other risk factors for prostate cancer include age, family history, diet and ethnicity.

GROWTH HORMONE LINKED TO AGING?

Anyone seeking the fountain of youth should think twice before turning to growth hormone, a fast-growing trend in anti-aging fringe medicine.

If conclusions from an obscure population living in Ecuador prove true, less growth hormone — not more — may prevent cancer and diabetes in old age.

The discovery, published last week in the journal Science Translational Medicine, backs earlier research showing that yeast, flies and rodents live longer — in some species, as much as 10 times longer — when they grow slowly.

"There are a lot of people giving human growth hormone to fight aging," said Dr. Nir Barzilai, a researcher at the Albert Einstein College of Medicine in new York, who was not involved in the research. "the question is, will you live longer and healthier?

"I think these studies suggest, maybe not."

The discovery hinged on a group of extended relatives in Ecuador, many of whom share a genetic mutation that shuts off receptors to human growth hormone. the hormone helps regulate metabolism throughout the body as well as the way that cells change as they age.

The mutation, called E180, is one of several that cause Laron Syndrome. Laron is a disorder that stunts growth, limiting height to about 3 to 4 feet tall.

Study co-author Dr. Jaime Guevara-Aguirre, who treats the Laron patients, said virtually none got cancer or diabetes.

Guevara-Aguirre joined forces with co-author Valter Longo, a University of Southern California cell biologist. They found that serum from Laron patients protects DNA from breakage that can contribute to cancer and promoted a kind of suicide among damaged cells.

MONKEYS FATTEN UP FOR RESEARCH

Like many these days, Shiva sits around too much, eating rich, fatty foods and sipping sugary drinks. he has a pot belly that nearly touches the floor — when he’s on all fours, that is.

Shiva belongs to a colony of monkeys who have been fattened up to help scientists study the twin human epidemics of obesity and diabetes. the monkeys also test new drugs aimed at treating those conditions.

"We are trying to induce the couch-potato style," said Kevin L. Grove of the Oregon National Primate Research Center. "We believe that mimics the health issues we face in the United States today."

The corpulent primates serve as useful models, experts say, because they resemble humans much more than laboratory rats do, not only physiologically but in some of their feeding habits. They tend to eat when bored, even when they are not really hungry. and unlike human subjects who are notorious for fudging their daily calorie counts, caged monkeys’ food intake is much easier to count and control.

"Nonhuman primates don’t lie to you," said Grove, who is a neuroscientist. "We know exactly how much they are eating."

Group says implant risk downplayed

Breast Implants Linked to Rare Cancer – Cancer Information (Cancers, Symptoms, Treatment) on MedicineNet.com

By Steven ReinbergHealthDay Reporter Latest Cancer News

WEDNESDAY, Jan. 26 (HealthDay News) — The U.S. Food and Drug Administration said on Wednesday that breast implants may be linked to a heightened risk for a rare cancer, as evidenced in a small but growing number of cases that have been reported in recent years.

The agency now says that both silicon and saline implants may be linked to anaplastic large cell lymphoma (ALCL), which could develop within the scar tissue left by the implant procedure.

But the absolute risk to any one woman is likely to be very low, experts stressed.

“Lymphoma is a cancer involving cells of the immune system and ALCL is a very rare type of lymphoma,” Dr. William Maisel, chief scientist and deputy director for science at the FDA’s Center for Devices and Radiological Health, said during an early afternoon press conference Wednesday.

“The FDA believes that women with breast implants may have a small, but increased, risk of developing ALCL,” he said. Only about one of every 500,000 American women each year are diagnosed with ALCL, Maisel said, and “ALCL in the breast is even more rare, occurring in three of every 100 million in the United States.”

He added that “ALCL in the breast is not the same as breast cancer.”

Of the 5 million to 10 million women around the world who have implants, the FDA says it now knows of roughly 60 cases of ALCL. That number has been tough to verify, the agency said, since some cases may have been duplicated in separate reports.

The agency is asking doctors to report any cases of ALCL, and for makers of implants to update their labeling and other information to disclose the potential hike in risk to both doctors and patients.

The agency’s decision is also based of studies published from 1997 to 2010 that identified 34 cases of ALCL among women with either silicon or saline implants around the world, Maisel said.

Among these cases, 24 were related to silicon implants, seven to saline implants and the type of implant in the remaining three cases are not known, according to the FDA. In addition, 19 of the implants were inserted for cosmetic reasons and 11 were used in reconstructive procedures. The reasons for the other four procedures are not known, the agency said.

The majority of cases the agency is aware of came to light when women went to a doctor complaining of symptoms such as pain, lumps, swelling or anomalies in their breasts. These symptoms were the result of “fluid, hardening of breast area around the implant, or masses surrounding the breast implant,” the agency said. ALCL was found by testing the fluid and area around the implant.

Symptoms of ALCL can develop from one to 23 years after a women gets her implants, according to the FDA.

“Women with breast implants who are not showing any symptoms or problems require only routine follow-up,” Maisel said. “Physicians should consider the possibility of ALCL if the patient has late-onset and persistent fluid around the implant,” he added.

“Women should monitor their implants and report any noticeable changes to their doctors, particularly those that occur after the breast implants are fully healed,” Maisel said.

ALCL is usually treated with chemotherapy and radiation, and sometimes surgery, Maisel noted.

“I suspect this has caught the vast majority of plastic surgeons off-guard, as we have not heard anything remotely related to a potential warning before today,” said Dr. Jeffrey C. Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine.

This rare lymphoma develops in the naturally occurring capsule of tissue that normally forms around the implant, he said. “It is somewhat distressing to surgeons and patients alike but, the overall risk is exceedingly low,” Salomon added.

Maisel added that American Society of Plastic Surgeons (ASPS) is working with the FDA to set up a registry of cases so the agency can get a better idea of the relationship between implants and ALCL.

However, the president of the society was wary of the public overreacting to the risk.

“ASPS shares the FDA’s commitment to patient safety, but we also want to make certain this information does not raise false alarms with our patients,” Dr. Phillip Haeck said in a statement. “We’ve been down this path before. for nearly 20 years, American women were denied access to their choice of breast implants because of false claims and unfounded science. We are determined this shouldn’t happen again.”

Haeck is referring to the belief that silicon implants were associated with breast hardening, breast pain, breast implant rupture, and the need for additional surgery and a possible risk of cancer, which caused the FDA to ban them for 14 years.

After further review, the FDA allowed silicon implants to return to the market in 2006.

Commenting on the FDA’s announcement, Dr. Jasmine Zain, director of the Rita J. and Stanley H. Kaplan Stem Cell/Bone Marrow Transplant Center and an assistant professor in the department of medicine at the NYU Langone Medical Center in new York City, said that she was “aware of the link between breast implants and ALCL.”

“About five years ago, my colleagues and I discovered that there was a link between lymphoma and breast implants in several patients we treated. Over the years, other doctors have noted the link between rare lymphoma and breast implants. The occurrence is very rare, but women have to be very careful,” Zain said. “Women should be aware of the risk when deciding whether or not to get breast implants. Women thinking about getting breast implants and women with breast implants should talk to their doctors and be informed of the risk.”

MedicalNewsCopyright © 2011 HealthDay. All rights reserved.

SOURCES: Jeffrey C. Salomon, M.D., assistant clinical professor, plastic surgery at Yale University School of Medicine, new Haven, Conn.; Jasmine Zain, M.D., director, Rita J. and Stanley H. Kaplan Stem Cell/Bone Marrow Transplant Center, assistant professor, Department of Medicine, NYU Langone Medical Center, new York City; Jan. 26, 2011, teleconference with: William Maisel, M.D., M.P.H., chief scientist and deputy director for science, Center for Devices and Radiological Health, U.S. Food and Drug Administration; statement, American Society of Plastic Surgeons

Breast Implants Linked to Rare Cancer – Cancer Information (Cancers, Symptoms, Treatment) on MedicineNet.com