̽��ֱ�� of Cambridge - Suzanne Turner

Should breast implants come with a health warning?

cjb250 — Wed, 18 Mar 2015 17:40:54 +0000

“Breast implants to carry cancer warning” read the headline of an article on the MailOnline website today. This follows the outcome of a study by the French National Cancer Institute, which reported that there was “clearly a link” between breast implants and anaplastic large cell lymphoma, a relatively rare form of cancer of the immune system that usually affects children and young adults independently of breast implants.

This is the not the first health scare to surround breast implants in France: remember the “exploding” Poly Implant Prosthese (PIP) breast implants widely reported in 2010, which led to the company that manufacture them being closed down?

So, should women who have received a breast implant be concerned and should they consider having them removed?

I run an active research group at the Department of Pathology, ̽��ֱ�� of Cambridge. Last year, I co-led an independent study, funded by Leukaemia and Lymphoma Research, looking at the risks to women with breast implants of developing implant-associated anaplastic large cell lymphoma (iALCL). Our study, which was published last year in the scientific journal Mutation Research Reviews, was part of the evidence considered by the French National Cancer Institute when preparing its report.

In our study, we found 71 cases of iALCL worldwide: this means it is an extremely rare occurrence – for every three million breast implant procedures, we estimated that between one and six women would develop iALCL.

̽��ֱ��French study, which considered cases of iALCL diagnosed in France since 2011, found that of approximately 400,000 women with breast implants in France, 18 had been diagnosed with iALCL. This rate is clearly significantly higher than that found by our study – the reason why is not clear, though it may be due in part to better screening. ̽��ֱ��French National Cancer Institute suggests that this increasing incidence confirms a strong link between breast implants and cancer – as a consequence, some newspaper reports have suggested that the French government may even consider a ban on this cosmetic procedure in France.

Whether such drastic action is required will depend on future monitoring of these patients; of the 49 cases reported in our study where information on the patients’ progress was available, there were only five reported deaths. While some patients received chemotherapy and radiotherapy, for many women their lymphoma was put into remission simply through removal of the breast implant and surrounding tissue. This suggests that it is the body’s abnormal immune response to the implant that is causing the cancer. Chemotherapy did not appear to significantly increase a patient’s chances of survival.

So far, the incidence of iALCL has not been associated with any specific form of breast implant and there have been no links with the PIP prostheses, even though the first woman reported to die from this lymphoma in France was a carrier of a PIP implant.

On Tuesday, the French Minister of Social Affairs, Health and Women’s Rights, Marisol Touraine, called a press conference at which she sought to calm fears about the risks. According to the Mail, she said: “We do not recommend that women carrying these implants have them removed.” Instead, it has recommended that women remain vigilant for symptoms of iALCL, which include swelling of the breast sometimes associated with pain and ulceration and a general impaired condition around the breast containing the implant. If any of these symptoms are recognised, they should consult their GP for advice.

There are many reasons why women choose to have a breast implant. It’s not all about vanity, a desire for larger breasts, as unfairly characterised by much of the media. It can be about corrective surgery following breast cancer removal, increasing one’s self-image and confidence or correcting uneven breasts, for example.

I would like to see the UK establish a cancer registry to record and follow-up on all cases of iALCL in the future. There are still many unanswered questions and only by getting to the bottom of this very rare disease will we be able to find alternative ways to treat it. It’s becoming clear that having implants is not itself without risk, but the associated cancer risk is still extremely small. In the meantime, we need a measured debate: alarmist headlines do not help, but only serve to cause unnecessary anxiety.

Newspaper reports suggest that France may be considering health warnings – or even an outright ban – on breast implants, following a cancer scare. Should women be concerned? Dr Suzanne Turner from the Department of Pathology, ̽��ֱ�� of Cambridge, looks at the truth behind the headlines.

It’s becoming clear that having breast implants is not itself without risk, but the associated cancer risk is still extremely small

Suzanne Turner

National Cancer Institute/Linda Bartlett

Breast implant

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Cut-and-paste cancer: lymphoma’s genetic blueprint

bjb42 — Mon, 04 Jan 2010 14:32:32 +0000

Lymphoma is an umbrella term that describes cancer of the white blood cells of the lymphatic system, which normally acts to protect the body against infection. In lymphoma, malignant changes in a white blood cell causes it to divide abnormally and out of control; not only are these cells unable to protect the body against infection, and in fact interfere with the growth of healthy cells, but they also build up, often in lymph nodes, as tumours.

Lymphoma accounts for more than 9,000 new cancer cases diagnosed each year in the UK alone and the incidence is rising by about 4% per year. Some of these cases appear to result following viral infections, immunodeficiency or autoimmunity, but for the most part we don’t know what causes the genetic alterations underlying the different subtypes of lymphoma, of which over 30 are now known. However, progress is being made in understanding what effect the genetic alteration has on the cell in which it occurs.

Dr Suzanne Turner leads a group in the Department of Pathology who are interested in a subtype of lymphoma that, although rare, has become a paradigm for understanding the growth and development of lymphomas (lymphomagenesis) because of its well-defined genetic alteration.

̽��ֱ��many different subtypes of lymphoma have alterations that range from single mutations, through loss and gain in regions of genetic material, to large-scale chromosomal changes. ̽��ֱ��cancer that interests Dr Turner, anaplastic large cell lymphoma (ALCL), falls into this last category because it results when sections of genetic material from two chromosomes are essentially ‘cut and pasted’ in the wrong place.

Genesis of a lymphoma

Although relatively rare in adults, ALCL accounts for 1 in 10 cases of all lymphomas in children. ̽��ֱ��most common type of ALCL is caused by the swapping of genetic material between chromosomes 2 and 5. Rather like the joining together of parts of two different sentences, swapping segments of chromosomes can sometimes result in nonsense. But in some cases, the two parts produce an intelligible outcome, albeit with a different meaning. This is what happens in ALCL: the altered genetic code, which juxtaposes the gene for nucleophosmin (NPM) on chromosome 5 with the gene for anaplastic lymphoma kinase (ALK) on chromosome 2, generates a new gene product (NPM-ALK) at the fusion point between the two chromosomes. Although only portions of the two genes remain, together they create a new protein with altered functions.

Dr Turner’s group was one of the first research groups in the world to demonstrate that NPM-ALK can cause cancer. They discovered that the errant protein sets off a cascade of events that confers survival and growth properties on the cells in which it is expressed. ̽��ֱ��cells proliferate uncontrollably and a lymphoma is born.

A model system

Dr Turner’s group has developed model systems to investigate both the specific cell type in which the translocation and disease originate and whether the normal functions of the immune system contribute to the disease process. Potential new drugs and drug combinations, particularly those that inhibit the NPM-ALK protein, are being tested with the long-term aim of taking these into the clinic. A collaboration with Dr Amos Burke, Consultant Oncologist within the Department of Paediatric Haematology and Oncology at Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust, provides an important clinical perspective on the work. And new imaging methods developed by Professor Kevin Brindle in the Cambridge Research Institute are being used to detect treatment response at an early stage.

For ALCL, the long-term goal is to develop a way of inhibiting NPM-ALK and the catastrophic malignant effects that it initiates within the white blood cell in which it occurs. But these studies will also complete a story – one that explains the way in which lymphoma can be set in motion… and be stopped in its tracks.

For more information, please contact Dr Suzanne Turner (sdt36@cam.ac.uk) at the Division of Molecular Histopathology in the Department of Pathology. Dr Turner is a Leukaemia Research Bennett Fellow and is also funded by the Kay Kendal Leukaemia Fund and Cancer Research UK.

Researchers in the Department of Pathology have established precisely how the ‘cutting and pasting’ of genetic material from one chromosome to another results in cancer.

Suzanne Turner

Lymphoma

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