The breast implants that may be linked to blood cancer: Linzy was baffled by her symptoms but doctors solved the mystery in time for her to make a full recovery.
Linzy Bromfield, 48, believes she is lucky to be alive after her breast implants triggered a rare type of cancer. ‘My doctors said if this cancer had been left for only another month, it would have spread round my body and killed me,’ she says.
Around 29,000 breast implant operations are performed in the UK each year, many of them following cancer surgery.
Now the Royal College of Surgeons says prospective patients must be warned of the risk from a specific cancer triggered by breast implants: anaplastic large cell lymphoma (ALCL).
This is a form of blood cancer affecting the lymphatic system, which drains excess fluid from tissue and helps fight infection. It is very different from breast cancer which occurs in the breast tissue itself.
It is thought to be caused by a reaction between the body’s white blood cells — immune cells which mobilise to expel the foreign implant — and the new generation of rough surfaced breast implants introduced 15 years ago (designed to stay in place better than previous smooth implants, which were prone to rotate).
Untreated, the cancerous cells can travel around the body in the bloodstream. Three British women are reported to have died from the disease out of 41 diagnosed in the UK (a rise on the 25 reported last July by the Medicines and Healthcare products Regulatory Agency (MHRA).
However, experts believe the real number of cases may be much higher, because many women have their implants removed after suffering swelling and lump formation, unaware of the true cause.
‘Although the risk of ALCL is part of the breast implant consent procedure, doctors are simply not aware of it,’ says Elise Bevan, a medical negligence solicitor at Penningtons Manches in Guildford, Surrey, who is advising several women who required intensive treatment after cancer triggered by their implants was not picked up.
‘One GP simply refused to do the tests for it.’
In the case of one 38-year-old, who does not want to be identified, the ALCL spread to her reproductive organs and she had to have a hysterectomy.
Mother-of-two Linzy decided to have breast implants 13 years ago when she felt she had lost her femininity after having children, Courteney, 24, and Oakley, 16. ‘I just wanted to feel good about myself,’ she says.
With the blessing of her husband Nick, a police officer, also 48, she booked the £4,500 operation at the private practice of Jim Frame, a professor of cosmetic plastic surgery at Anglia Ruskin University in Chelmsford, Essex.
‘I went from a 34B to a 34D,’ says Linzy, who lives in Chelmsford and works in an NHS unit fitting artificial limbs. ‘I was delighted. My breasts looked really natural.’
Then, in late 2015, things started to go wrong. ‘I felt as if my right boob had got bigger,’ she says.
‘At first, I just thought I’d strained something in the gym. Then I couldn’t get my bra on. It was as though it had gone up two cup sizes.’
She went to the GP three times in the following weeks and each time a cupful of fluid was drained off. But the swelling came back within days.
She was referred to specialists at Broomfield Hospital in Chelmsford and early last year the doctors diagnosed ALCL after testing the fluid.
‘I was told I needed the implants taken out as soon as possible, and I couldn’t have new ones because of the risk that the cancer would come back,’ she says.
‘They did a whole body scan to see if the cancer had spread. It took four days to get the results, which were the longest four days of my life. I really thought I was going to die.’
Fortunately, the scan came back clear. ‘They’d caught it just in time,’ says Linzy.
Professor Frame, who observed the operation as he’d never seen ALCL, told Linzy that the affected implant ‘had to be completely drained of the cancer-cell-carrying fluid — it came out looking like a crumpled carrier bag’.
Linzy says: ‘Having the implants out has given me a new lease of life. I realised afterwards I had felt very tired and achey for ages, so the cancer must have been developing for a while. I’d been off sick with lots of minor problems and I was having to sneak off at work to have little sleeps.
‘I’ve been incredibly lucky. They told me I was the 74th woman in the world to be diagnosed with the condition.’
ALCL can occur in people who don’t have implants and elsewhere in the body, though it is rare and typically affects children and young adults.
ALCL in women with breast implants has been reported as far back as 1997, and in 2012 regulators at the U.S. Food and Drug Administration (FDA) issued a national alert warning doctors of the link between implants and the cancer.
Breast-implant-associated ALCL was also recognised as a separate disease by the World Health Organisation in 2016, and last year the Royal College of Surgeons issued a warning of the possible cancer risk to women considering cosmetic breast enlargement.
The condition takes on average ten years to develop and breast implant surgeons are now instructed to warn patients of the recently discovered danger.
Women receiving implants should be told that lumps or swelling around an implant could be an early indication the malignancy is affecting them.
However, there are concerns this message is being downplayed.
‘There still seems to be an effort to keep the risk of this cancer under wraps,’ says Professor Frame. ‘I think it is a potential bombshell. This condition is curable only if an early diagnosis is made.’
The MHRA, which is in charge of monitoring the safety of medical devices in the UK, set up the Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG) last year to review the risks associated specifically with breast implants.
‘There is no definitive evidence of an association with ALCL and any specific make or model of implant, but we are monitoring the issue,’ an MHRA spokesman told Good Health.
The MHRA advises that the risk is low, but it says women are ‘strongly encouraged to check for symptoms such as lumps, swelling or distortions through continued regular self-examination, and to consult their doctor if they have any concerns’.
The risk of ALCL may have risen since the introduction of textured implants, although there have been cases reported linked to smooth implants, too. In reports collected by the FDA in the U.S., 203 cases of ALCL were linked to textured implants and 28 to smooth implants.
‘It does appear that texturing of the implant surface significantly increases the risk,’ says Laura Johnson, a specialist breast surgeon at Bart’s Hospital in London, and a leading expert on the disease, who has been asked to join the PRASEAG group.
DR Suzanne Turner, a researcher in cellular and molecular tumour biology at the University of Cambridge, is investigating breast-implant-associated ALCL.
She says there is a need to find out exactly what breast implants are made of. Unlike the tight regulations surrounding drug ingredients, manufacturers of implanted medical devices are not required to reveal what materials they use.
Dr Turner believes ALCL is caused by an interaction between particular types of bacteria and specific toxins on the implants, with TH-17 cells which are a type of white blood cell.
‘Because the manufacturers don’t disclose what’s in the implants, we just don’t know what ingredient could be causing this effect,’ she says.
A spokesman for Allergan, which makes market leader Naturelle implants, said no specific brand had been identified as a risk and patient safety is their priority.