Assessing Cancer Risk for Breast Implants
- Singer-songwriter Solána Imani Rowe, professionally known as SZA, has opened up about how she had her breast implants removed due to her family history of the disease and that she has dense breasts. She admitted in a recent podcast interview that she’s “not supposed to have breast implants” but chose to get them done anyway, but “pain” led her to get them removed.
- The FDA continues to urge anyone considering breast implants or those who may already have them to learn about the risks and benefits of implants, be aware that cases of skin cancer and various lymphomas in the breast implant scar tissue have been reported, and monitor your breasts or implants for changes.
- The U.S. Preventive Services Task Force recommends women at average breast cancer risk begin screening for breast cancer at age 40.
- Women with the BRCA gene mutation, who have a family history of cancer or have dense breasts, are at higher risk and should talk with their doctor about when to screen which may be younger than 40.
- Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. While mammograms are extremely valuable for breast cancer screening, more effective screening methods exist for women with dense breasts.
- It is also recommended that black women begin breast cancer screening earlier since previous research indicates they tend to be diagnosed at later stages, making treatment more difficult.
The 34-year-old Grammy Award-winning musician—whose genre consists of a mix of rhythm and blues, hip-hop, and soul—said she’s “not supposed to have breast implants” during recent podcast interview.
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Despite being at a higher risk for the disease, SZA chose to get breast implants, however. She ultimately decided to take them out when they started causing her discomfort.
RELATED: More Cases Of Skin Cancer in People With Breast Implants: Do You Need to Get Yours Removed?
SZA said, “I put them in. They ended up hurting me. I got way too much scar tissue because my breasts are too dense, and I’m not supposed to have breast implants.
“I didn’t feel good and it was painful. So, I took them out, and now, they’re just my boobs.”
More On Breast Implants
- Breast Implants & Cancer: One Doctor Asks How Much Silicone Has to Leak Before The FDA Does Something?
- Breast Implants That May Cause Cancer– The FDA’s Meeting About Safety Concerns
- Breast Reconstruction After Cancer is Not a Boob Job; What To Know About The Surgery & Clearing Up The Misconception
- Breast Reconstruction: Implants vs. Your Own Tissue
- More Cases Of Skin Cancer in People With Breast Implants: Do You Need to Get Yours Removed?
- All Breast Implants Should Come With Detailed Safety Warnings, Urges FDA — What The Experts Say About the Risks
SZA was speaking to podcast host Mary Alice Haney and board-certified OB/GYN Dr. Thais Aliabadi, who recounting learning that the singer’s lifetime risk [based on multiple factors like height, weight, etc.] of developing breast cancer was 53%.
Dr. Aliabadi said on the podcast, “What happens when your lifetime risk is more than 20% you need to start breast imaging at age 30, not 40.”
SZA noted that when she had her breast implants done, her surgeon took out some of her fibrosis, the thickening or scarring of connective tissues.
She said, “When I got my boobs done, my doctor took out some of my fibrosis, but.. there was so much fibrosis, it was crazy. And he took it out. And so, when I went back, a lot of the concerns were gone. It was so weird.
“I like seeing somebody spiritual about it, specifically the breast cancer situation and the marker before I had the results of the biopsy and all that, I had talked to somebody, because I was like, I got to figure out what’s going on in the higher realms and what needs to be done about it,” she added.
SZA also admitted she should have seen her doctor before getting the breast implant surgery, but she “snuck” through and got the surgery without checking with Dr. Aliabadi first.
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SZA also noted that she hasn’t done a self breast check in about two years but she just set up another appointment screen for breast cancer.
“I scheduled it. I’m really naughty … but also really attentive. I’m obsessed with doing things the right way. I have to know whats going on and I have to know why. And all the potential side effects of something,” she said.
Breast Implants & Cancer
Questions surrounding whether breast implants themselves cause cancer have remained for years. Just last year, the FDA released safety communication regarding the potential risks of squamous cell carcinoma (SCC) and lymphoma, a type of cancer that starts in the lymphatic system.
SCC is among the most common types of skin cancer. According to the Centers for Disease Control and Prevention, squamous cells are “thin, flat cells that form the top layer of the epidermis.” This skin cancer type isn’t life-threatening and grows slowly, according to the American Academy of Dermatology Association.
The FDA’s safety communication indicated it received ten medical device reports about squamous cell carcinoma. A medical device reporting is a method the FDA uses to collect and analyze data about a marketed device scientifically. The federal agency says it also received 12 reports about varying types of lymphomas related to breast implants.
“The report states that the FDA is aware of 19 cases of SCC in the capsule around the breast implant from published literature,” noting the information includes the FDA’s review of medical literature and reports. “There have been reports in the literature of deaths from progression of the disease. While the FDA continues to believe that occurrences of SCC in the capsule around the breast implant may be rare, the cause, incidence, and risk factors remain unknown.”
The warning follows previous reports of SCC and various lymphomas (cancer of the immune system) related to breast implants. The various lymphomas noted differ from those previously described by the FDA as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).
The FDA pinpointed textured implant manufacturer Allergan to remove some of its textured breast implants and tissue expanders from the market amid its report.
“Based on the currently available information, including data submitted in 2019, our analysis demonstrates that the risk of BIA-ALCL with Allergan BIOCELL textured implants is approximately six times the risk of BIA-ALCL with textured implants from other manufacturers marketing in the U.S.,” an FDA spokesperson wrote to SurvivorNet in an email. A complete list of recalled styles can be found via the FDA’s website.
Are Breast Implants Dangerous?
Doctors Weigh In On Breast Implant Concerns
In an earlier interview with SurvivorNet, Dr. Sarah Cate, the lead physician for the Special Surveillance Breast Program at Mount Sinai Beth Israel, and Dr. Jordan Jacobs, a plastic and reconstructive surgeon, discussed breast implant concerns for survivors of breast cancer, following the release of an FDA safety communication. The FDA received 10 medical device reports (MDRs) about squamous cell carcinoma and 12 reports about various lymphomas connected to breast implants.
Doctors Cate and Jacobs tell SurvivorNet, regarding the FDA safety communication, “personally don’t think there is cause for alarm.”
The doctors believe the data shared by the FDA does not conclusively tie breast cancer to implants. Although, the pair does say, “the fact that the cancers were found in the implant capsules is certainly concerning and requires further investigation.”
Dr. Cate and Dr. Jacobs note how the FDA has required the placement of warnings on breast implant packaging. Additionally, there is newly an implant checklist that patients must sign and review before undergoing implant surgery. The doctors noted how ALCL, a rare form of non-Hodgkin lymphoma, has been associated with implants for years.
The doctors affirmed that textured implants, those linked to ALCL, are not used at Mount Sinai. The doctors also note that implants require monitoring, and that if there are an adverse conditions spotted after the implants, they should be reported to the FDA.
Dr. Cate and Dr. Jacobs tell SurvivorNet, “Patients who have implants placed for either cosmetic or reconstructive purposes should have yearly follow-ups with their surgeons.” They add that “there are recommendations from the FDA for routine (every 2-3 years) MRIs to evaluate the integrity of the implant and the surrounding capsule.”
It’s important to note that most women who get breast implants do not get the textured kind that’s linked to cancer. The more popular option is “smooth” implants, which are usually filled with either silicone or saline. Unlike textured implants, smooth ones have not been linked to cancer. However, smooth implants have previously had potential complications reported in the past, such as joint pain, muscle aches, confusion, chronic fatigue, and autoimmune diseases.
“The use of any foreign object in the human body has potential risks,” Dr. Dung Nguyen, Director of Breast Reconstruction at Stanford Medicine, told SurvivorNet in an earlier interview.
“Some are rare and are not known until years after they are in clinical use. It is our professional responsibility to inform our patients of these risks and any changes to them as our experience with the device broadens. The goal is not to cause a mass scare, but to provide evidence-based information in a relatable way so that women can make educated decisions about the use of breast implants for themselves.”
When Should You Be Concerned About Your Implants?
Moreover, there are signs of cancer that Dr. Cate and Dr. Jacobs want people with breast implants to keep an eye out for. If anyone with implants present the following symptoms, they should contact their physician:
- Breast swelling
- Pain
- Redness
- Tightening
- A change in the shape of their breasts
If you do find yourself in a situation where an evaluation of your implants is needed, you will undergo a physical exam and imaging studies “to evaluate the implant shell integrity, determine if there is fluid around the implant and visualize the implant capsule.” Most breast radiologists can perform sampling fluid, as well, so that the fluid can be examined to see if there are any abnormal cells present.
“Surgical management includes removal of the implant and the surrounding capsule, which is sent to pathology to rule out atypical cells and/or cancer,” Dr. Cate and Dr. Jacobs added.
Helpful Information About Breast Cancer Screening
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives. For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women with a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
WATCH: Understanding the BRCA gene mutation
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
RELATED: 3D Mammography Detects 34% More Breast Cancers Than Traditional Mammography
Family History & Breast Cancer Risk
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
RELATED: Is Genetic Testing Right for You?
Different types of genetic testing can help people with a family history of cancer better ascertain their cancer risks. Your doctor will discuss your family history of cancer with you in the context of your type of tumor and your age at diagnosis. Hereditary genetic testing is usually done with a blood or saliva test.
WATCH: Understanding genetic testing for breast cancer.
About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center.
“We encourage only those with a family history to get [genetic testing],” Dr. Ginsburg previously told SurvivorNet. “I would say that if you have anyone in your family diagnosed with a rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome.
The second test involves the genetic sequencing of your tumor if you’ve been diagnosed with cancer by this point. These genetic changes can be inherited, but most arise during a person’s lifetime. This process usually involves examining a biopsy or surgical specimen of your tumor. This testing can lead to decisions on drugs that might work against your cancer.
“Digital mammography, it turns out, significantly improves the quality of the mammogram… It’s 3D or tomosynthesis mammography,” Dr. Lehman explains.
“This allows us to find more cancers and significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.
Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance.
Dr. Elizabeth Comen breaks down factors that may increase your breast cancer risk.
Screening Options for Women with Dense Breasts
Women with dense breasts should get additional screening to supplement their mammograms. Dense breasts mean more fibro glandular tissue and less fatty breast tissue exists.
The dense tissue has a “masking effect on how well we can perceive cancer and find cancer on mammograms,” Dr. Cindy Ly, a radiology doctor at NYU Langone Medical Center, told SurvivorNet in an earlier interview.
Survivors Encourage Women to Ask Their Doctors About Dense Breasts
Glandular tissue within dense breasts appears white on mammograms, which can help mask potential cancer. The “frosted glass” effect from the glandular tissue can thus mask cancerous areas, especially developing ones. Undetected, these cancers can progress, growing large and advanced. They will then likely require more intensive treatments to cure or can become incurable altogether.
Women with dense breasts may not know they have it based on feeling alone. It’s important to know that breast density is determined by its appearance on a mammogram. Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital, previously explained to SurvivorNet that fatty breast tissue appears gray on an X-ray. Conversely, dense breast structures appear white during an X-ray. Cancers also appear white on an X-ray, meaning the dense breast structures can mask the possibility of cancer. Luckily, advanced mammograms exist to help doctors navigate this obstacle.
WATCH: 3D Mammograms explained.
“Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Lehman explains.
“This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.
Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance. These tests include:
- 3-D Mammogram (Breast Tomosynthesis): This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
- Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer could justify obtaining breast MRIs.
- Molecular Breast Imaging (MBI): MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.
A new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify patients about their breast tissue density and recommend they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details must be shared with the patient to make the communication clear and understandable.
Black Women & Breast Cancer Risk
It is recommended that black women begin breast cancer screenings sooner than white women.
“Black women are younger when they are diagnosed with breast cancer and have cancer at more advanced stages at diagnosis” according to a study published in Annals of Internal Medicine. The research suggests breast cancer-related deaths can be reduced by 57% if they begin mammograms at age 40.
Dr. Anita Johnson explains that access to care is key.
One of the reasons Black women tend to have a harder time with breast cancer stems from racial disparities in healthcare.
“When it comes to breast cancer the mortality rates for African American women are substantially higher than Caucasian women,” Dr. Anita Johnson, a Breast Surgical Oncologist at Cancer Treatment Centers of America told SurvivorNet.
“When we look at stage four, the outcomes are much worse as compared to Caucasian women. When we look at the standard of care treatment options based on stages, in some cases, African American women are not being treated with the same standard of care treatment options,” Dr. Johnson added.
Dr. Johnson points to more education, clinical trials, and increased access to care to help improve health outcomes for Black women battling breast cancer.
Contributing: SurvivorNet Staff
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