Breast implants and cancer


Earlier this March, the U.S. Food and Drug Administration (FDA) reported that “nine deaths and hundreds of cases of a rare cancer have been linked with breast implants.”

The malignancy here is not breast cancer but an immune system cancer known as anaplastic large-cell lymphoma (ALCL). The cancer nurtures itself in the breast, notably in the scar tissue around the foreign body implant. Fortunately, in most cases this is treatable.

The implant-cancer link was noted in 2011.

As of February 2017, the FDA has recorded 359 cases of ALCL linked to breast implants.

The New York Times reported that “the disease is most likely to occur with textured implants that have a pebbly surface rather than a smooth surface…and of the 359 reported cases, there was information about the implant surface in 231. Of those, 203 patients had textured implants and 28 had smooth implants….Whether the implants contained silicone gel or saline appeared much less important than surface texture in disease risk.” The number of this ALCL cases worldwide is not known.

According to the American Society of Plastic Surgeons, there were about 290,000 women in the United States in 2016 who had implants for breast enlargement and 109,000 received implants for reconstruction after breast cancer surgery.

Any pain, lumps, fluid accumulation or swelling of the breast after an implant, no matter when surgery was done need to be evaluated by the surgeon.

To prevent blindness

A retrospective study published in the JAMA Ophthalmology found that many children and adolescents with diabetes are not being screened in a timely fashion for diabetic retinopathy, a common cause of blindness among diabetics.

Diabetic retinopathy is a dangerous complication of diabetes, which causes blood vessels in the eyes to leak, causing distortion of vision and can eventually lead to blindness. In early stages, this disease of the retina may not have symptoms.

The American Academy of Ophthalmology strongly recommends retinopathy screening be performed five years after a diagnosis of type 1 (Juvenile) diabetes is confirmed to reduce the risk of blindness. For those with type 2 diabetes, common among adults, screening is done at the time diagnosis is made, not later.

Diabetics and parents/guardians of diabetic children are advised to confer with their attending physician about this retinal screening.

Dangers of body art

Body Art is a popular fad especially among adolescents and young adults, which includes tattooing or body part piercing. The tattoos are usually on the chest, arms, belly, butts, ankles, or on just about any area of the body. They come in different shapes, design, color and various objects, like a girl, snake, flag, heart, words of protest or love messages.  It is estimated that 10 percent to 25 percent of young adults (25 and under) have at least one tattoo.

A survey in one university involving 454 students (236 females and 218 males), which was 14 percent of the total enrollment, revealed that 23 percent (106) of them had one to three tattoos. This could well mirror the prevalence in other schools and universities in the country, perhaps higher in big cities, compared to the conservative communities. The most popular sites were the back among women and the arms and hands among men. One hundred twenty-nine (51 percent) of those surveyed had a least one body piercing, 90 percent of men having had ears pierced, and 54 percent of the females had pierced navel, 49 percent on the ears and 27 percent on the tongue. Some of both the males and females had pierced nipples, eyebrows and genitalia.

Complications of body art include infection of the tattooed or pierced skin, transmission of hepatitis B and C, and HIV (AIDS).  Allergic reactions, besides pain, swelling and bleeding, are potential complications of tattooing or body piercing. Keloid and scar formation is another. Infection is common because the needle and instruments used for tattooing or body piercing are mostly not medically sterile. A significant number of patients with hepatitis subsequently develop hepatoma, cancer of the liver, which is deadly.

Botox

Clostridium botulinum is a bacteria, whose toxin produces muscle paralysis among the victims of botulism food poisoning. Advances in medical technology have made it possible for physicians, usually plastic surgeons, to use the botulinum toxin (botox) as a shot in the face to induce transient and localized paralysis in the facial muscles to smoothen out wrinkles between the eyebrows, for frown lines and furrowed brows. The cosmetic effect has been impressive, but this is temporary. Besides this, botox shot has also been found to stave off migraine headaches among individuals who are resistant to conventional therapy. There are much more uses of this “good” toxin in clinical medicine today.

Colonoscopy saves lives

Colonoscopy is a procedure where a flexible endoscope (malleable tube like a telescope), equipped with fiberoptic lighting and (video CCD) camera, is passed through the anus, to view and examine the inner walls of the colon (large bowels) and distal part of the small bowels for any abnormality, like bleeding, ulcers, or the presence of benign poly(s), or cancer. Thru the colonoscope, excision of polyps, or biopsies may also be performed for a definitive microscopic tissue diagnosis. A sigmoidoscope is another scope that examines the final two feet of the colon, while the colonoscope examines the rest of the entire colon which is about four to five feet long. Many times it is done in conjunction with colonoscopy.

Colorectal cancer is the third-most common cancer in humans, topped only by cancer of the lungs and female breasts. More than 150,000 people in the United States each year discover they have cancer of the colon or rectum, and approximately 46,000 will die from it this year alone. The incidence starts to rise at the age 40 and the peak is between ages 60 to 75. Colon cancer is more common in women and cancer of the rectum among men. About 5 percent of the patients have both (synchronous cancer).

It appears that meat eaters have a higher risk for the development of colorectal cancer. This malignancy is found more prevalent in populations whose diet is low in fiber and high in animal proteins, fats, and refined carbohydrates. The incidence of colorectal cancer is indeed high among those who eat red meat (pork, beef, etc) compared to those who eat high fiber diets (vegetables, fruits, wheat, bran, etc) and fish. The other predisposing factors include chronic ulcerative colitis, granulomatous colitis, and familial polyposis.  The older the person is, the higher the risk. Smoking and alcohol abuse increase the risk for cancer in general.

Everyone 50 years old and older should have an annual fecal occult blood test (FOBT), a rectal digital exam, and a prophylactic colonoscopy every three to five years. Those with a strong family history of cancer should have the examinations more frequently in accordance with the physician’s determination.

***

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA,  a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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