BIA-ALCL

Breast Implant Informed Consent Should Include the Risk of Anaplastic Large Cell Lymphoma.

Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin lymphoma (NHL), which is a kind of blood cancer; that involves abnormal T-cells. T cells are a type of white blood cell in your body that help fight diseases. These abnormal T-cells may build up in the lymph nodes (small oval-shaped immune system organs) causing them to swell. Common symptoms include painless swelling in the neck, armpit, or groin due to the enlarged lymph nodes. Other symptoms include loss of appetite, tiredness, night sweats, fevers, or weight loss. ALCL can initially appear in either skin, lymph nodes or other organs throughout the body. When it appears in the skin, it is called primary cutaneous ALCL and has a less aggressive disease course. ALCL is diagnosed through the examination of any enlarged lymph nodes. Further inspection may be required through a biopsy in which doctors will remove the lymph node itself. Other tests include bone marrow samples, blood tests, x-rays or scans. ALCL is divided into two types at present, depending on whether or not their cells have an abnormal form of a protein on their surface called “anaplastic lymphoma kinase” (ALK). ALK- positive ALCL is considered more likely to affect children or young adults and responds well to standard chemotherapy treatments, putting most patients in long-term remission. ALK-negative ALCL more likely affects individuals over 60 and although it responds well to treatment at first, it is more likely to return. The causes of ALCL are currently unknown. However, it is neither infectious nor can it be passed on to other people. The main treatment for ALCL is chemotherapy, but radiotherapy and/or stem cell treatment may be recommended. Talk to your doctor to see if you or a family member has been diagnosed with this condition to find the most current treatment options available. 

Abstract

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma arising around breast implants. Public awareness has increased following a safety communication warning of the association of breast implant-associated ALCL by the U.S. Food and Drug Administration in 2011. Difficulty with determining an accurate assessment of risk, including diagnosis, or standardized treatment regimen has led surgeons to commonly omit pre-operative discussion of this rare and frequently misunderstood cancer.  Risk disclosure is a form of respect for patient autonomy, and informed consent has positive practical and moral consequences for the practice of plastic surgery. A model of breast implant-associated ALCL informed consent implementation and health care provider education are reviewed with 1-year process follow-up at a tertiary cancer centre.   Breast implant-associated ALCL should be included during pre-operative counselling on the risks of breast implantation when obtaining informed consent. Pertinent aspects of decision-making include disease awareness, presenting symptoms, and resources for concerned patients. Education of health care professionals and provision of patient-focused materials ensures effectiveness of the informed consent process.

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