When talking to patients about a rare type of cancer linked to breast implants, plastic surgeons should call it “a condition” and avoid using the words cancer,
tumor, disease or malignancy, the president of the American Society of Plastic Surgeons advised members during an online seminar on Feb. 3.
The comments, by Dr. Phil Haeck, the society president, were made public on Thursday by Public Citizen’s Health Research Group, an advocacy group in Washington. The group also wrote to the
Food and Drug Administration, characterizing the advice as part of a misinformation campaign devised to play down the risks of implants, and urging health officials to put a stop to it.
Dr. Haeck was traveling and not available for an interview, according to a spokesman for the plastic surgeons’ group, which issued a statement responding to Public Citizen’s claims.
The surgeons’ group said Public Citizen had taken Dr. Haeck’s remarks out of context and misconstrued them. He was discussing a possible link between the implants and anaplastic large-cell lymphoma or ALCL, a cancer that involves the immune system.
The statement said, in part, “Far from intending to trivialize or minimize the issue, Dr. Haeck’s extemporaneous remarks were well understood by physicians present to mean that the type of ALCL that has been observed in possible association with breast implants does not appear to have the malignant course of classic ALCL which is a systemic disease.”
The events grew out of an announcement on Jan. 26 by the
Food and Drug Administration that breast implants might cause a small but significant increase in the lymphoma, which is rare but treatable. It is not
breast cancer. It is usually a systemic disease, but in the cases linked to implants, the lymphoma grew in the breast, usually in the capsule of
scar tissue around the implant.
Though some evidence suggests that the lymphoma associated with implants might be less aggressive than the more common form of the disease, that evidence is not conclusive, said Dr. William Maisel, the chief scientist and deputy director for science in the Center for Devices and Radiological Health at the Food and Drug Administration.
The disease is exceedingly rare. At the time of the January announcement, the drug agency said it knew of only about 60 cases worldwide, a tiny number compared with the 5 million to 10 million women who have implants. But even that small number appears to be an excess of cases when compared with the usual incidence in the breast of this type of lymphoma in women who do not have implants: 3 in 100 million.
In some cases simply removing the implant and scar tissue appeared to eliminate the disease, but in others women were given chemotherapy or radiation, or both.
The online seminar, about an hour long, was available only to members of the American Society of Plastic Surgeons or the
American Society for Aesthetic Plastic Surgery. About 600 members logged in. A plastic surgeon who saw the session made a transcript of portions of it and sent them to Public Citizen. The New York Times viewed the seminar and verified that Dr. Haeck did advise the audience to call the lymphoma a “condition” when talking to patients “rather than disturb them by saying this is a cancer, this is a malignancy.”
The doctor who provided the transcript said in an interview that he did so because he was disturbed by the advice to avoid calling the lymphoma a type of cancer, and felt that the plastic surgeons’ society was misleading its members who might in turn mislead their patients. He asked that his name be withheld because he did not want to make enemies of his colleagues by contributing to bad news about implants.
The Food and Drug Administration issued a statement saying it was reviewing Public Citizen’s letter, and added: “The F.D.A. has been very clear in our communications of the possible association between breast implants and the development of ALCL, which is a very rare type of cancer. It’s important that health care professionals and women who have breast implants or are considering breast implants are aware of F.D.A.’s recommendations on this issue.”
The agency has said that women with implants should pay attention to changes in their breasts and see a doctor if swelling, lumps, pain, asymmetry or other symptoms develop. The lymphoma can occur years after the implant surgery.
Dr. Felmont Eaves III, president of the American Society for Aesthetic Plastic Surgery, said: “When the numbers are so incredibly rare as this, the danger is sometimes an overreaction. We want to make sure that women and surgeons put it into the proper perspective.”
New York Times
Published: February 17, 2011