Recent investigations have uncovered an increasing number of women with breast implants who develop a rare form of non-Hodgkin lymphoma: anaplastic large-cell lymphoma. This breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) has been linked to women with textured implants rather than those with a smooth surface. Typical presenting signs and symptoms include fluid collection in the area of the implant; breast tenderness, pain, or enlargement; and, in a minority of cases, a lump or mass. In most cases, surgical removal of the cancer, the implant, and the surrounding fibrous scar capsule is curative.
While BIA-ALCL is now well discussed in the plastic surgery and hematology-oncology communities, awareness of the lymphoma as well as noncancerous implant-related complications remains largely unknown in primary care circles. This is important because primary care clinicians—in ob-gyn, family medicine, and internal medicine practice—have an opportunity to recognize early symptoms of BIA-ALCL and to refer patients promptly for diagnostic workup and intervention by a multidisciplinary team of specialists.
This curriculum is designed for family physicians, internists, obstetrician-gynecologists, radiologists, nurse practitioners, and physician assistants.
After completing the activity, the participant should be better able to:
Describe the newly recognized disease entity known as breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL), its epidemiology, and how it differs from other types of cancer
Recognize the symptoms of BIA-ALCL and the wide variability in its clinical presentation (indolent vs aggressive)
Outline a role for primary care clinicians in recognizing early signs of the disease and reporting them to hematology, oncology, radiology, and plastic surgery specialists for multidisciplinary follow-up
Take part in efforts to help educate patients about BIA-ALCL and provide an appropriate perspective on the relative risks of the disease vis a vis other benefits and risks of breast implant procedures
Conflicts of Interest Disclosure Policy
In accordance with the ACCME Standards for Commercial Support, HME requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. HME resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational activities.
Mark Jewell, MD Private Practice Jewell Plastic Surgery Associate Clinical Professor, Plastic Surgery Oregon Health Science University Eugene, OR
Dr. Jewell has received consulting fees from Allergan and Solta Medical.
Martin C. Mahoney, MD, PhD Professor of Oncology Roswell Park Cancer Institute Professor, Department of Family Medicine University at Buffalo - SUNY Buffalo, NY
Dr. Mahoney is on the speakers’ bureaus for and has received consulting fees from Sanofi, Merck & Co., Inc., and Pfizer Inc. He has received research support from Pfizer Inc.
Patricia McGuire, MD Parkcrest Plastic Surgery Clinical Instructor of Surgery Washington University School of Medicine St. Louis, MO
Dr. McGuire is a consultant for Allergan and Establishment Labs and an investigator in Motiva FDA clinical trials.
Accredited Provider Disclosure
Haymarket Medical Education staff involved in the planning and content review of this activity have no relevant financial relationships to disclose.
AMA PRA Category 1 Credit(s)TM
Haymarket Medical Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
HME designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure of Unlabeled Use
This educational activity may contain discussion of approved and/or investigational uses of agents that are not indicated by the FDA. Allergan and HME do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Allergan or HME. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
To obtain credit, a score of 70% or better on the post-test is required. This activity is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the post-test and evaluation, and have received a digital copy of your credit certificate. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.