Abstract
Introduction and hypothesis
Polypropylene (PP) mesh has come under increased scrutiny owing to previous FDA safety communications regarding the risks of mesh in trans-vaginal surgery and ensuing class action litigation for post-operative complications. Additional concerns have been raised regarding a possible link between implanted PP mesh and the long-term development of malignancy. Until recently, no research was specifically committed to the exploration of such a link. Our objective was to provide an overview of the recent literature focusing on any association between the use of PP mesh for midurethral sling procedures and the development of malignancy.
Methods
Multiple online research databases were searched for information related to any possible carcinogenic potential of PP mesh.
Results
There was no increased incidence in the development of malignancy after midurethral sling procedures using PP mesh in any of the studies.
Conclusion
Given the scarcity of evidence suggesting otherwise, the likelihood of PP mesh causing malignancy is exceptionally low. However, with few studies and an unknown latency period between exposure and diagnosis, more observational data would prove useful to exclude causality.
Similar content being viewed by others
References
Williams DF. On the mechanisms of biocompatibility. Biomaterials. 2008;29(20):2941–53.
Oppenheimer BS, Oppenheimer ET, Stout AP, Willhite M, Danishefsky I. The latent period in carcinogenesis by plastics in rats and its relation to the presarcomatous stage. Cancer. 1958;11(1):204–13.
Brand KG, Buoen LC, Brand I. Multiphasic incidence of foreign body-induced sarcomas. Cancer Res. 1976;36(10):3681–3.
McGregor DB, Baan RA, Partensky C, Rice JM, Wilbourn JD. Evaluation of the carcinogenic risks to humans associated with surgical implants and other foreign bodies—a report of an IARC Monographs Programme Meeting. International Agency for Research on Cancer. Eur J Cancer. 2000;36(3):307–13.
King AB, Zampini A, Vasavada S, Moore C, Rackley RR, Goldman HB. Is there an association between polypropylene midurethral slings and malignancy? Urology. 2014;84(4):789–92.
Linder BJ, Trabuco EC, Carranza DA, Gebhart JB, Klingele CJ, Occhino JA. Evaluation of the local carcinogenic potential of mesh used in the treatment of female stress urinary incontinence. Int Urogynecol J. 2016;27(9):1333–6.
Vollmar J, Ott G. Experimental tumor induction by plastics from a surgical point of view. Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 1961;298:729–35.
Nakamura A, Kawasaki Y, Takada K, Aida Y, Kurokama Y, Kojima S, et al. Difference in tumor incidence and other tissue responses to polyetherurethanes and polydimethylsiloxane in long-term subcutaneous implantation into rats. J Biomed Mater Res. 1992;26(5):631–50.
Blanchard KT, Barthel C, French JE, Holden HE, Moretz R, Pack FD, et al. Transponder-induced sarcoma in the heterozygous p53+/− mouse. Toxicol Pathol. 1999;27(5):519–27.
Witherspoon P, Bryson G, Wright DM, Reid R, O’Dwyer PJ. Carcinogenic potential of commonly used hernia repair prostheses in an experimental model. Br J Surg. 2004;91(3):368–72.
Update on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse: FDA Safety Communication. 13 July 2011. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm. Accessed 26 April 2016.
Chapple CR, Raz S, Brubaker L, Zimmern PE. Mesh sling in an era of uncertainty: lessons learned and the way forward. Eur Urol. 2013;64(4):525–9. doi:10.1016/j.eururo.2013.06.045.
Considerations about Surgical Mesh for SUI. 27 March 2013. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/ucm345219.htm. Accessed 26 April 2016.
Position Statement on Mesh Midurethral Slings (MUS) for Stress Urinary Incontinence. 7 January 2014. Available at: http://www.augs.org/d/do/2535. Accessed 26 April 2016.
Williams DF. Carcinogenicity of implantable materials: experimental and epidemiological evidence. Int Urogynecol J. 2014;25(5):577–80.
Moore GE, Palmer WN. Money causes cancer: ban it. JAMA. 1977;238(5):397.
Weinberg DS, Maini BS. Primary sarcoma of the aorta associated with a vascular prosthesis: a case report. Cancer. 1980;46(2):398–402.
Weiss WM, Riles TS, Gouge TH, Mizrachi HH. Angiosarcoma at the site of a Dacron vascular prosthesis: a case report and literature review. J Vasc Surg. 1991;14(1):87–91.
Bell RS, Hopyan S, Davis AM, Kandel R, Gross AE. Sarcoma of bone-cement membrane: a case report and review of the literature. Can J Surg. 1997;40(1):51–5.
Grubitzsch H, Wollert HG, Eckel L. Sarcoma associated with silver coated mechanical heart valve prosthesis. Ann Thorac Surg. 2001;72(5):1739–40.
Keel SB, Jaffe KA, Petur Nielsen G, Rosenberg AE. Orthopaedic implant-related sarcoma: a study of twelve cases. Mod Pathol. 2001;14(10):969–77.
Rana B, Shetty S, Grigoris P, Reid R. Sarcoma arising adjacent to a total hip arthroplasty. Scott Med J. 2001;46(1):17–9.
King AB, Goldman HB. Current controversies regarding oncologic risk associated with polypropylene midurethral slings. Curr Urol Rep. 2014;15(11):453.
Moalli P, Brown B, Reitman MT, Nager CW. Polypropylene mesh: evidence for lack of carcinogenicity. Int Urogynecol J. 2014;25(5):573–6. doi:10.1007/s00192-014-2343-8.
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357(9255):539–45.
Moizhess TG. Carcinogenesis induced by foreign bodies. Biochemistry (Mosc). 2008;73(7):763–75.
Kirkpatrick CJ, Alves A, Köhler H, Kriegsmann J, Bittinger F, Otto M, et al. Biomaterial-induced sarcoma: a novel model to study preneoplastic change. Am J Pathol. 2000;156(4):1455–67.
Ostergard DR, Azadi A. To mesh or not to mesh with polypropylene: does carcinogenesis in animals matter? Int Urogynecol J. 2014;25(5):569–71.
Weber A, Strehl A, Springer E, Hansen T, Schad A, Kirkpatrick CJ. Biomaterial-induced sarcomagenesis is not associated with microsatellite instability. Virchows Arch. 2009;454(2):195–201.
Birolini C, Minossi JG, Lima CF, Utiyama EM, Rasslan S. Mesh cancer: long-term mesh infection leading to squamous-cell carcinoma of the abdominal wall. Hernia. 2014;18(6):897–901.
Lin HZ, Wu FM, Low JJH, et al. A first reported case of clear cell carcinoma associated with delayed extrusion of midurethral tape. Int Urogynecol J. 2016;27:377.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
R Shapiro is a proctor for Boston Scientific. S Zaslau is a retained expert witness for Johnson & Johnson, Inc.
Rights and permissions
About this article
Cite this article
Adel, E., Shapiro, R. & Zaslau, S. Carcinogenic potential of polypropylene mid-urethral slings: what do we know so far?. Int Urogynecol J 28, 657–660 (2017). https://doi.org/10.1007/s00192-016-3170-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-016-3170-x