Breast Implants and Mammography: Do They Get In The Way?
After ]]>nose reshaping]]> and liposuction, ]]>breast augmentation]]> is the third most common type of cosmetic plastic surgery in the United States. In fact, over a quarter-million breast augmentation procedures were performed in 2002.
While there is no evidence that breast augmentation causes cancer, some studies suggest that breast implants may interfere with routine ]]>mammography]]> evaluation and possibly increase the risk of being diagnosed with more advanced ]]>breast cancer]]> .
A new study in the January 28, 2004 issue of the Journal of the American Medical Association found that while breast augmentation decreases the accuracy of mammography screening, breast cancer diagnosed in women with breast augmentation is not likely to be more advanced than breast cancer diagnosed in other women.
About the Study
Researchers used data from the Breast Cancer Surveillance Consortium (BCSC), a National Cancer Institute-sponsored registry of 2.2 million mammography examinations and 28,000 breast cancer cases.
This study included over one million women with no history of breast cancer who had a mammography from 1995-2002. Approximately 1% of the women had breast augmentation. For the purposes of this study, mammograms were considered positive if they required additional evaluation or suggested malignancy or a suspicious abnormality. Mammograms were considered negative if they suggested a benign condition or had no finding.
The researchers categorized the women according to the following criteria:
- Implant augmentation vs. no augmentation
- Symptoms of breast cancer (symptomatic) or not (asymptomatic)
- Invasive cancer vs. ductal cancer (that hasn’t spread beyond the lining of the breast duct)
- Prognostic characteristics of invasive cancer
The researchers followed the women for one year and compared the diagnostic accuracy of the mammograms in women with augmentation compared to those without.
Mammography was more likely to miss cancers in women with augmentation. Specifically, mammograms missed two-thirds of cancers in asymptomatic women with augmentation and only one-third in those without. Among symptomatic women, mammograms missed 26% of cancers in those with augmentation, compared with 19% in those without.
In the asymptomatic women who didn’t develop breast cancer, mammograms were slightly more accurate in women with breast augmentation. About 2% of women with augmentation and 3% of those without had false-positive mammograms. In symptomatic women who didn’t develop breast cancer, augmentation didn’t affect accuracy; about 13% of these women received false-positive mammogram results.
Cancers in women with augmentation were no more aggressive than those in women without augmentation. Although women with augmentation were more likely to be diagnosed with invasive cancers, their tumors tended to be smaller in size, lower grade, and estrogen-receptor positive (all indicators of better prognosis).
How Does This Affect You?
These findings suggest that although mammography missed more cancers in women with breast augmentation, the cancers in women with augmentation were no more advanced than those in women without augmentation.
Previously, two large studies suggested that women with breast implants were more likely to be diagnosed with more advanced cancer, presumably due to delays in diagnosis. But since the 1980s, when these studies were conducted, radiologists have begun using “displacement views” during mammography as the standard of care for women with breast augmentation. The displacement views improve visualization of the breast tissue by pulling breast tissue forward and pushing the breast implant back. The current study suggests that women with augmentation may not be at a disadvantage in terms of prognosis after the diagnosis of breast cancer.
Women with breast augmentation should be encouraged to have routine screening mammograms. Mammograms can be life-saving; they can detect cancer in its early stages, when it is too small to be felt. The earlier breast cancer is detected, the more treatment options there are, which can be expected to improve prognosis. The National Cancer Institute recommends that women in their 40s and older get mammograms every 1–2 years. There is no evidence that this advice should be altered in women who have undergone breast augmentation.
American Cancer Society
National Cancer Institute
About the BCSC. National Cancer Institute website. Available at: http://breastscreening.cancer.gov/ . Accessed January 28, 2004.
Breast augmentation. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/ . Accessed January 28, 2004.
Miglioretti DL, Rutter CM, Geller BM, et al. Effect of breast augmentation on the accuracy of mammography and cancer characteristics. Journal of the Americal Medical Association . 2004;291:442-450.
Quick facts on cosmetic and reconstructive plastic surgery. American Society of Plastic Surgeons website. Available at: http://www.plasticsurgery.org/ . Accessed January 28, 2004.
Last reviewed Jan 30, 2004 by ]]>Richard Glickman-Simon, MD]]>
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