Effect of Breast Augmentation on the Accuracy of Mammography and Cancer Characteristics

Abstract

REAST AUGMENTATION IS THE third most common type of plastic surgery performed for cosmetic reasons in the United States, with 268 888 procedures in 2002. 1 In 2 studies conducted in the late 1980s, between 3.3 and 8.1 per 1000 women reported ever having breast implants. 2,3 Although breast implants have not been found to be associated with an increased risk of breast cancer, 4,5 implants may interfere with routine mammography evaluation; therefore, women with breast augmentation may be more likely to be diagnosed with advanced disease. [6][7][8][9][10][11][12][13][14][15][16] Previous studies of breast cancer following breast augmentation have typically had small study samples and yield conflicting results as to whether breast implants delay cancer diagnosis. 4,7,8,[16][17][18][19][20][21][22][23][24][25] In addition, these studies include cancers diagnosed in the early 1980s when routine screening mammography was uncommon 26 and radiologists did not use implantation displacement views, a technique that improves visualization of breast tissue in women with implants. 12 Two recent larger studies of breast cancer following augmentation mammoplasty suggest breast cancer diagnosis may be delayed in women with augmentation. 4,7 Brinton et al 4 found women with breast implants (N = 78) tended to have later-stage disease compared with women without augmenta-Author Affiliations and Financial Disclosure are listed at the end of this article.

Reasonably safe? Breast implants and informed consent

“…An implant shows up as a solid white orb on a mammogram, which can hide tumours above or below the implant. 9 Specially trained technicians can partially compensate by taking additional views of the implanted breast, but additional views generally cost more, take more time, and expose the woman to more radiation. Since most women wanting breast implants plan to have them for the rest of their lives, it is important to stress this issue to women of all ages before they make a decision about getting breast implants.…”

Do Breast Implants Adversely Affect Prognosis among Those Subsequently Diagnosed with Breast Cancer? Findings from an Extended Follow-Up of a Canadian Cohort

“…In addition to our previous report, 2 publications by Silverstein and colleagues reported that breast implant women presented with more advanced stage at breast cancer diagnosis when compared with nonaugmented women (19,20). Although not statistically significant, several studies showed a tendency toward advanced breast tumors at diagnosis for women who received augmentation mammaplasty (6,(29)(30)(31)(32)(33)(34)(35). However, several other publications found little or no evidence that implant women were diagnosed at a later stage (9,12,(22)(23)(24)(25)(26)(27)(28)57).…”

“…Only 3 publications, including our previous report, showed a statistically significant shift toward more advanced breast tumors at diagnosis among augmented women (19)(20)(21). However, several other publications reported no statistically significant differences in breast cancer stage at diagnosis comparing augmented to nonaugmented women (6,9,12,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Furthermore, specific implant characteristics such as implant volume and placement might affect the detection of breast cancer (36).…”

“…Incident breast cancer cases were identified among a Canadian cohort of women (N ¼ 40,451) who previously underwent bilateral cosmetic breast augmentation (N ¼ 24,453) or other cosmetic surgery (N ¼ 15,893) in Ontario or Quebec between January 1, 1974 and December 31,1989, and who were 18 years of age or older at the time of first cosmetic surgery. A detailed description of the study population with selection criteria is provided in our previous publications (7,21,40).…”

3–9 Influence of Computer-Aided Detection on Performance of Screening Mammography

“…Women were classified on the basis of demographic and clinical covariates known to be associated with the accuracy of mammography, 17,22,23 including age (in 5-year categories), breast density, and months since the most recent mammography. Facilities were classified according to academic affiliation, relative frequencies of screening and diagnostic imaging, interpretation of screening mammograms in batches of 10 or more, availability of interventional services (e.g., core biopsy), number of radiologists who specialized in breast imaging, interpretation of screening mammograms by more than one radiologist (i.e., double-reading), and the frequency of feedback about performance and the method used to review it.…”