Breast Cancer Detection in Women with Implants

Breast augmentation is popular in the United States; likewise, breast cancer is prevalent among our population. It is therefore inevitable that a large number of augmented women will eventually develop breast cancer. Concerns have been raised about whether implants might interfere with detection of cancer. We review our experience with augmented breast cancer patients to determine the effect of implants on cancer diagnosis and prognosis, and to formulate recommendations regarding physical and radiological evaluation of the augmented breast. We reviewed a prospective database containing detailed information on 3953 nonaugmented and 129 augmented breast cancer patients. Various parameters in the two groups were compared and differences were analyzed using appropriate statistical methodology. We additionally reviewed mammograms of all women with palpable lesions to determine the sensitivity of mammography in augmented and nonaugmented patients. Our data reveal that augmented patients present with a statistically greater frequency of palpable lesions, have a slightly greater risk of invasive tumors, an increased likelihood of axillary lymph node metastases, and a significantly higher rate of false-negative mammograms. Despite this, there was no significant difference in stage of disease between augmented and nonaugmented patients; mean tumor size, recurrence rates, and breast cancer-specific survival were virtually identical in both groups. Based on our findings, we conclude that, despite the diminished sensitivity of mammography in women with implants, augmented and nonaugmented patients are diagnosed at a similar stage and have a comparable prognosis. Although implants might impair mammography, they may facilitate detection of palpable breast cancers on physical examination. MRI and breast ultrasound are useful adjuncts in some women with implants, but conventional mammography remains the most reliable tool for diagnosing early breast cancer in augmented patients.