Breast Cancer Diagnosis and Prognosis in Augmented Women

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Background: Recent years have witnessed growing concerns about the possible
adverse effects of implants on breast cancer diagnosis and treatment. Numerous
reports describe how implants might interfere with mammography and impair
the ability to detect cancer. Several publications document the diminished
sensitivity of mammography in augmented patients with palpable tumors. However,
epidemiologic studies comparing stage of disease at time of diagnosis in
augmented and nonaugmented women are equivocal. The purpose of this study
was to review the authors’ experience with a large number of breast cancer
patients to determine whether implants impair early diagnosis or adversely affect
prognosis.

Methods: The authors reviewed their prospective database, which contains
detailed information on 3953 nonaugmented and 129 augmented breast cancer
patients. Various parameters of the two groups were compared and differences
were analyzed using appropriate statistical methodology.

Results:
The authors’ data reveal that augmented patients present with a statistically
greater frequency of palpable lesions, have a slightly greater risk of
invasive tumors, and have an increased likelihood of axillary lymph node metastases.
Despite this, there was no statistically 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.

Conclusions: Based on these findings, the authors 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. While implants may impair mammography, they appear to
facilitate detection of palpable breast cancers on physical examination. (Plast.
Reconstr. Surg. 118: 587, 2006.)

Breast enlargement surgery is popular in the
United States; it is estimated that more
than 334,000 women underwent elective
augmentation in 2004.1 Carcinoma of the breast
is also common, with an estimated annual incidence
of more than 267,000 new cases (including
both invasive and noninvasive tumors).2 A
woman in the United States now has a 1 in 7
(13.4 percent) lifetime risk of developing breast
cancer. Based on these statistics, it can be projected
that nearly 45,000 women undergoing
augmentation each year will develop breast cancer
at some time during their lives.

There does not appear to be an etiologic link
between implants and breast tumors. Numerous
studies show that the rate of breast cancer is not
increased among augmented women,3–9 and
some studies actually demonstrate lower than
expected rates.10–12 However, because a large
number of augmented women eventually will
develop breast cancer, there have been persistent
concerns about possible adverse effects of
implants on cancer detection and treatment.13,14

There is substantial literature to suggest that
implants can interfere with mammography.15–18
Likewise, several clinical studies document an
increased rate of false-negative mammograms in
augmented patients with palpable tumors.19–22
However, when it comes to determining whether
implants actually result in cancer being diagnosed
at a more advanced stage, the findings are
equivocal. Some studies indicate that augmented
breast cancer patients are diagnosed with more
advanced cancers than nonaugmented
patients,16,23,24 while other studies indicate that
the stage of disease is virtually identical in the
two groups.5,8,25–27

We have collected data pertaining to a large
number of augmented and nonaugmented
breast cancer patients treated over a 23-year period.
Our data reveal that augmented breast cancer
patients are diagnosed more frequently with
palpable tumors, have a lower incidence of in
situ lesions, and have a