Cancer screening is a big deal for women. Breast cancer rates are high. It seems all of us are touched directly by breast cancer. So when you do surgery on the breast, the effect surgery has on your ability to see a cancer is important.
A new study in the May 1, 2010 issue of the International Journal of Cancer says implants may hinder the early detection of breast malignancies, but they do not affect patient survival.
This sounds like a lightening rod in the world of breast implants. What did they find?
The study analyzed 24,000+ women who had breast augmentation in Canada between 1974 and 1989. Cancers and mortality were looked at through 1997.
Breast cancer was found in 182 patients of the implant group and 202 in the control group.
- Implants delayed the diagnosis in augmented patients
- No statistical differences were seen in age at diagnosis, tumor size, histology type.
- The delay in diagnosis did not affect overall prognosis.
- Breast cancer survival was similar in both groups.
What does this mean?
I have not been able to read the whole article. Due to the timing of the original breast augmentations, I suspect most of these women had first or second generation noncoehsive gel implants in front of the muscle. Many likely had capsular contracture. I don’t know in Canada what the breast cancer screening process is, when it is done, when it starts, how often it is done, if they use techniques like Ecklund, etc.
What I do believe:
- There is some impairment of mammograms when you put in breast implants.
- The impairment is significantly less when you go under the muscle (which is one of the big reasons I prefer submuscular. One study quotes 39% impairment in front of the muscle vs. 9% behind the muscle relative to nonaugmented women.)
- Hard breasts / capsular contracture makes it more difficult to view the breast tissue (another reason to go submuscular, as the capsular contracture rates are lower behind the muscle)
- If you use the Ecklund technique and take more films (two additional CC and MLO views, with a fifth lateral view if needed), and use other modalities (such as ultrasound if needed) you can further reduce the risk.
- If you have implants, you should go to a mammogram center which does these techniques and is well versed in evaluating women with implants.
- Ecklund and others (published in radiology journals in the late 80s) argued implants help thin the overlying glandular breast tissue and give you a smooth backdrop, thereby enhancing the physical breast exam.
So I will tell you what I tell all my patients. Breast implants will reduce your ability to visualize the breast. This reduction is lower when behind the muscle. If you have a strong family history of breast cancer, you need to strongly consider this risk. If doing gel implants where the risk of capsular contracture is higher, particularly if you have a strong family history of breast cancer, consider a preoperative MRI so you can see your baseline prior to augmentation. Anyone over the age of 35 should get a good baseline mammogram prior to any breast surgery. And don’t forget your self exams (or ask a spouse/friend). Just don’t forget.
