Implants Do Not Appear to Affect Outcome of Breast Cancer Survival
A small study of women with breast cancer suggesting that those who have previously undergone breast augmentation surgery have similar survival rates as women without implants. The same study also found mammograms were less accurate at picking up abnormalities in women with breast implants.
The study was presented Friday, April 29, at the American Society of Breast Surgeons' annual meeting in Washington D.C. The study’s findings are preliminary and have not yet been published in a peer-reviewed journal.
The issue is very important as more and more women have breast implant surgery. A survey by the American Society for Aesthetic Plastic Surgery reported 318,123 breast augmentations in 2010. Unfortunately, one in eight women will develop breast cancer at some point in their lives. In other words, more than 35,000 of the women who had breast augmentation in the year 2010 can be expected to develop breast cancer.
Lead author Jessica Rayhanabad, MD (Keck School of Medicine, University of Southern California, Los Angeles, CA) and colleagues note “It is commonly thought that augmentation mammoplasty interferes with our ability to diagnose breast cancer.” They reviewed their series of patients with breast cancer to determine whether the augmented patients presented with more advanced disease and therefore had a poorer prognosis.
The researchers reviewed a prospective breast cancer database of women. Augmented patients (n=195) were compared to non- augmented patients (n=4810) by numerous factors, including but not limited to: palpability of tumor, tumor size, nuclear grade, percent in situ, nodal positivity, lymphovascular invasion, and breast cancer specific survival (BCSS).
Pre-biopsy mammography performed in 121 of 132 augmented patients with palpable lesions failed to reveal an abnormality in 43 of the women. This translates into a false negative rate of 36% in mammograms in this study.
Rayhanabad and colleagues not the false negative mammography rate in the general population (15%).
A literature review by Dr. Rod Rohrich and colleagues in 2004 noted reports of 22 to 83 percent (average, 38 percent) of the breast tissue was obscured by the implant with a standard mammogram. Patients with implants should have Eklund views done and even then not all of the breast tissue is visible with mammography.
Mammography is further affected by placement (better visualization with implant in submuscular position) and capsule contracture (makes it more difficult to compress the breast tissue).
Rayhanabad found no significant difference in tumor size, nuclear grade, recurrence-free and overall survival between the two groups.
These findings are similar to those found by Dr. Alan R. Shons and colleagues in their review, “Breast cancer patients with implants appear to present at a similar stage as a control population without implants.”
Ten year survival was 83% in breast implant patients and 82% in the non-augmented patients (p-value 0.80%).
The prescience of implants lower the quality of mammography. MRI and ultrasound are important tools for this subgroup of patients. Augmented patients were more likely to have palpable and, therefore, node positive cancers. In spite of this, distant recurrence, breast cancer specific and overall survival in augmented women were not statistically different from the non-augmented population.
Outcome in Augmented Patients Who Subsequently Develop Breast Cancer; Abstract 1654, American College of Surgeons 2011 Annual Meeting; Lead Author: Jessica Rayhanabad, MD (Keck School of Medicine, University of Southern California, Los Angeles, CA)
Breast Cancer and Augmentation Mammaplasty: The Preoperative Consultation; Shons, Alan R.; Plastic & Reconstructive Surgery. 109(1):383-385, January 2002.
Breast Cancer in Patients with Prior Augmentation: Presentation, Stage, and Lymphatic Mapping; Jakub, James W.; Ebert, Mark D.; Cantor, Alan; Gardner, Mary; Reintgen, Douglas S.; Dupont, Elisabeth L.; Cox, Charles E.; Shons, Alan R.; Plastic & Reconstructive Surgery. 114(7):1737-1742, December 2004; doi: 10.1097/01.PRS.0000142482.08917.24
Breast Augmentation: Cancer Concerns and Mammography-A Literature Review; Jakubietz, Michael G.; Janis, Jeffrey E.; Jakubietz, Rafael G.; Rohrich, Rod J.; Plastic & Reconstructive Surgery. 113(7):117e-122e, June 2004.