What is The Impact of Breast Implants on Diagnosis & Treatment of Breast Cancer
by Dr. C.H. Weaver M.D. updated 2/2109
Do breast implants increase the risk of developing breast cancer?
According to an article published in the Journal of the National Cancer Institute, women with breast implants do not have an increased risk of developing breast cancer. Researchers from Sweden conducted a clinical study to further evaluate the possibility of an association between cosmetic breast implants and the incidence of breast cancer. This study included nearly 3,500 women in Sweden who had cosmetic breast implants. Rates of breast cancer were compared to that of the general public and the study authors reported that there was not an increased risk for developing breast cancer among women with breast implants:
- Women with breast implants actually had a lower risk of developing breast cancer than the general public. However, lifestyle choices that are associated with a reduction in breast cancer were more common among women with breast implants than in the general public.
Do breast implants delay the diagnosis of breast cancer?
Concern has arisen among women and physicians regarding the possibility that breast implants may interfere with the detection of breast cancer. This could result in diagnosis at a later stage and ultimately a risk of decreased survival in these women.
This in fact was the conclusion of a major study published in the British Medical Journal. The study shows that women with implants who are subsequently diagnosed with breast cancer may have an increased risk of dying from the disease.
Researchers conducted two meta-analyses of 12 studies that included a total of 28,924 women. The first meta-analysis compared women with implants who had breast cancer and women without implants who had breast cancer. The second meta-analysis (of five studies) evaluated the relationship between cosmetic breast implantation and survival.
The researchers found that breast cancer patients were 38 percent more likely to die from the disease if they had implants. What’s more—women with implants were 26 percent more likely to have a more advanced stage of cancer at diagnosis.
The results of a study published in the British Journal of Cancer, however did not find that breast implants delayed the diagnosis of breast cancer. Researchers from Denmark evaluated nearly 3,000 women who had breast implants between 1973 and 1997. Of these women, 23 developed breast cancer. Researchers compared these women to women without breast implants who had been diagnosed with breast cancer and registered in the Danish Breast Cancer Cooperative Group's register (“control group”). There was no difference in the stage at which breast cancer was diagnosed and the overall survival between women with breast implants and the control group.
As with all research, caution is necessary in interpreting the results. While not all studies have not found an association between implants and a delayed diagnosis of breast cancer women with implants should be cautious and adhere to a strict screening schedule developed with their physician.
Breast augmentation may however decrease the ability of mammography to detect breast cancer. However, women with breast augmentation who are diagnosed with breast cancer have similar prognostic characteristics as women without breast augmentation who are diagnosed with breast cancer.
However, researchers continue to evaluate this issue. Recently, a multi-institutional clinical trial was conducted to further evaluate the impact of breast augmentation on the detection of breast cancer. This trial included over 800 women with breast cancer – 137 of whom had breast augmentation, and 685 of whom did not have augmentation who were diagnosed between 1995 and 2002. Nearly 100,000 women without breast cancer were also included in the study – 10, 533 of whom had breast augmentation and 974, 915 of whom did not have augmentation. All women underwent mammography screening.
The ability of mammography to detect breast cancer was reduced among women with breast augmentation, compared to women without augmentation. However, prognostic factors of cancers, including estrogen-receptor status, the presence, absence or number of lymph nodes to which the cancer had spread, the extent to which the cancer had spread (stage), and the size of the cancer, were similar between women with or without breast augmentation. Women with breast augmentation tended to have less aggressive cancers.
The researchers concluded that even though the ability to detect breast cancer is reduced by mammography in patients with breast augmentation compared those without augmentation, the prognostic factors of the cancer are similar between the two groups of women. Women with breast augmentation should discuss with their physician the most appropriate screening schedule for breast cancer for their individual case.
FDA Warns of Possible Link between Breast Implants and Rare Cancer
The US Food and Drug Administration (FDA) has reported a possible link between breast implants and a rare type of non-Hodgkin’s lymphoma known as anaplastic large cell lymphoma (ALCL).
Worldwide, an estimated 5 million to 10 million women have breast implants. Thus far, ALCL has been reported in only 60 women, but close examination of some of these cases prompted the FDA to state that women with breast implants may have a very small but increased risk of developing ALCL.
ALCL involves cells of the immune system. In the cases evaluated by the FDA, ALCL was found within the scar capsule around the breast implant. ALCL has been reported in women with saline and silicone implants, and tended to be diagnosed years after the implant surgery. The diagnosis of ALCL was often made after a woman noticed changes in the look or feel of the area surrounding the implant.
The FDA makes the following recommendations for women with implants:
The FDA is establishing a registry to collect information about additional cases of ALCL in women with breast implants, and asks that healthcare professionals report any confirmed cases. The FDA will provide updates as information becomes available. In the meantime, the FDA notes that “the existing data support the continued marketing and use of breast implants.”
- Miglioretti D, Rutter C, Geller B, et al. Effect of Breast Augmentation on the Accuracy of Mammography and Cancer Characteristics.
- The Journal of the American Medical Association. 2004;291:442-450.
- Holmich L, Mellemkjaer L, Gunnarsdottir A, et al. Stage of breast cancer at diagnosis among women with cosmetic breast implants. British Journal of Cancer. 2003;88:832-838.
- Lavigne E, Holowaty EJ, Pan SY, et al. Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies. BMJ. 2013; 346: f2399.
- FDA Consumer Health Information. FDA advises women with breast implants. January 2011.
- McLaughlin J, Lipworth L, Fryzek J, et al. Long-Term Cancer Risk Among Swedish Women With Cosmetic Breast Implants: An Update of a Nationwide Study. *Journal of the National Cancer Institute.*2006; 98: 557-560