Breast cancer diagnosis and prognosis in women augmented with silicone gel-filled implants

Article Abstract:

Over 1.5 million women have undergone silicone implantation to augment their breasts, and an additional 150,000 women undergo this procedure each year. Since 10 percent of American women may expect to develop breast cancer at some point in their lives, it is reasonable to ask what will happen to the breast implant patients who are likely to develop cancer. Breast augmentation with silicone implants may delay the detection of a breast lump (tumor), and might interfere in screening for early cancer with mammography. Any delay in the diagnosis of breast cancer is likely to result in a poorer prognosis for the patient. Therefore, the cases of 35 women, who had breast augmentation and subsequently developed breast cancer, were reviewed to determine if this group was different from the overall population of women with breast cancer. It was found that the women with breast augmentation, who presented with palpable masses, had a similar profile of disease stage and prognosis to other nonaugmented women who also presented with palpable masses. However, among women whose cancers were first identified during mammographic screening, the women with augmented breasts had a greater rate of cancer invading neighboring tissue, and a higher rate of cancer spreading to lymph nodes than did women who did not have breast implants. The authors suggest that women who are considering augmentation mammoplasty, i.e., silicone implants, be advised that the presence of the implant may make the subsequent mammographic identification of a developing tumor more difficult. Physicians should also be aware of this problem in women who have had breast augmentation. Pre-augmentation mammography should be performed in all patients over the age of 30. (Consumer Summary produced by Reliance Medical Information, Inc.)

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The effect of silicone-gel-filled implants on mammography

Article Abstract:

About 150,000 women per year in the US have plastic surgery to alter their breasts. There has been some concern in the medical community that the use of implants filled with silicone gel to augment breasts may interfere with mammographic screening. Early detection of breast cancer greatly improves the prospects for successful treatment. As many as one woman in nine will develop breast cancer at some time, and anything that interferes with early detection may have enormous costs in patient health. A study was conducted to evaluate the effect of silicone gel implants on mammography. Fifty-four recipients of implants were examined with mammography; each of these women had mammography prior to breast augmentation, so films were available for comparison. The mammograms were taken using the implant compression technique, which is the standard mammographic method. When possible, mammograms were also obtained using the implant displacement technique. Comparison of the before and after mammograms among women who received implants placed under the breast glandular tissue revealed that the area of breast tissue visible on the mammogram had decreased by 44 percent. The results of the implant displacement technique were not much better; when compared with the pre-augmentation mammograms, a loss of visualized area of 36 percent had occurred. Results were slightly better for women who had received implants placed under a portion of the chest musculature. However, the results were clearly inferior to those obtained on unaltered breasts, and indicate that state-of-the-art mammography is impossible for most women with silicone implants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mammaplasty, Breast reconstruction

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Intraductal carcinoma of the breast (208 cases): clinical factors influencing treatment choice

Article Abstract:

Mastectomy used to be the treatment for all forms of breast cancer. More recently, however, the trend has been to use breast-conserving surgery when possible. Since ductal carcinoma in situ (DCIS), a form of breast cancer, is wholly noninvasive, it would seem to be a prime candidate for breast-conserving surgery. Nevertheless, some patients who undergo breast-conserving therapy do experience recurrences, and often these are invasive recurrences with a very poor prognosis. Therefore, it is important to evaluate the natural history of DCIS before decisions about breast-conserving therapy can be made. This was done in a total of 208 cases of DCIS. The cancers that were removed had a variety of histological types based on microscopic evaluation. The most common was a subtype called comedocarcinoma, occurring in 105 cases; other subtypes included cribriform and macropapillary cancers. The comedocarcinoma subtypes had an eight percent rate of recurrence, significantly greater than the one percent rate of recurrence observed for the other subtypes. Furthermore, recurrences were more common among women who had received breast-conserving therapy than among those who had mastectomy. An additional finding was that the lymph nodes were free of cancer cells in the majority of patients with DCIS. These results indicate that dissection of the lymph nodes is probably not useful for patients with intraductal carcinoma. Furthermore, although breast-conserving therapy may be considered for many patients with intraductal carcinoma, it should be considered very cautiously for patients with DCIS of the comedocarcinoma subtype. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Identification and classification, Carcinoma, Ductal, Ductal carcinoma

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