Breast implants may mask early cancer

Breast augmentation is the leading cosmetic surgery in North America, with roughly 400,000 procedures a year in the United States alone. A study now finds some evidence that breast implants may hinder early detection of breast malignancies. The good news: This didn’t affect survival.

Some 83 to 84 percent of women in this study, regardless of implant status, survived their cancer through the followup period, which was typically at least 3.5 years. The findings appear in the May 1 International Journal of Cancer

A team of researchers from two Canadian universities, the Public Health Agency of Canada and Cancer Care Ontario pored over health data for almost 40,500 women who had elected to get some form of cosmetic surgery between the mid 1970s and end of 1989. The incidence of subsequent breast cancers differed little between women who had gotten breast implants and those who had other procedures, such as facelifts or surgeries to reshape the nose and ears. The researchers also found no change between the two groups in the size of breast tumors at diagnosis or the time between diagnosis and treatment.

What did differ was the stage of cancer — how advanced it was. Women with implants were almost 2.5 times as likely (13.2 percent) to have more advanced cancers — stage III or IV — as were those in the control group, women in a similar socioeconomic group who had undergone other cosmetic surgeries. And that’s a potentially big deal since later-stage cancers tend to be more aggressive.

Implants can be relatively opaque to the x-rays used in mammography. So radiologists have been encouraged to make sure technicians push implants to the side, so to speak, when performing mammograms.

How successful technicians have been may explain, in part, why earlier studies have offered mixed evidence about any risk of delayed diagnosis associated with implants. Also hampering those earlier reports: None had data for as many women. Indeed, the new report’s authors note: “Our study is the largest to date and the first to show a statistically significant shift toward later stage at diagnosis of breast cancer among breast implant patients.”

What their data certainly suggest is that women who have implants should make sure that they mention them when they come in for mammograms, and encourage technicians to shove those implants out of the way as much as possible (as uncomfortable as that may be) to maximize the chance of revealing any nascent tumors.