Clinical Question: Does breast augmentation interfere with the detection of breast cancer?

Setting: Population-based

Study Design: Cohort (prospective)

Synopsis: Previous studies have shown that breast augmentation is not associated with an increased risk of breast cancer. It is uncertain, however, whether implants can interfere with the detection of breast cancer and delay diagnosis, possibly compromising treatment and long-term survival. Data from women followed prospectively in seven separate mammography registries were examined to determine mammography accuracy and tumor characteristics at diagnosis in women with and without breast augmentation.

A total of 137 women with breast augmentation who were diagnosed with breast cancer were each matched with five women without augmentation but with breast cancer; match was by age, race/ethnicity, index examination within two years of diagnosis, first or subsequent mammograms, and mammography registry. To calculate the sensitivity and specificity of mammography, mammograms that occurred within one year of cancer diagnosis were selected.

Among asymptomatic women, the sensitivity (i.e., the percentage of women with the disease who test positive) was lower in women with augmentation than in women without (45.0 percent versus 66.8 percent; P = .008), and specificity (i.e., the percentage of women without the disease who test negative) was slightly higher in women with augmentation (97.7 percent versus 96.7 percent; P <.001). Among symptomatic women, the sensitivity and specificity of mammography were nonsignificantly lower in the women with augmentation.

Tumor characteristics (stage, size, receptor status, and nodal status) at diagnosis were similar in asymptomatic women, with or without augmentation. Interestingly, among symptomatic women, those with augmentation had tumors with better prognostic characteristics, including smaller size, lower grade, and estrogen-receptor–positive status.

Bottom Line: Breast augmentation decreases the sensitivity of screening mammography in asymptomatic women but does not increase the false-positive rate. The prognostic characteristics of tumors at the time of diagnosis and treatment in these women are not influenced by augmentation, suggesting but not proving that there is no effect on long-term morbidity or mortality rates. Among symptomatic women with augmentation, the accuracy of mammography appears to be unaffected and the prognostic characteristics of tumors are slightly more favorable. As with other women, those with breast augmentation should be encouraged to undergo routine screening mammography at recommended intervals. (Level of Evidence: 2b)