May 31st, 2013
In May of 2013, two major breast-health announcements hit the news. First, a study published in the British Medical Journal suggested that women with breast implants have an increased risk of developing breast cancer. What garnered more media attention (including the cover of Time Magazine), however, was the revelation that Angelina Jolie had undergone a bilateral (double) mastectomy and reconstruction for a positive BRCA test - she did not have breast cancer, but had the genetic mutation that meant that her risk for developing it was around 90%.
Here is what you need to know before you read any further:
Breast implants DO NOT cause breast cancer.
Many of my Knoxville Plastic Surgery consultations for breast augmentation include some question about long-term illness as a result of the implants themselves. The vast majority of this stems from the silicone implant controversy of the 1990s when the implants were pulled off the market in the US over concerns that they caused auto-immune disease. Fortunately, after a decade of testing, these fears were disproven. Very little is mentioned about cancer risk, though.
The paper in the BMJ is a thoroughly boring read unless you enjoy dry scientific writing. It summarizes the work of 17 separate studies that have been done looking at a) the number of women with cosmetic breast implants who develop cancer and b) survival rates among women with cosmetic breast implants who develop cancer. Unless you are the type of person who enjoys reading about logistic regression analyses, odds ratios and meta-analyses, the paper is painful to try and make it through. I read it and am summarizing it here so you don't have to. Thank me later...
The bottom line is this: breast implants make it more difficult for radiologists to view all breast tissue with a standard mammogram, which can cause them to miss seeing a tumor. This contributes to women with breast cancer having larger tumors when they are found. Secondly, women who have implants who develop breast cancer tend to have higher stage disease at the time of diagnosis than women without implants and their subsequent survival rates are slightly lower. However, these studies were looking at tumors found by imaging only. The authors admit that implants make FEELING a tumor easier, and there is published data out there that this fact alone can improve survival.
Also, most of the studies this paper reviewed were older and did not take into account the rise of more accurate imaging that is used to diagnose breast cancer now - MRI and tomosynthesis - both of which can more accurately visualize the whole breast, regardless of whether an implant is there or not.
So, here is what you need to take away from this post:
1. Breast implants DO NOT cause breast cancer
2. Breast implants DO make it more difficult for all the breast tissue to be seen with standard mammograms, and other imaging may be needed.
3. Breast implants DO make it easier to feel tumors in the breast, but tumors that can't be felt are harder to see on traditional imaging.
4. If a woman with implants does develop breast cancer that can't be felt, they are likely to be higher stage (larger) tumors - likely as a result of #3.
5. If a woman with implants develops breast cancer, their survival rates are slightly lower than women without implants.
Breast augmentation is a safe, satisfying procedure that remains the most popular cosmetic surgery performed in the United States. Both past and potential breast augmentation patients must remember to remain vigilant when it comes to breast cancer screening from both a perspective of routine self-examinations and breast imaging, especially if you have breast cancer that runs in your family.