Breast implants: Do they affect mammograms?

Do women with implants experience higher incidences of breast cancer?
No. Many studies have found that breast cancer incidence in women who have had implants is actually lower than that of the general female public. One study from Sweden followed 3,400 women who had received cosmetic breast implants between the years 1965 and 1993. They had an average follow-up of 18 years. The women with implants were found to have a 30 percent reduced risk for breast cancer when compared to women without implants. Another study, this time in the U.S., compared breast cancer incidence rates among 13,000 women who had breast implants with expected rates based on U.S. surveillance. And here too the risk was slightly lower. It’s possible, though many feel not medically probable (or even statistically proven) that breast implants may decrease breast cancer incidence by:

• Compressing breast tissue and interfering with its blood supply.
• Decreasing temperature in the breast.
• Stimulating an immunological response, which helps destroy potential breast cancer cells.

It may be, however, that the apparent decreased incidence of breast cancer in women with breast implants reflects the fact that these women are more likely to be thin (obesity is a significant risk factor for breast cancer). Also, the women with implants tend to be in a higher socioeconomic group with better nutrition, exercise, and cancer screening. They see their physicians, especially the breast specialist more frequently, have more frequent mammograms and better access to medical care than their cohorts who don’t have implants. 

When cancer is found in women with implants, is the disease at a later stage?
This has been addressed in another study published in The Journal of the American Medical Association (JAMA), which used the data collected from the National Cancer Institute funded Breast Cancer Surveillance Consortium (BCSC).  They compared 141 women with augmentation and nearly 21,000 without who were diagnosed with breast cancer between 1995 and 2002. The tumors were diagnosed at a similar stage and size, but tended to be lower grade (less worrisome) for women with breast augmentation compared to those without. The authors concluded that “although sensitivity of screening mammography is lower with breast augmentation, there’s no evidence that this results in more advanced disease at diagnosis compared with women without augmentation.”

What happens if a mammogram demonstrates a suspicious area?
In some cases, an open biopsy (with an incision into the breast) rather than an ultrasound guided needle biopsy or stereotactic biopsy may be required so that the implant is not punctured. But with the right expertise this is not necessarily the case. There is no question that the expertise of the physician who evaluates an abnormal finding by performing a biopsy (either the radiologist or breast surgeon) can determine the type of procedure that will be performed. And if cancer is found, the implants, especially if placed above the chest muscles, may make it less amenable to treatment with “just” lumpectomy and radiation. It can be difficult to achieve a cancer-free surgical margin while preserving the implant. Radiation may also cause the implant to harden and contract. 

Dr. Reichman’s Bottom Line: Breast implants do not increase your risk of breast cancer. Don’t raise your risk of a delayed diagnosis by letting your implants prevent you from getting a mammogram.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.

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