Breast cancer diagnosis and prognosis in augmented women.
BACKGROUND
Recent years have witnessed growing concerns about the possible adverse effects of implants on breast cancer diagnosis and treatment. Numerous reports describe how implants might interfere with mammography and impair the ability to detect cancer. Several publications document the diminished sensitivity of mammography in augmented patients with palpable tumors. However, epidemiologic studies comparing stage of disease at time of diagnosis in augmented and nonaugmented women are equivocal. The purpose of this study was to review the authors' experience with a large number of breast cancer patients to determine whether implants impair early diagnosis or adversely affect prognosis.


METHODS
The authors reviewed their prospective database, which contains detailed information on 3953 nonaugmented and 129 augmented breast cancer patients. Various parameters of the two groups were compared and differences were analyzed using appropriate statistical methodology.


RESULTS
The authors' data reveal that augmented patients present with a statistically greater frequency of palpable lesions, have a slightly greater risk of invasive tumors, and have an increased likelihood of axillary lymph node metastases. Despite this, there was no statistically significant difference in stage of disease between augmented and nonaugmented patients; mean tumor size, recurrence rates, and breast cancer-specific survival were virtually identical in both groups.


CONCLUSIONS
Based on these findings, the authors conclude that despite the diminished sensitivity of mammography in women with implants, augmented and nonaugmented patients are diagnosed at a similar stage and have a comparable prognosis. While implants may impair mammography, they appear to facilitate detection of palpable breast cancers on physical examination.
Handel
Neal
N
Division of Plastic Surgery, The David Geffen School of Medicine, University of California at Los Angeles, and the Keck School of Medicine, University of Southern California, USA. drhandel@aol.com
Silverstein
Melvin J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002277:Carcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015993:Life Tables; D008207:Lymphatic Metastasis; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome