Woman with fake boobs has real health worries

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Woman with fake boobs has real health worries

A 40-year-old wants to know if breast implants ruin

mammogram results. ‘Today’ health editor Dr. Judith

Reichman says they could affect treatment

Dear Dr. Reichman: I'm 40 and I know that I need to

begin to have annual mammograms. I had breast implants

six years ago, and now I’m worried. Can the mammogram

procedure rupture the implants? And can my implants

obscure signs of breast cancer? — Busty and bothered

Dear Busty: You have two valid concerns. Breast

augmentation is the second most frequent surgery

performed by plastic surgeons. It's estimated that

over 4 million women have had this surgery,

approximately 80 percent for cosmetic reasons and 20

percent for reconstruction after mastectomy. Breast

cancer will affect 12.5 percent or 1 out of 8 women in

their lifetime. As breast cancer incidence peaks

(between the ages of 50 and 69) women who have had

augmentation will be faced by the same concern —can

breast cancer be found if you have an implant?

Recent studies of over 36,000 women with implants

compared the observed rate of diagnosed breast cancer

in these women with that expected in the general

population. Paradoxically, it was found that the

breast cancer incidence in women with augmentation not

only did not increase, but was somewhat lower than

that seen in the general population. The reason this

is somewhat surprising is that implants can cause a 15

to 50 percent decrease in the mammographically

visualized breast tissue and several studies have

reported false negative mammograms (those that missed

the cancer) in 12 to 67 percent of women with

augmentation.

The latter numbers are hardly reassuring, but it's

possible (though many feel not medically probable)

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 just 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 breast

implants tend to be in a higher socioeconomic group

with better nutrition, exercise, cancer screening, and

access to medical care.

Having given you this reassurance let me point out

that in order to properly visualize an augmented

breast, the breast should be compressed in a special

fashion that may require 4 separate views. And if

biopsy is required, you’ll need to have an open biopsy

so that the implant is not punctured. Otherwise, you

could have an ultrasound-guided needle biopsy or a

stereotactic biopsy.

If cancer is found, the implants, especially if placed

above the chest muscles, make it difficult to treat

with “just” a 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.

Let me address your concern that a mammogram could

“hurt” your implants. There were only 41 cases of

implant ruptures during mammography reported to the

U.S. Food and Drug Administration between June 1992

and October 2002. Another 17 cases related to

mammograms have been reported in the medical

literature. This occurrence is obviously quite rare,

so implants should not be a disincentive to getting

your mammogram.

Finally, some of my patients ask if ultrasound, which

is a softer, gentler procedure, can be used to screen

for cancer in lieu of a mammogram. My answer is no.

Ultrasound doesn’t pick up the minute calcifications

that are the hallmark of early breast cancer and its

results vary tremendously based on who is performing

and viewing the image. Ultrasound as an adjunct test

used to distinguish between solid and cystic masses or

to help assess very dense breasts, but it should not

be the primary screening tool to detect breast cancer.

An MRI can be used to detect a silent rupture in a

silicone implant, but routine use for breast cancer

detection is limited to high risk women (those who

have a strong genetic history, are known to have BRCA

mutations or who had had previous diagnosed breast

cancer). This may become “the test of the future” but

currently it’s very expensive and has a high rate of

false positive results (findings that require a biopsy

but turn out to be benign).

Dr. Reichman’s Bottom Line: You’ve already manifested

breast concerns by having an augmentation procedure.

Your 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 Morrow, a

division of Harper.