This is a study published in the British Journal of Medicine April 2013. “Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta analysis of observational studies.” This study was done out of Canada.
Objective: to figure out whether there is a difference in stage of breast cancer detection or a difference in post diagnosis survival between women who have implants versus those without implants.
Study: They did a review of previous studies so they could do meta analysis (small studies can skew results as the sample size is not large enough, so you pool the smaller studies into a giant study to look at statistical significance.) They had criteria the studies had to meet to allow them to be included. In total, they reference 12 studies.
Findings: “The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.”
What do I think?
This is not new news. It makes sense implants impair the ability to image the breast, and therefore may affect breast cancer detection. I discuss this with patients during my consultation. There was a large study out of Canada in 2010 – YOU CAN SEE MY BLOG ON THAT HERE- looking at 24,000 women showing an issue with breast cancer detection in women with implants. As I stated in my review of the original article, I think you need to be careful when evaluating this study. I do not think older studies should be included, as our techniques for placing the implants and our techniques for imaging the breast (MRI, ultrasound, Ecklund views on mammogram, digital mammography) have changed. With respect to the current study:
- I think it is dangerous to lump these 12 studies together. As the authors themselves acknowledge, “findings should be interpreted with caution, as some studies… did not adjust for potential confounders.”
- I do think implants decrease the ability to image the breast by mammogram.
- The radiology literature indicates a large difference between implants in front of the muscle versus behind the muscle. Submuscular implants interfere much less with breast cancer detection, and that is one reason I recommend implants be placed behind the muscle.
- Is there capsular contracture? Implants which have a firm capsular contracture are more difficult to image. The newer generations of cohesive gel and the style 410 gummy bear implant have lower capsular contracture rates than older generations of implants.
- There are some studies which indicate for small breasted women implants may actually improve self exam and ability to palpate a nodule.
I think the study is important and clearly warrants further evaluation. I also hope our ability to image the breast to look for cancer continues to improve.