Breast Implants and Cancer: Causation, Delayed Detection, and Survival

Hoshaw, Susan J.; Klein, P; Clark, Brian; Cook, Ralph R.; Perkins, Laura

doi:10.1097/00006534-200105000-00012

Cited by 65 publications

(32 citation statements)

References 62 publications

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“…Tellingly, the estimated apparent survival advantage of reconstruction was particularly strong within this subgroup (HR ¼ 0.47; 95% CI, 0.28 to 0.80). Although the observed association between reconstruction and improved survival may, as suggested by others, be due, in part, to direct physiologic or immunologic effects, 21 a more likely hypothesis is that reconstruction is a surrogate marker for breast cancer patients destined to do well on the basis of socioeconomic factors.…”

Section: Discussionmentioning

confidence: 89%

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

Bezuhly

Temple

Sigurdson

et al. 2009

Cancer

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BACKGROUND: Although immediate breast reconstruction is increasingly offered as part of postmastectomy psychosocial rehabilitation, concerns remain that it may delay adjuvant therapy or impair detection of local recurrence. No single population‐based study has examined the relationship between immediate breast reconstruction and breast cancer‐specific survival. METHODS: By using data from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries, breast cancer‐specific survival was compared for female unilateral mastectomy patients who did or did not undergo immediate breast reconstruction. Cox proportional hazards models were fitted, adjusting for known demographic and disease severity variables and stratifying on reconstruction type (implant or autologous) and age. RESULTS: Improved breast cancer‐specific survival was observed among all immediate breast reconstruction patients compared with patients who underwent mastectomy alone (hazard ratio [HR] = 0.74; 95% confidence interval [CI], 0.68 to 0.80). Implant reconstruction patients below 50 years of age demonstrated the greatest apparent survival benefit (HR = 0.47; 95% CI 0.28 to 0.80). Similarly, autologous reconstruction was associated with improved cancer‐specific survival among patients below the age of 50 (HR = 0.58; 95% CI, 0.42 to 0.80) and between ages 50 to 69 (HR = 0.61; 95% CI, 0.43 to 0.85). CONCLUSIONS: Immediate breast reconstruction is associated with decreased breast cancer‐specific mortality, particularly among younger women. We believe this association is more likely attributable to imbalances in socioeconomic factors and access to care than to inadequate adjustment for tumor characteristics and disease severity. Further research is needed to identify additional prognostic factors responsible for the improved cancer survival among women undergoing immediate postmastectomy reconstruction. Cancer 2009. © 2009 American Cancer Society.

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Section: Discussionmentioning

confidence: 89%

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

Bezuhly

Temple

Sigurdson

et al. 2009

Cancer

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“…Others have reported similar findings and concluded that women with cosmetic breast implants are not at increased risk of subsequent breast cancer (Berkel et al, 1992;Deapen et al, 1997;McLaughlin et al, 1998;Brinton et al, 2000b); on the contrary, a recent metaanalysis reported a 30% reduction of breast cancer risk among women with breast implants (RR ¼ 0.72; 95% CI 0.61 -0.85) and it was concluded that breast implants may confer a protective effect against breast cancer (Hoshaw et al, 2001). Several explanations for this protective effect have been put forward: activation of the immune response as result of foreign body reaction may enhance detection and degradation of precancerous lesions; compression of the glandular tissue from the implant may diminish blood perfusion, which may alter cellular metabolism, and a local decrease in body temperature caused by the implant could diminish cellular metabolism (Deapen et al, 1997;Brinton et al, 2000b;Hoshaw et al, 2001). However, different preoperative characteristics among women seeking breast implantation compared with other women could perhaps more likely account for the decreased breast cancer risk among implant women.…”

Section: Discussionmentioning

confidence: 89%

“…There is no evidence that breast implants increase the risk of breast cancer (Brinton et al, 2000b;Mellemkjaer et al, 2000). On the contrary, several reports document that women with cosmetic breast implants seem to be at a lower risk of developing breast cancer (Berkel et al, 1992;Deapen et al, 1997;McLaughlin et al, 1998;Hoshaw et al, 2001). However, the issue of potential delay in breast cancer diagnosis in the augmented breast has been raised, since breast implants are radiopaque and this influences the sensitivity of mammography (Eklund et al, 1988;Hayes et al, 1988;Silverstein et al, 1992).…”

mentioning

confidence: 99%

Stage of breast cancer at diagnosis among women with cosmetic breast implants

et al. 2003

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Concern has been raised about the potential delay in breast cancer diagnosis in the augmented breast. We linked a cohort of 2955 women, who received cosmetic breast implants in Denmark during the period 1973 -1997 with the Danish Cancer Registry and the Danish Breast Cancer Cooperative Group register. We identified 23 incident cases of invasive breast cancer diagnosed subsequent to breast implantation. We randomly selected 11 controls for each case from the Danish Breast Cancer Cooperative Group's register, and obtained detailed information on all study subjects about surgery, histopathology and stage of breast cancer at diagnosis, intended adjuvant treatment according to trial protocols and overall survival. We found that women with breast implants on average were diagnosed with breast cancer at the same stage as controls. Significantly more women with breast implants had tumour cells in the surgical margins according to the Danish Breast Cancer Cooperative Group's data. There was no significant difference in overall survival between the two groups after an average of 6.4 years of follow-up. Based on this limited number of women with breast cancer subsequent to breast augmentation, breast implants do not appear to delay the diagnosis of breast cancer, and no evidence of impaired survival after breast cancer diagnosis in augmented women was found.

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“…Often a concern is that breast implants can interfere with mammographic imaging, thereby preventing early detection of breast tumors and consequently decreasing overall survival [5]. Le et al [6] conducted a large population-based study of approximately 5,000 women, with data from the Surveillance, Epidemiology, and End Results (SEER) Breast Implant Surveillance Study, over 12 years.…”

Section: Introductionmentioning

confidence: 99%

A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center

Destounis¹,

Morgan²,

Arieno³

et al. 2011

Breast Cancer

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Despite developments in surgical technique, radiation treatment, and chemotherapeutic agents, tumor recurrence and distant disease have remained a major concern in breast cancer management. Breast imaging after mastectomy in the screening arena remains a controversial topic for breast imagers. Many feel the yield of finding a recurrent cancer with imaging in the asymptomatic patient is too low to be beneficial; others believe imaging should be performed on these patients as the risk of recurrence exists. Patients after a mastectomy procedure are considered high risk and, when they present with clinical symptoms, will require evaluation by the radiologist. In this diagnostic/symptomatic scenario, imaging becomes the routine and current imaging tools, such as mammography, ultrasound, and magnetic resonance imaging (MRI), can easily be incorporated to diagnose recurrent cancer. Our facility has a large population of patients that undergo mastectomy after a carcinoma diagnosis as well as a number of patients that have undergone a mastectomy procedure because of their high-risk status (whether family history or genetic predisposition). A certain percentage of these patients have proceeded to reconstructive surgery. We image these patients routinely as part of our screening protocol. Over the years we have become familiar with the appearance of remaining tissue along the chest wall after mastectomy as well as the reconstructed breasts. This familiarity is important as the imaging of these patients with mammography and other modalities available today can be challenging. This manuscript will discuss the benefits and some limitations surrounding imaging these patients, in both the asymptomatic and symptomatic scenarios, as well as what imaging protocols can be integrated within a facility's standard evaluation.

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Breast Implants and Cancer: Causation, Delayed Detection, and Survival

Cited by 65 publications

References 62 publications

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

Immediate postmastectomy reconstruction is associated with improved breast cancer‐specific survival

Stage of breast cancer at diagnosis among women with cosmetic breast implants

A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center

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