Friday, January 30, 2004

No surprise from another meta-analysis about mammograms and breast implants.

Scientists sifted through data from seven mammography registries across the country on women who had the tests between 1995 and 2000.

Of those, 137 women with implants and 685 women without implants developed breast cancer within one year of their test.

Mammograms missed 55 percent of breast cancers in women with implants compared with 33 percent among women without implants. Routine mammograms help detect small tumors and calcium deposits before other symptoms appear.

The conventional wisdom in the surgical community was that while breast implants did not increase the incidence of breast cancer, followup is more difficult. Once a breast cancer is found in a augmented breast, treatment becomes more difficult. Breast conservation a harder goal to achieve due to two main reasons:

The studies on breast conservation did not include patients with breast implants

Breast implants do not tolerate radiation well as they tend to contract and result in cosmesis that is less than desirable.

Implants also make biopsy more difficult, since one loses style points if the implant is violated. This is one area where I personally have found stereotactic biopsy to be advantageous as the machine tends to push the implant out of the field.

However, to researchers' surprise, tumors in women with implants were not discovered at a more advanced stage.

"That's the good news," said Diana Miglioretti, a biostatistician at Group Health Cooperative's Center for Health Studies and the lead author of the article in today's Journal of the American Medical Association.

"(Tumors) are being detected somehow even though they're being missed on mammograms," Miglioretti said.

As I don't have the full text of the JAMA article in front of me, I can't comment on how the tumors were found. Physical exam? Ultrasound? Or a later mammogram that had a more definitive lesion that was biopsied and had been missed on the initial study?

So what should the woman who is considering or has breast implants do?

If someone was trying to decide if they were going to get (implants), I would say this is a potential risk," said Dr. Karla Kerlikowske, a primary care physician at the University of California-San Francisco and one of the study's authors. "For those who already have implants, I would make sure they're going to a facility that has the capability of doing displacement views," Kerlikowske said

Of course the missed-cancer rate of 33 percent of the non-augmented breast is nothing to brag about.
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