MIAMI BEACH, Fla--Between 1 and 2 million women in the United
States have received silicone-gel-filled implants for breast augmentation,
and, based on the general population risk, about 10% will ultimately
develop breast cancer.
This translates into somewhere between 125,000 and 250,000 potential
breast cancer cases in women with silicone implants and represents
a major challenge for early detection of these cancers, Melvin
Silverstein, MD, said at the 12th Annual International Breast
Implants do not increase the risk of breast cancer (see story
on opposite page), but Dr. Silverstein has shown that they can
delay diagnosis and thus may alter prognosis. "Patients with
implants are far more likely to be diagnosed with palpable rather
than nonpalpable breast cancer, and to me that's a major problem,"
said Dr. Silverstein, medical director of The Breast Center, Van
He stressed that patients who have been augmented "have lost
access to state-of-the-art mammography." Screening mammography
is inadequate to detect tumors in most implant patients and has
no role in this population, he said.
Rather, such women should have diagnostic mammography, including
an examination and compression and displacement mammography in
both the mediolateral and craniocaudal views, although even these
procedures may have a high false-negative rate, he said.
In an earlier study, Dr. Silverstein and his colleagues measured
the amount of breast tissue that can be seen before and after
augmentation, using both compression and displacement mammography
techniques (see figures). "Anywhere from 0 to 80% of the
measurable breast parenchyma was obscured," he said, with
an average loss per film of 28% of the measurable surface area.
Severe capsular contracture caused the most loss of visualization.
Displacement mammography provided better visualization than compression
mammography, and submuscular implants presented fewer problems
than subglandular placement.