Early detection is extremely important for a favourable prognosis of breast cancer patients. It is important to follow the recommendations of your local health organisation and consult your healthcare professional to review your personal history and potential risk factors. Among the screening tests available, many health organizations recommend annual mammogram screening to all women from 50 years of age, or even younger than that.
However, when you have breast implants many questions arise: Do mammogram screening tests change with implants? Do the implants impact the test results? Can the mammogram damage the implants? Is special equipment needed for testing women post breast reconstruction?
Dr. Gianfranco Scaperrotta, Radiologist and Breast Specialist of the National Cancer Institute of Milan answers.
“Women with breast implants do not have a more complex process for breast cancer screening, but rather a more personalized one. The reason is not due to any higher risk for breast cancer: The physical presence of the implant can reduce the sensitivity of the mammogram and the ability to detect any nodules. This reduction in sensitivity is compensated by ultrasound and by relying on competent professionals ".
Do mammogram screening tests change when you have breast implants?
In Italy is alone, every year 55 thousand women are diagnosed with breast cancer, and this statistic is not affected by the presence of breast implants*. By adjusting the screening test, we have similar efficacy with and without implants.
Dr. Scaperrotta elaborates: “That is correct and an important message to convey. In Italy, mammogram screening is recommended for women between 49 and 69 years old. In some regions, screening ranges are even wider (45-75 years old). It is important to note that patients with breast implants following breast reconstruction (for example: after removing a tumor), are excluded from the general screening protocols and instead follow a personalized follow-up plan based on their specific needs.”
And for women who choose breast implants for aesthetic reasons?
“Generally, these are younger women, between the ages of 25 and 35, and therefore have a relatively lower general cancer risk. Over time and with age, the oncological risk increases, and they should follow the general health organization recommendation for mammography screening. Until a few years ago, women with implants were excluded from the general recommendation and were encouraged to perform mammogram and breast ultrasound annually. Today in most regions, also women with breast implants follow the local programmes. For example, in the Italian region of Emilia Romagna women with implants have access to a screening that already includes an ultrasound. It is not because the presence of implants increases the risk of developing a tumor, it is amply demonstrated by literature that this is not the case, but because, as stated above, with implants the ability to detect any tumor lesions with mammography does not reach the sensitivity criteria accepted for adequate screening.”
A question regarding ultrasound, it seems that this test is particularly useful for women with implants. Can you tell us why?
“While mammogram is a very sensitive screening test, it has limitations in cases where the breast tissue is dense or compact. In these cases, ultrasound helps the diagnostician to detect even smaller masses. This applies to all women. The rule is that in the absence of dense breasts, it is not automatically necessary to undergo ultrasound. However, given that implants reduce the ability of mammograms to detect smaller masses, ultrasound is commonly used if implants are present. From 40 years and onwards, the general recommendation for patient with implants is to undergo mammogram and ultrasound annually.”
What about before the age of 40?
“Before the age of 40, a plastic surgeon or breast specialist checkup is often accompanied by ultrasound test. It is not an oncological screening, it is something else: it is useful to check that the implants are in place, that there is no rotation, dislocation, tearing, capsular contractures etc.”
Let's talk about equipment: Can mammogram tests cause damage to the breast implants, given the strong pressure they exert on the breast?
“While ultrasound cannot cause any damage to the implant, mammogram has a potential of such damage: an abrupt, aggressive compression can actually compromise the integrity of the implant. However, it is also true that any radiologist today knows that with implants, the approach must be managed in a different way. In short, it is more a problem of technique than a machinery issue. In newer mammogram machinery we have specific programmes for women with implants: with a click of a button the mammograph automatically applies the right pressure. It goes without saying that it is essential for women to report that they have implants before undergoing a mammogram.”
What can you tell women around the age of 50, who opted for breast implants when they were young and now express greater concern that a possible tumor will not be detected?
“It is true that women share this concern, as a sort of an afterthought. But with a well-managed implant, in a specialized environment, there should not be any compromise with the ability for early detection of breast cancer. The presence of implants does not represent a diagnostic problem.”
What happens when a woman with implants is diagnosed with breast cancer?
“If women with implants develop breast cancer, they may have some additional considerations, not in the diagnostic aspect but surgically. Surgeons do attempt to preserve the existing implant as much as possible, but this is not always successful. If not successful, the implant in the breast affected by the tumor is removed, but then a new one is introduced. And then there is an additional potential concern with radiotherapy, which can cause capsular contracture. Women should be aware of the importance of choosing a facility with a high flow of reconstruction surgeries with implants, and where experienced professionals work.”
Originally published in the Italian blog of mani sul cuore
* I Numeri del Cancro 2020, by AIOM, Italian Association of Medical Oncology