Mammography and breast implants

General
There is no evidence that women with breast implants are at increased risk of breast cancer. It is important that all women including those with breast implants participate in a routine programme of breast cancer detection, including both breast self examination and (for women over 50) mammography.

Mammography is a special X-ray examination of breast tissue used in the early detection of breast cancer. The NHS Breast Screening Programme provides free screening every three years for women, in the UK, aged 50 and above. More information on breast screening in the UK can be found on the NHS Breast Screening Programme website:

www.cancerscreening.nhs.uk/breastscreen/index.html

Breast implants
The presence of silicone gel filled breast implants may interfere with standard mammography as silicone is radiopaque, and the physical presence of the implant may obscure part of the breast tissue and distort breast structure. The amount of interference varies depending on a variety of factors including the position of the implant. However studies indicate that breast cancer in women with breast implants is not diagnosed at a later stage compared with women without implants.

Deposits of calcium containing salts (calcification) are known to occur in the tissue around implants. These deposits are believed to increase with time and may remain once the implant has been removed. Although these calcifications are not considered harmful in themselves, they can be seen on mammograms and may interfere with mammographic findings and interpretation of results. Since calcification may also be seen in women with breast cancer, further tests (including a biopsy) may be needed to differentiate between calcification due to breast implant related or cancer.

To increase sensitivity, a different mammographic technique needs to be used in women with breast implants. It is therefore vital that the centre carrying out the mammography is aware of the presence of breast implants (and the type of implant if known) before the mammography takes place. Mobile breast screening units may not have the necessary facilities for screening women with breast implants and it may therefore be necessary to refer these women to a fixed breast screening unit.

Concern regarding the possibility that the pressures used during mammography might damage the implant should not discourage women from undergoing this procedure. There is only anecdotal information in the literature regarding the breast implant rupture during mammography. The radiographer should however take this potential risk into account when performing the mammography.

Both the Royal Collage of Radiologists and the NHS Breast Screening Programme have issued guidance to radiographers on mammography in women with breast implants.

The UK NHS Breast Screening Programme is not designed for detection of implant rupture but rather the early detection of breast cancer.

The breast screening program has published a leaflet for women with breast implants. This leaflet "Breast Implants and Breast Screening" is available from local breast screening units.

References
US Institute of Medicine, Safety of Silicone Breast Implants, National Academy Press Washington DC 1999.

Dominic S Raso et al, Elemental Analysis and Clinical Implications of Calcification Deposits Associated with Silicone Breast Implants, Annals of Plastic Surgery Vol 42 p117-123.

Guidance on Screening and Symptomatic Breast Screening, Board of Faculty of Clinical Radiology.

Information and advice for Radiographers, NHS Breast Screening Programme, NHSBSP Publication No 19 October 1997, Appendix 3.

S J Hoshaw et al, Breast implants and cancer: Causation, delayed detection and survival, Plastic and Reconstructive Surgery 2001 107, 1393-1408.