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1 24th January 08:41
pureheart
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Default Effect of Breast Augmentation on the Accuracy of Mammography and Cancer Characteristics (breast cancer)


Vol. 291 No. 4, January 28, 2004


Effect of Breast Augmentation on the Accuracy of Mammography and
Cancer Characteristics

Diana L. Miglioretti, PhD; Carolyn M. Rutter, PhD; Berta M. Geller,
EdD; Gary Cutter, PhD; William E. Barlow, PhD; Robert Rosenberg, MD;
Donald L. Weaver, MD; Stephen H. Taplin, MD; Rachel Ballard-Barbash,
MD, MPH; Patricia A. Carney, PhD; Bonnie C. Yankaskas, PhD; Karla
Kerlikowske, MD

JAMA. 2004;291:442-450.

Context Breast augmentation is not associated with an increased risk
of breast cancer; however, implants may interfere with the detection
of breast cancer thereby delaying cancer diagnosis in women with
augmentation.

Objective To determine whether mammography accuracy and tumor
characteristics are different for women with and without
augmentation.

Design, Setting, and Participants A prospective cohort of 137 women
with augmentation and 685 women without augmentation diagnosed with
breast cancer between January 1,1995, and October 15, 2002, matched
(1:5) by age, race/ethnicity, previous mammography screening, and
mammography registry, and 10 533 women with augmentation and 974 915
women without augmentation and without breast cancer among 7
mammography registries in Denver, Colo; Lebanon, NH; Albuquerque, NM;
Chapel Hill, NC; San Francisco, Calif; Seattle, Wash; and Burlington,
Vt.

Main Outcome Measures Comparison between women with and without
augmentation of mammography performance measures and cancer
characteristics, including invasive carcinoma or ductal carcinoma in
situ, tumor stage, nodal status, size, grade, and estrogen-receptor
status.

Results Among asymptomatic women, the sensitivity of screening
mammography based on the final assessment was lower in women with
breast augmentation vs women without(45.0% [95% confidence interval
{CI}, 29.3%-61.5%] vs 66.8% [95% CI,60.4%-72.8%]; P = .008), and
specificity was slightly higher in women with augmentation (97.7% [95%
CI, 97.4%-98.0%] vs 96.7% [95% CI, 96.6%-96.7%]; P<.001). Among
symptomatic women, both sensitivity and specificity were lower for
women with augmentation compared with women without but these
differences were not significant. Tumors were of similar stage, size,
estrogen-receptor status, and nodal status but tended to be lower
grade (P = .052) for women with breast augmentation vs without.

Conclusions Breast augmentation decreases the sensitivity of
screening mammography among asymptomatic women but does not increase
the false-positive rate. Despite the lower accuracy of mammography in
women with augmentation, the prognostic characteristics of tumors are
not influenced by augmentation.


Author Affiliations: Center for Health Studies, Group Health
Cooperative (Drs Miglioretti, Rutter, Barlow, and Taplin), Department
of Biostatistics, University of Washington (Drs Miglioretti, Rutter,
and Barlow), and Cancer Research and Biostatistics (Dr Barlow),
Seattle, Wash; Health Promotion Research (Dr Geller) and Department of
Pathology (Dr Weaver), University of Vermont, College of Medicine,
Burlington; Center for Research Design and Statistical Methods,
University of Nevada School of Medicine, Applied Research Facility,
Reno (Dr Cutter); Department of Radiology, University of New Mexico,
Health Sciences Center, Albuquerque (Dr Rosenberg); Applied Research
Program, Department of Cancer Control and Population Sciences,
National Cancer Institute, Bethesda, Md (Dr Ballard-Barbash); Norris
Cotton Cancer Center, Dartmouth-Hitch**** Medical Center, Department
of Community and Family Medicine, Dartmouth Medical School, Lebanon,
NH (Dr Carney); Department of Radiology, University of North
Carolina, Chapel Hill (Dr Yankaskas); and General Internal Medicine
Section, Department of Veterans Affairs and Department of Medicine
and Epidemiology and Biostatistics, University of California, San
Francisco (Dr Kerlikowske). Dr Taplin is now at the Applied Research
Program, Department of Cancer Control and Population Sciences,
National Cancer Institute, Bethesda, Md.

http://jama.ama-assn.org/cgi/content/abstract/291/4/442?ct
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