From the Guidelines
Yes, a 48-year-old woman with breast implants can undergo a mammogram. According to the most recent guidelines, women with breast implants should continue regular breast cancer screening, including mammograms 1. The procedure requires special techniques called implant displacement views, where the technologist will take additional images by pushing the implant back against the chest wall and pulling the breast tissue forward. This allows better visualization of the breast tissue that might otherwise be obscured by the implant.
Some key points to consider:
- Inform the mammography facility in advance about having implants so they can schedule adequate time and ensure a technologist experienced with imaging implants performs the exam.
- Modern techniques have improved visualization significantly, despite implants making mammogram interpretation more challenging.
- Some women with implants may experience mild discomfort during the procedure as the breast tissue needs to be manipulated around the implant, but this is temporary.
- Regular screening remains essential as women with implants still face breast cancer risks, and mammography remains the most effective screening tool available.
It's also important to note that the American College of Radiology recommends annual screening mammography beginning no later than 40 years of age for women at intermediate risk 1. Women should continue screening mammography as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified.
In terms of specific guidelines for women with breast implants, the ACR Appropriateness Criteria for breast implant evaluation recommends that asymptomatic women with saline or silicone implants do not require routine imaging for implant evaluation 1. However, for women with suspected implant complications, imaging modalities such as mammography, ultrasound, or MRI may be recommended.
Overall, the benefits of regular mammography screening in women with breast implants outweigh the potential risks, and annual screening mammography is recommended for women 40-84 years of age 1.
From the Research
Mammography for Women with Breast Implants
- A 48-year-old woman with breast implants can undergo a mammogram, but special mammographic views are indicated to enhance accuracy 2.
- There are no specific breast cancer screening recommendations for patients with breast implants, but mammography is still a viable option 2.
- The sensitivity of mammography for detecting breast cancer is lower compared to other modalities like MRI, with an overall sensitivity of 54.5% (range 27%-86.8%) 3.
- However, mammography can still be useful in detecting breast implant ruptures, with a sensitivity of 70% and a specificity of 93% in diagnosing intact implants 4.
Alternative Imaging Modalities
- MRI is the most sensitive modality for detecting breast cancer, with an overall sensitivity of 94.6% (range 85.7%-100%) 3.
- MRI is also the most sensitive modality for detecting breast implant ruptures, with a sensitivity of 99% 4.
- Ultrasound can be a reliable imaging method for patients younger than 50 years, with a sensitivity of 67.2% (range 26.9%-87.5%) for detecting breast cancer 3.
- Combining multiple imaging modalities, such as MRI, ultrasound, and mammography, can increase diagnostic accuracy compared to using a single modality alone 3, 4.
Considerations for Women with Breast Implants
- Women with breast implants should undergo routine screening for implant rupture with MRI or ultrasonography completed five to six years postoperatively and then every two to three years thereafter 2.
- Special consideration should be given to the type of implant, breast density, and patient history when selecting an imaging modality 3, 4.
- The use of contrast-enhanced mammography (CE-MM) and MRI (CE-MRI) can also be considered, especially in cases where there are contraindications to MRI or in dense breast tissue 3.