The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry

BACKGROUND: Women diagnosed with breast carcinoma in situ are at increased risk for developing a contralateral breast cancer. The magnitude of this risk and the relationship between this risk and age, time since diagnosis, histologic subtype, and treatment for the first breast cancer is continuing to be defined. METHODS: The risk of developing a contralateral breast cancer is examined among 4198 women diagnosed with breast carcinoma in situ and reported to the Connecticut Tumor Registry (CTR) between January 1, 1975 and March 14, 1998 using Kaplan-Meier estimation. A Cox proportional hazards model is used to assess the effect of surgical treatment, radiation therapy, age at diagnosis, race, histology, marital status, anatomic location within the breast, and time since diagnosis upon this risk. RESULTS: The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a ductal breast carcinoma in situ (DCIS) were 4.3% (95% confidence interval, 3.6-5.0%) and 6.8% (95% confidence interval, 5.5-8.2%), respectively. These risks are 3.35 times greater than those for women without a history of breast cancer but are similar to those for women diagnosed with non-metastatic invasive ductal carcinomas of the breast. The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a lobular breast carcinoma in situ (LCIS) were 11.9% (95% confidence interval, 9.5-14.3%) and 13.9% (95% confidence interval, 11.0-16.8%), respectively. CONCLUSIONS: Women diagnosed with LCIS were 2.6 (95% confidence interval, 2.0-3.4%) times more likely than women with DCIS to be diagnosed with a contralateral breast cancer within the first six months of the first breast primary. The risk of developing a contralateral breast cancer more than 6 months after the initial breast cancer was independent of surgical or radiation therapy, time since diagnosis, age at diagnosis, histology, race, marital status, or anatomic location of the cancer within the breast.     

Association between mode of breast cancer detection and diagnosis delay

We investigated the association between mode of breast cancer (Bca) detection and diagnosis delay in a case-series of primary, histologically confirmed Bca patients from Southern Italy.Nine hundred and fifty nine women diagnosed with incident, primary Bca were recruited in two southern Italian regions. We grouped the mode of detection into two categories: Self-Detection (S-D) and Mammography (MG). Diagnosis delay was defined as the time between detection and a histologically confirmed diagnosis of invasive Bca.20.9% detected Bca with MG while 79.1% had S-D Bca. Women who detected Bca themselves (S-D) were more likely to delay breast cancer diagnosis than women who were diagnosed by a mammography (MG) (OR: 2.0; 95% CI: 1.39–2.87); when considering the model adjusted for health system-related characteristics, the risk increased (OR: 2.13; 95% CI: 1.47–3.09).Our study indicates a disadvantage in terms of diagnostic delay for women who were admitted and treated in community hospitals compared to women admitted and treated in breast health services.     

Rural-urban differences in the presentation, management and survival of breast cancer in Western Australia

From all women diagnosed with invasive breast cancer in 1999 in Western Australia, rural and urban women were compared with regard to mode of detection, tumour characteristics at presentation, diagnostic investigations, treatment and survival. Women from rural areas with breast cancer (n=206, 23%) were less likely to have open biopsy with frozen section (P<0.001), breast-conserving surgery (P<0.001), adjuvant radiotherapy (P=0.004) and hormonal therapy (P=0.03), and were less likely to be treated by a high caseload breast cancer surgeon (P<0.001). Adjusting for age and tumour characteristics, rural women had an increased likelihood of death within 5 years of breast cancer diagnosis (HR 1.62, 95% CI 1.10-2.38). This difference was not significant after adjustment for treatment factors (HR 1.36, 95% CI 0.90-2.04).     

MAMMOGRAPHIC FOLLOW UP: A VITAL COMPONENT OF BREAST CANCER MANAGEMENT

Women with proven breast cancer are at high risk for development of a second breast malignancy or a recurrence. An important component of clinical care is regular mammographic follow up, to enable pre-clinical diagnosis and avoid delay in treatment. One hundred and forty-two women with previous breast cancer attended a pilot mammographic screening program. Eleven had suspicious mammographic lesions, all clinically occult; nine breast cancers were diagnosed (two recurrences and seven new tumours). The cancer detection rate in this high-risk group of women was 6.3%, compared with 0.8% in 16 283 women screened with no history of breast cancer. Examination of the mammographic history of the 142 women showed that mammography was used infrequently as part of their clinical surveillance, and this led to a delay in diagnosis of the new or recurrent cancer. Recommendations for an appropriate regimen for use of mammography in new and established cases of breast cancer are made.     

In-hospital delay in the diagnosis of breast cancer

BACKGROUND: There is evidence that delay in the diagnosis of breast cancer may prejudice survival. The aim of this study was to determine the incidence, time trends and causes of delay in a dedicated breast clinic. METHODS: The interval between first breast clinic visit and a definitive diagnosis was recorded in all patients with invasive breast cancer between 1988 and 1997. In all patients with a delay of 3 months or more, the case notes were reviewed for evidence of a triple assessment (clinical examination, imaging and needle biopsy). The principal cause of delay was identified. RESULTS: Of 1004 patients with invasive breast cancer, there was a delay in diagnosis of 3 months or more in 42 patients between 1988 and 1997, an incidence of 4.2 per cent. The median delay was 6 months and the median age at diagnosis was 53 (range 27-89) years. Triple assessment was undertaken in 30 patients; ten did not have a needle biopsy performed and three patients had no mammography. The principal cause of delay was: false-negative or inadequate fine-needle aspiration cytology (FNAC) in 19 patients, failure of follow-up in eight, clinical signs did not impress in five, FNAC not carried out in four, false-negative mammogram in three, failure of needle localization in two and one patient did not accept clinical advice. The annual incidence of delay in diagnosis did not change significantly over the 10-year interval. CONCLUSION: Triple assessment is not sufficiently sensitive to detect every breast cancer and a small incidence of diagnostic delay is therefore inevitable with current techniques.     

Safety and efficacy of contra-lateral breast reduction for women with mammary hypertrophy undergoing mastectomy for breast cancer

Women with mammary hypertrophy undergoing mastectomy for breast cancer suffer disability because of disproportionate asymmetry. The case notes of all women with mammary hypertrophy undergoing mastectomy and immediate contra-lateral reduction mammaplasty for primary breast cancer from February 2001 to December 2008 were reviewed. Thirty-three women were identified of whom twenty-seven underwent inferior pedicle reduction mammaplasty and six inferior dermoglandular pedicle reduction with free nipple graft. The duration of surgery ranged from 75 to 146 (median 110) minutes. Between 475 and 2350 (median 1090) grams of breast tissue was excised from the contra-lateral breast. No immediate or delayed complications were observed and there were no delays in commencing adjuvant therapy. Immediate contra-lateral breast reduction in women with mammary hypertrophy undergoing mastectomy for breast cancer is safe and effective means of reducing the physical, psychological and cosmetic problems associated with unilateral mammary hypertrophy following mastectomy.     

There is no difference in survival between African-American and white women with breast cancer

A difference in survival by race in women with breast cancer has been reported. We examined survival of African-American (AA) and white (W) women diagnosed with breast cancer and evaluated variables that may affect survival at a university teaching hospital. A retrospective review of tumor registry data for breast cancer was performed in all AA and W female breast cancer patients diagnosed between the years 1990 and 1999 at a university hospital. Survival between AA and W women diagnosed with breast cancer during that period was compared using Kaplan-Meier analysis. Variables including age and stage of disease at diagnosis, receptor status, treatment, and tobacco exposure were evaluated utilizing Chi-square testing. A P value <0.05 was considered statistically significant. A total of 585 AA and W women were diagnosed with breast cancers between the years 1990 and 1999. Mean ages were 51.8 years for AA and 56.9 years for W (P = 0.001). Overall survival (7.8 years AA and 7.6 years W) and survival by stage were not statistically different between the groups. AA patients were younger (P = 0.001), presented with higher-stage tumors (P = 0.017), more often had positive axillary lymph nodes (P = 0.012), more often were estrogen and progesterone receptor negative (P = 0.004), and more often were premenopausal (P = 0.048). AA women were more likely treated with chemotherapy while W women tended to receive hormone therapy (P = 0.01). Statistical significance was not reached for differences in tumor histology or tobacco exposure. We conclude that despite presenting with worse prognostic indicators AA women experience survival equivalent to their W counterparts.     

Surgical caseload and outcomes for women with invasive breast cancer treated in Western Australia

We have assessed the outcomes for all women diagnosed with invasive breast cancer in Western Australia during 1989, 1994 and 1999, and compared the results for surgeons who treat 20 or more cases per year with those of surgeons who treat less. Women treated by high caseload surgeons were more likely to retain their breast (53.3% vs. 36.7%, p<0.001), have adjuvant radiotherapy (50.0% vs. 30.6%, p<0.001), and be alive after 4 years (1989, 86% vs. 82%; 1994, 89% vs. 84%; 1999, 90% vs. 79%, HR 0.71, p=0.03). Adjusting for age and year of diagnosis, women were not more likely to be treated with adjuvant chemotherapy (29.2% vs. 20.9%, p=0.28). In 1989 35% of women were treated by high caseload surgeons. By 1999 this had risen to 82%. The results confirm that women treated by high caseload surgeons have better outcomes.     

Atypical hyperplasia, proliferative fibrocystic change, and exogenous hormone use

BACKGROUND: The association between breast cancer development and exogenous hormone use (EHU) is suggested by indirect clinical evidence. We undertook this study to better define the relationship that EHU has with proliferative fibrocystic change (PFC) and atypical hyperplasia (AH). METHODS: Women diagnosed with AH without associated carcinoma from January 1990 to December 1999 were compared with control subjects who underwent breast biopsy procedures during the same interval and who were diagnosed with either a proliferative fibrocystic change (PFC) or a nonproliferative fibrocystic change (NPFC). EHU was defined as the use of estrogen or progesterone taken together or separately within 3 months of biopsy. RESULTS: EHU was significantly higher in patients with AH compared with women with NPFC (P =.01). This observation was also significant if all proliferative change (both AH and PFC) was compared with NPFC (P =.03); it was not significant when PFC alone was compared with NPFC. No significant difference in EHU was demonstrated between women with AH and those with PFC. CONCLUSIONS: There is strong association between AH and EHU. These results support the theory that a continuum exists between hyperplasia and carcinoma and that EHU may influence the transition from one to the other in an undefined subset of women. We encourage our patients with AH to discontinue EHU.     

Irregular screening participation increases advanced stage breast cancer at diagnosis: A population-based study

ObjectiveTo evaluate the effect of irregular screening behaviour on the risk of advanced stage breast cancer at diagnosis in Flanders.MethodsAll women aged 50–69 who were invited to the organized breast cancer screening and diagnosed with breast cancer before age 72 from 2001 to 2018 were included. All prevalent screen and interval cancers within 2 years of a prevalent screen were excluded. Screening behaviour was categorized based on the number of invitations and performed screenings. Four groups were defined: regular, irregular, only-once, and never attenders. Advanced stage cancer was defined as a stage III + breast cancer. The association between screening regularity and breast cancer stage at diagnosis was evaluated in multivariable logistic regression models, taking age of diagnosis and socio-economic status into account.ResultsIn total 13.5% of the 38,005 breast cancer cases were diagnosed at the advanced stage. Compared to the regular attenders, the risk of advanced stage breast cancer for the irregular attenders, women who participated only-once, and never attenders was significantly higher with OR_adjusted:1.17 (95%CI:1.06–1.29) and OR_adjusted:2.18 (95%CI:1.94–2.45), and OR_adjusted:5.95 (95%CI:5.33–6.65), respectively.ConclusionsIn our study, never attenders were nearly six times more likely to be diagnosed with advanced stage breast cancer than regular attenders, which was much higher than the estimates published thus far. An explanation for this is that the ever screened women is a heterogeneous group regarding the participation profiles which also includes irregular and only-once attenders. The benefit of regular screening should be informed to all women invited for screening.     

Infectious Complications in Irradiated Breasts Following Conservative Breast Therapy

Abstract: Delayed infectious complications are reported to occur following radiation therapy in women who have undergone conservative breast therapy. Herein, we have reviewed the clinical history of women undergoing conservative therapy in our institution. Of 46 patients treated over a span of 2 years, 13% developed a delayed infectious complication in their irradiated breast ranging from cellulitis to abscess. Onset occurred weeks to months following the completion of radiotherapy. Women experiencing these infections typically had undergone excision of a large volume of breast tissue and had received a radiation boost as part of the radiotherapy technique. Treatment entailed aggressive antibiotic therapy plus drainage of any abscess. All cases resolved; one patient experienced multiple episodes. Resulting cosmetic appearance was often less than ideal. Awareness of this potential problem is important when discussing treatment options with women newly diagnosed with breast cancer, especially those with larger lesions.     

Distress, coping, and social support among rural women recently diagnosed with primary breast cancer

This study examined distress, coping, and group support among a sample of rural women who had been recently diagnosed with breast cancer. We recruited 100 women who had been diagnosed with primary breast cancer at one of two time points in their medical treatment: either within a window up to 3 months after their diagnosis of breast cancer, or within 6 months after completing medical treatment for breast cancer. Their mean age was 58.6 years (SD = 11.6), and 90% were of white/European American ethnicity. Women completed a battery of demographic and psychosocial measures prior to being randomized into a psychoeducational intervention study, and then again 3 months later at a follow-up assessment. The focus of this article is on the women's self-reported psychosocial status at baseline. Many of the women experienced considerable traumatic stress regarding their breast cancer. However, this distress was not reflected in a standard measure of mood disturbance that is frequently used in intervention research (the Profile of Mood States). The average woman considered her diagnosis of breast cancer to be among the four most stressful life events that she had ever experienced. Also, women on average reported a high level of helplessness/hopelessness in coping with their cancer. On average, women felt that they "often" (but not "very often") received instrumental assistance, emotional support, and informational support. Women varied considerably in which kind of social group provided them with the most support, with as many reporting that they found the greatest support in spiritual/church groups or within their family units as with breast or general cancer groups. These results suggest that among these rural women with breast cancer, distress with the diagnosis of breast cancer must be carefully assessed, as women who are highly distressed about their breast cancer may not report general mood disturbance. Furthermore, the kinds of groups that rural women with breast cancer experience as most supportive need to be identified so that psychosocial interventions can be matched to breast cancer patients' individual needs.     

Body weight correlates with mortality in early-stage breast cancer

HYPOTHESIS: Body weight correlates with risk of breast cancer death. DESIGN: A retrospective cohort study using patient medical records, electronic cancer registry data, and archived tissue specimens. SETTING: A 395-bed, comprehensive community hospital. PATIENTS: One thousand three hundred seventy-six women, aged 24 to 81 years, who were diagnosed with breast cancer between January 1, 1988, and December 31, 1995, and for whom complete medical records and adequate tissue specimens existed. MAIN OUTCOME MEASURES: Body weight at the time of diagnosis and patient status (ie, alive and free of breast cancer, living with breast cancer, dead of breast cancer, or dead of other cause) at the time of longest follow-up. Additional data collected, including age at diagnosis, menopausal status, tumor size, tumor grade, lymph node status, stage at diagnosis, race, estrogen-receptor (ER) status, and treatment information, were used to create multivariate Cox proportional hazards models to estimate hazard rate (HR) ratios and 95% confidence intervals (CIs) for breast cancer death. We collected ER status from the patients' medical records, when available, and supplemented the information by using immunohistochemical techniques to determine ER status from archived paraffin-embedded tumor blocks. RESULTS: Patients were followed up for a median of 6.8 years after diagnosis. Two hundred forty-six patients died from breast cancer. Among patients with early-stage disease (I and IIA), we observed a dose-response relationship of increasing weight with increasing likelihood of dying of breast cancer. Compared with women in the lowest category of weight (< 133 lb [60 kg] at diagnosis), women in the highest category (> or = 175 lb [79 kg]) experienced a 2.5-fold increased risk of dying from breast cancer (HR ratio, 2.54 [95% CI, 1.08-6.00]; trend P = .02). Women with ER-negative cancer experienced an approximately 2-fold higher risk of dying from breast cancer compared with women with ER-positive cancer, regardless of stage at diagnosis. Women in the upper 50th percentile of weight with early-stage disease and with ER-negative tumors had a nearly 5-fold increased risk of dying (HR ratio, 4.99 [95% CI, 2.17-11.48]; P for interaction = .10) compared with women in the lower 50th percentile of weight and ER-positive tumors. The results were similar for body mass index, a measure of obesity in which weight is adjusted for height. CONCLUSION: Body weight at diagnosis and ER status are important predictors of breast cancer death in early-stage disease.     

Management and outcomes of isolated axillary node recurrence in breast cancer

HYPOTHESIS: Management strategies affect the outcome of axillary recurrence in breast cancer. DESIGN: Population-based analysis. SETTING: Cancer agency breast cancer database. PATIENTS: Two hundred twenty women diagnosed with stage 0 through III breast cancer between 1989 and 2003 who subsequently developed an isolated axillary relapse. MAIN OUTCOME MEASURES: Overall survival rate and disease-free survival rate according to treatment strategy of the axillary recurrence. RESULTS: Among 19 789 women diagnosed with stage 0 through III breast cancer during the study era, 220 had an isolated axillary recurrence (Kaplan-Meier 5-year isolated axillary relapse rate, 1.0%). The median interval between primary breast cancer diagnosis and axillary recurrence was 2.2 years (range,1.8 months to 11.9 years). Median follow-up time after axillary recurrence was 5.4 years. Treatment for the axillary recurrence included lymph node biopsy (47.3%), complete axillary dissection (25.9%), axillary radiation (65.0%), chemotherapy (24.1%), and hormonal therapy (68.2%). The 5-year Kaplan-Meier overall survival rate estimate after axillary recurrence was 49.3% (95% confidence interval, 42.0-56.3). Median survival time from the isolated axillary recurrence was 4.9 years (range, 2.0 months to 15.1 years). Overall (P < .001) and disease-free (P = .006) survival times were highest in those treated with a combination of surgery and radiation. Other factors associated with improved overall survival rate were an interval from diagnosis to relapse greater than 2.5 years (P = .003), no initial axillary radiation (P < .001), asymptomatic presentation of the recurrence (P = .05), and subsequent systemic treatment (P = .02). CONCLUSIONS: The 5-year isolated axillary recurrence rate of women treated for breast cancer was 1.0%. Multimodality management at the time of recurrence, including axillary surgery, radiation, and systemic therapy, significantly improved overall and disease-free survival.     

The relationships among clinician delay of diagnosis of breast cancer and tumor size, nodal status, and stage

BACKGROUND: The objective of this study was to determine the impact of delay of diagnosis by clinicians on breast cancer prognostic factors and survival. METHODS: The medical records of patients whose breast cancer diagnosis was delayed by clinicians were reviewed. Data collected included primary tumor diameter, number of positive lymph nodes, tumor grade, pathologic stage, length of diagnostic delay, and follow-up status. Data were analyzed for correlations between prognostic factors and length of delay. The Fisher exact test was used to correlate delay and stage with survival. RESULTS: Forty patients had delays from 3 to 36 months. There were no significant correlations between delay and natural log of primary tumor diameter (r = -.16, P = .33), number of positive lymph nodes (r = .22, P = .90), tumor grade (R = -.16, P = .36), or pathologic stage (R = -.09, P = .59). A higher stage correlated with decreased survival (P = .03), but delay did not. CONCLUSIONS: Clinician diagnostic delays of up to 36 months did not correlate with worsening prognostic factors or with survival rates.     

Contralateral Risk-Reducing Mastectomy in Young Breast Cancer Patients with and without Genetic Cancer Risk Assessment

Background  Decisions regarding contralateral risk-reducing mastectomy (CRRM) among women diagnosed with unilateral breast cancer can potentially be influenced by age at diagnosis and other factors. In this study, we examined the use of CRRM before versus after genetic cancer risk assessment (GCRA) in women diagnosed with breast cancer before age 50. Methods  We conducted a retrospective analysis of women with invasive breast cancer diagnosed before age 50 who were seen for GCRA between October 1996 and March 2005. Associations between the presence of generally accepted indications for risk-reducing surgery among women who had CRRM and the timing of GCRA were examined. Results   The cohort included 378 women, of whom 57 had CRRM pre-GCRA and 45 had CRRM post-GCRA after a median follow-up of 26 months. Women who had CRRM pre-GCRA were more likely to not have a generally accepted indication for the procedure than those who did after GCRA (odds ratio [OR] 5.3, 95% confidence interval [95% CI] 1.6–17.8, P = .007). Women diagnosed with breast cancer before BRCA genetic testing became clinically available (1997) were more likely to have had CRRM pre-GCRA than those who were diagnosed more recently (OR 2.9, 95% CI 1.6–5.2, P = .0003). Conclusion   When personal and family history was carefully examined, a substantial proportion of women seen in our clinic did not have a clear indication for CRRM. Decreased use of empiric CRRM among women diagnosed after 1997 may indicate increased awareness and use of GCRA. Thus, judicious application of GCRA may help focus use of surgical risk reduction measures to the most risk-appropriate patients.     

A Population‐Based Cross‐Sectional Study Comparing Breast Cancer Stage at Diagnosis between Immigrant and Canadian‐Born Women in Ontario

There is limited information on stage at breast cancer diagnosis in Canadian immigrant women. We compared stage at diagnosis between immigrant women and Canadian‐born women, and determined whether ethnicity was an independent factor associated with stage. 41,213 women with invasive breast cancer from 2007 to 2012 were identified from the Ontario Cancer Registry. Women were classified as either immigrants or Canadian‐born by linkage with the Immigration, Refugees, and Citizenship Canada's Permanent Resident database. Women's ethnicity was classified as Chinese, South Asian, or remaining women in Ontario. Logistic regression was performed to calculate the odds ratio (OR) of being diagnosed at stage I breast cancer (versus stage II–IV). 4,353 (10.6%) women were immigrants and 36,860 (89.4%) were Canadian‐born women. The mean age at breast cancer diagnosis was 53.5 years for immigrants versus 62.3 years for Canadian‐born women (p < 0.0001). Immigrant women were less likely than Canadian‐born women to be diagnosed with stage I breast cancers (adjusted OR = 0.85; 95% CI: 0.79–0.91; p < 0.0001). The adjusted OR of being stage I was 1.28 (95% CI: 1.14–1.43; p < 0.0001) for women of Chinese ethnicity and was 0.82 (95% CI: 0.70–0.96; p = 0.01) for women of South Asian ethnicity, compared to the remaining women in Ontario. Canadian immigrant women were less likely than Canadian‐born women to be diagnosed with early‐stage breast cancers. Ethnicity was a greater contributor to the stage disparity than was immigrant status. South Asian women, regardless of immigration status, might benefit from increased breast cancer awareness programs.     

Relationship between method of detection of breast cancer and stage of disease, method of treatment, and survival in women aged 40 to 49 years.

The optimal breast cancer screening program for women 40 to 49 years of age remains controversial. To help assess the value of screening mammography for this age group, we studied the relationship between the method of breast cancer detection and stage, therapy, and survival. Cases of breast cancer diagnosed at Sinai Hospital (Detroit, MI) between January 1985 and December 1994 were reviewed. A total of 181 cases involving 40- to 49-year-old women were available for analysis. The distribution of stage of disease significantly differed among the three methods of detection (P<0.0001). Breast-conserving surgery was more commonly performed in cases detected by screening mammography and clinical breast examination than in cases detected by breast self-examination (P = 0.001). Variation in the stage of disease resulted in improved survival for cases detected by screening mammography and clinical breast examination when compared with those detected by breast self-examination (P = 0.019). Women diagnosed with breast cancer between the ages of 40 and 49 years had earlier stage disease, were more likely to be treated with breast-conserving therapy, and had better survival if their disease was first recognized by screening mammography. Screening mammography has an important role for women of this age.     

Augmentation mammoplasty: effect on diagnosis of breast cancer.

Breast augmentation for cosmetic purposes is an increasingly common procedure in the USA and UK. In the USA in 2003, a total of 254 140 breast augmentation procedures were carried out [American Society of Plastic Surgeons, http://www.plasticsurgery.org/news_room/Procedural-Statistics-Press-Kit-Index.cfm9-1-2005; 2006.(1)]. It has been previously estimated that between 1 and 1.5 million women in the USA have prosthetic breast implants [Cook RR, Delongchamp RR, Woodbury M, et al. The prevalence of women with breast implants in the United States, 1989. J Clin Epidemiol 1995;48:519-25.(2)]. The UK National Breast Implant Registry has recorded a rise in the numbers of women receiving breast implants, with over 13 000 procedures registered in 2001; an estimated 77% of these were for cosmetic purposes. No association has been found between the presence of breast implants in a breast and an increased risk of breast cancer, and this subject has been comprehensively reviewed elsewhere [Hoshaw SJ, Klein PJ, Clark BD, et al. Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg 2001;107:1393-407.(3)]. However, as the population of women with breast implants ages, an increasing number of them will develop breast cancer; a reflection of the fact that the incidence of the disease increases with increasing age. Debate continues on the effect of breast implants on the efficacy of mammography in diagnosing breast cancer, and the role of other imaging techniques for this purpose, as well as the limitations that the presence of implants place on percutaneous biopsy techniques. We review the literature on the radiological and tissue diagnosis of breast cancer in women with a history of previous augmentation mammaplasty.