Implant-displacement views alone for breast cancer screening in women with implants: a multicenter retrospective study

To evaluate the necessity of breast implant-inclusion (BII) views in breast cancer screening for women with breast implants. This retrospective study was conducted on patients who underwent full-field digital mammography, including four BII and four implant-displacement (BID) views, at three institutions in South Korea between January 2009 and December 2020. The true positive rate and radiologic findings were assessed and compared between BII and BID views. Factors associated with the change in suspicion level of malignancy and radiation dose were analyzed. Of the total 1470 patients (45.6 ± 8.4 years) evaluated, 215 were diagnosed with breast cancer (15%), and the cancer was not demonstrable in 37 cases in both BII and BID views. The true positive rates of the BII and BID views were 54% (116/215) and 83% (178/215), respectively ( p < 0.01). The suspicion level of malignancy increased in 72% (129/178) and remained unchanged in 28% (49/178) in BID view compared to BII view. The implant location and tumor size differed between the increased suspicion and unchanged groups ( p = 0.01 and < 0.01, respectively). The radiation dose per breast was 1.2 ± 0.5 mGy and 1.1 ± 0.4 mGy in BII and BID views ( p < 0.01), respectively. BID view alone may be sufficient for breast cancer screening in women with breast implants while minimizing radiation exposure, particularly in those with subpectoral implants. Question Does the implant-inclusion view provide additional diagnostic value over the implant-displacement view in breast cancer screening for women with breast implants? Findings Implant-displacement view demonstrated a higher true positive rate and lower radiation dose than implant-inclusion view, with no cancers detected exclusively by implant-inclusion view. Clinical relevance Screening with implant-displacement view alone in women with breast implants is sufficient for cancer detection while reducing radiation exposure—particularly in those with subpectoral implants, supporting a protocol that benefits patient safety and clinical efficiency.