Home Journal Excerpts Breast Implants Cancer Risk at Sites Other than the Breast Following Augmentation Mammoplasty
Cancer Risk at Sites Other than the Breast Following Augmentation Mammoplasty PDF Print E-mail
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Tuesday, 01 May 2001 00:00
“Silicone breast implants were first introduced in the United States in the early 1960s and became widely sold during the next three decades. Although it has been estimated that between 800,000 and one million women received the devices, there has been limited assessment of their long-term effects. Most attention has focused on connective tissue disorders, but the range of immunologic disturbances observed in women with implants suggests other chronic diseases, including cancer. The greatest attention regarding cancer risk has focused on breast cancer, given clinical reports of an association and observation that mammographic visualization is compromised by implants. Some, although not all, epidemiological studies have suggested that breast cancer risk might be reduced among women with implants, although the biologic mechanism remains undefined.”

“Other cancers have not been well evaluated, despite some animal as well as clinical data to suggest potential risks for selected sites, including sarcomas and certain hematopoietic malignancies. There have only been limited attempts to address the relationships epidemiologically, and the available studies suffer from small numbers of events and absence of information on most potential confounding variables.”

“This retrospective cohort study identified patients from 18 plastic surgery practices in six geographic areas … In order to maximize opportunities for assessing long-term effects, all female subjects who had a first bilateral augmentation Mammoplasty at these practices prior to 1989 were eligible for study inclusion.”

“A total of 3936 comparison subjects were identified for the study. Some subjects had multiple procedures. Prioritizing operations according to the following categories showed that 20.5% had abdominoplasty or liposuction; 34.2% blepharoplasty or rhytidectomy (operations for removal of wrinkles of the face and neck); 28.1% rhinoplasty, otoplasty, mentoplasty, or genioplasty (operations involving the nose, ear, and chin); and 17.2% another type of plastic surgery.”

“Among the implant patients, statistically significant elevations were seen for cancers of the stomach (SIR [Standardized Incidence Ratio] = 2.65, 95% CI 1.0-7.1), cervix (SIR = 3.18, 95% CI 2.3-4.3), vulva (SIR =2.51, 95% CI 1.1-5.6), and brain (SIR = 2.16, 95% CI 1.2-3.9), and for leukemia (SIR = 2.9, 95% CI 1.1-4.4). Non-significant excesses of two-fold or greater were noted for liver and gallbladder (2.56), laryngeal (2.19), and connective tissue (2.48) cancers, although each was based on small numbers of cases. Among the comparison patients, significant excesses were observed for kidney cancers (SIR = 3.22, 95% CI 1.5-6.7), melanoma (SIR = 1.88, 95% CI 1.0-3.4) and eye cancers (SIR = 7.38, 95% CI 1.8-29.5), although the latter estimate was based on only two observed cases.”

“Internal analysis based on comparison subjects, showed no overall excess cancer risk (RR = 1.0, 95% CI 0.9-1.2). This primarily reflected a change in risk from the external analyses for cervical cancer (RR = 1.78, 95% CT 0.7-4.8). Non-significant excesses, however persisted for cancers of the liver and gallbladder (RR = 1.83). Respiratory cancer, which had not been significantly elevated when SEER rates were used to compute expected values, was significantly elevated in the internal analyses (RR = 2.40, 95% CI 1.2-4.7). The majority of these were lung cancers (SMR = 2.23, 95% CI 1.1-4.5).”

“… the respiratory cancer excess was highest among those women with extended follow-up, with the RR being 2.85 among patients with 15 or more years of follow-up. A total of 49.7% of the subjects received silicone gel implants, 34.1% double lumen implants, 12.2% saline implants, 0.1% other types of implants, and 3.8% unspecified type. There was no significant heterogeneity in the risks of all cancers or for the individual sites according to type of implant. We also attempted to evaluate whether the risks were affected by the type of implant cover, since polyurethane-foam coated implants have been shown to leak chemicals shown to be carcinogenic in laboratory animals. However, only 1.3% of the implants were noted to have such covers.”

“In summary, in comparison with the general population, this study, like previous investigations, found excess risks of cervical, vulvar, and lung cancers among women with previous augmentation mammoplasties. Internal comparison of the implant patients with other types of plastic surgery suggested that the excesses of cervical and vulvar cancers may be related to reproductive or lifestyle characteristics of the implant patients, rather than to any effect of their breast implants. Although the internal analyses suggested similar risks for most cancer sites between implant and comparison patients, a few differences persisted, including higher risks for respiratory and brain cancers, and leukemia. That latter excess may be a chance finding, given the histologic diversity of the observed cancers. Reasons for the elevations of respiratory and brain cancers were less apparent.”

Louise A. Brinton, PhD; Jay J. Lubin, PhD; Mary Cay Burich, MA; Theodore Colton, ScD; S. Lori Brown, PhD; and Robert N. Hoover, MD, ScD, "Cancer Risk at Sites Other than the Breast Following Augmentation Mammoplasty", Annals of Epidemiology, May 1, 2001, Vol. 11, Num. 4, pp. 248-256


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Last Updated on Thursday, 25 June 2009 02:23