Incidence of Breast and Other Cancers Among Finnish Women with Cosmetic Breast Implants, 1970–1999

Pukkala, Eero; Boice, John D.; Hovi, Sirpa-Liisa; Hemminki, Elina; Asko‐Seljavaara, Sirpa; Keskimäki, Ilmo; McLaughlin, Joseph K.; Pakkanen, Matti; Teppo, Lyly

doi:10.1615/jlongtermeffmedimplants.v12.i4.60

Cited by 46 publications

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“…In the large Canadian study, 19 3 cases of multiple myeloma were observed (SIR 5 0.46; 95% CI 0.09-1.33). Similarly, in the US breast implant cohort 29 and a recent Finnish study of 2,171 women with cosmetic breast implants, 24 no multiple myeloma was observed (compared with 1.73 and 0.2 expected, respectively).…”

Section: Discussionmentioning

confidence: 76%

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Cancer among Scandinavian women with cosmetic breast implants: A pooled long‐term follow‐up study

Lipworth

Tarone

Friis

et al. 2008

Intl Journal of Cancer

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No increased risks of specific types of cancer following breast implantation have been consistently reported, but data on risk beyond 15 years are limited. We have pooled the results of 2 nationwide cohort studies of 3,486 Swedish and 2,736 Danish women who underwent cosmetic breast implantation between 1965 and 1993. Cancer incidence through 2002 was ascertained through nationwide cancer registries. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated to compare cancer incidence among women with implants with women in the general population. Mean duration of follow up was 16.6 years (range 0.1-37.8 years). Over 50% of women were followed for 15 years or more after breast implantation and 13.3% for at least 25 years. There was a reduced incidence of breast cancer (SIR 5 0.73; 95% CI 0.58-0.90), whereas lung cancer was above expectation (SIR 5 1.64; 95% CI 1.10-2.36). The increased risk of lung cancer is expected due to the high prevalence of smoking among the women with implants in our study. With respect to other site-specific cancers, no significantly increased or decreased SIR was observed. This study, which includes women followed for almost 4 decades, represents the longest follow up of women with cosmetic breast implants to date. The results provide no evidence of an association between breast implants and any type of cancer. ' 2008 Wiley-Liss, Inc.Key words: breast implants; cancer incidence; epidemiology; cohort study Based on the results of numerous epidemiologic studies and independent scientific reviews, 1-6 there is no evidence for an association between cosmetic breast implants and the occurrence of breast cancer. In fact, women with cosmetic breast implants consistently have a lower than average risk for breast cancer. Concerns about other types of cancer have been raised by reports of silicone-induced plasmacytomas in genetically susceptible mice, 7 and by anecdotal reports of lymphoma and multiple myeloma in women with cosmetic breast implants. [8][9][10][11] However, no increased risks of specific types of cancer have been consistently reported in epidemiologic studies.We pooled the results of 2 nationwide cohort studies of women with cosmetic breast implants in Sweden 12 and Denmark. 13 This analysis based on 6,222 women with over 100,000 person-years of follow up, including women followed for more than 37 years after implantation, represents the longest follow up of women with cosmetic breast implants published to date, thus allowing us to present risk estimates for numerous additional cancer sites with too few cases to be included in the original reports. Material and methods Breast implant cohortsDetails about study cohorts and methods have been presented elsewhere. 12,13 Briefly, the studies were conducted in Sweden and Denmark using essentially complete nationwide population-and health care registers, including Hospitalization Registers, Cancer Registers, Death Registers, Migration Registers, and Population Registers. Unique personal identifiers assigned ...

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Section: Discussionmentioning

confidence: 76%

“…19,[24][25][26][27][28] In the most recent update of the single original study reporting a brain cancer excess, 29,30 no additional deaths from brain cancer were observed (SMR 5 1.4; 95% CI 0.8-2.5). 31 Concerns about multiple myeloma are not supported by epidemiologic studies.…”

Section: Discussionmentioning

confidence: 99%

Cancer among Scandinavian women with cosmetic breast implants: A pooled long‐term follow‐up study

Lipworth

Tarone

Friis

et al. 2008

Intl Journal of Cancer

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“…Women diagnosed with Ductal Carcinoma in situ were excluded from the analysis, so as to be consistent with our earlier article (21) and previous investigations (9,12).…”

Section: Ascertainment Of Breast Cancer Prognostic Factorsmentioning

confidence: 78%

“…Only 3 publications, including our previous report, showed a statistically significant shift toward more advanced breast tumors at diagnosis among augmented women (19)(20)(21). However, several other publications reported no statistically significant differences in breast cancer stage at diagnosis comparing augmented to nonaugmented women (6,9,12,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Furthermore, specific implant characteristics such as implant volume and placement might affect the detection of breast cancer (36).…”

Section: Introductionmentioning

confidence: 75%

“…Public health concern arose in the past decades about possible long-term health effects of breast augmentation (1,(3)(4)(5). Numerous epidemiologic investigations focused on long-term cancer risk, especially for breast carcinoma because of the proximity of the tissue to the implant (6)(7)(8)(9)(10)(11)(12). However, studies showed either no association or a negative association between breast implants and breast cancer development (6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Do Breast Implants Adversely Affect Prognosis among Those Subsequently Diagnosed with Breast Cancer? Findings from an Extended Follow-Up of a Canadian Cohort

Lavigne

Holowaty

Pan

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Cosmetic breast implants may impair the ability to detect breast cancers. The aims of this study were to examine whether implants and implant characteristics are associated with more advanced breast tumors at diagnosis and poorer survival.Methods: Study population includes all invasive breast cancer cases diagnosed during follow-up of the large Canadian Breast Implant Cohort. A total of 409 women with cosmetic breast implants and 444 women with other cosmetic surgery were diagnosed with breast cancer. These women were compared for stage at diagnosis using multinomial logistic regression models. Cox proportional hazards regression models were used for breast cancer-specific mortality analyses. Comparisons were also conducted according to implant characteristics.Results: Compared with women with other cosmetic surgery, those with cosmetic breast implants had at later stage breast cancer diagnosis (OR of having stage III/IV vs. stage I at diagnosis: 3.04, 95% confidence interval (CI): 1.81-5.10; P < 0.001). A nonstatistically significant increase in breast cancer-specific mortality rate for women with breast implants relative to surgical controls was observed (HR ¼ 1.32, 95% CI: 0.94-1.83, P ¼ 0.11). No statistically significant differences in stage and breast cancer mortality were observed according to implant characteristics.Conclusions: At diagnosis, breast cancers tended to be at more advanced stages among women with cosmetic breast implants. Breast cancer-specific survival was lower in these women although the reduction did not reach statistical significance.Impact: Further investigations of the effect of breast implants on breast cancer prognosis are warranted. Cancer Epidemiol Biomarkers Prev; 21(10); 1868-76. Ó2012 AACR.

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Cancer risk among Danish women with cosmetic breast implants

Friis

Hölmich

McLaughlin

et al. 2005

Intl Journal of Cancer

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The available epidemiologic evidence does not support a carcinogenic effect of silicone breast implants on breast or other cancers. Data on cancer risk other than breast cancer are limited and few studies have assessed cancer risk beyond 10-15 years after breast implantation. We extended follow-up of our earlier cohort study of Danish women with cosmetic breast implants by 7 years, yielding 30 years of follow-up for women with longest implant duration. The study population consisted of women who underwent cosmetic breast implant surgery at private clinics of plastic surgery (n 5 1,653) or public hospitals (n 5 1,110), and a control group of women who attended private clinics for other plastic surgery (n 5 1,736), between 1973-95. Cancer incidence through 2002 was ascertained using the Danish Cancer Registry. Risk evaluation was based on computation of standardized incidence ratios (SIR) and Cox proportional hazards models, adjusting for age, calendar period and reproductive history. We observed 163 cancers among women with breast implants compared to 136.7 expected based on general population rates (SIR 5 1.2; 95% confidence interval [CI] 5 1.0-1.4), during a mean follow-up period of 14.4 years (range 5 0-30 years). Women with breast implants experienced a reduced risk of breast cancer (SIR 5 0.7; 95% CI 5 0.5-1.0), and an increased risk of non-melanoma skin cancer (SIR 5 2.1; 95% CI 5 1.5-2.7). Stratification by age at implantation, calendar year at implantation and time since implantation showed no clear trends, however, the statistical precision was limited in these analyses. When excluding non-melanoma skin cancer, the SIR for cancer overall was 1.0 (95% CI 5 0.8-1.2). With respect to other site-specific cancers, no significantly increased or decreased SIR were observed. Similar results were found when directly comparing women who had implants at private clinics with women who attended private clinics for other plastic surgery, with rate ratios for cancer overall, breast cancer and non-melanoma skin cancer of 1.1 (95% CI 5 0.8-1.6), 0.7 (95% CI 5 0.4-1.3) and 1.5 (95% CI 5 0.8-2.7), respectively. In conclusion, our study lends further support to the accumulating evidence that silicone breast implants are not carcinogenic. Reasons for the consistently reported deficit of breast cancer among women with breast implants remain unclear, whereas increased exposure to sunlight may explain the excess occurrence of non-melanoma skin cancer. We found no indication of delayed diagnosis of breast cancer due to the presence of breast implants. ' 2005 Wiley-Liss, Inc.Key words: breast implants; cancer incidence; risk; epidemiology; cohort studyThe carcinogenic potential of silicone has been questioned since the 1950s when silicone and other foreign materials were found to induce sarcomas in rodents.1,2 Such foreign body carcinogenesis, however, occurs in rodents with exposure to a wide array of substances, and there is no convincing evidence that a similar risk exists in humans.3,4 Silicone has also been reported to induc...

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Incidence of Breast and Other Cancers Among Finnish Women with Cosmetic Breast Implants, 1970–1999

Cited by 46 publications

References 0 publications

Cancer among Scandinavian women with cosmetic breast implants: A pooled long‐term follow‐up study

Cancer among Scandinavian women with cosmetic breast implants: A pooled long‐term follow‐up study

Do Breast Implants Adversely Affect Prognosis among Those Subsequently Diagnosed with Breast Cancer? Findings from an Extended Follow-Up of a Canadian Cohort

Cancer risk among Danish women with cosmetic breast implants

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