Do Breast Implants Affect Breast Cancer Survival?

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Do Breast Implants Affect Breast Cancer Survival?

An Expert Interview With Jacques Brisson, MD, DSc

Cosmetic breast augmentation is the most popular procedure performed by plastic surgeons worldwide, with 1,205,251 of these procedures reported in an international 2011 survey. The United States had the highest rates, followed by Brazil, China, Japan, and Mexico,[1] and its popularity is increasing everywhere. In 2012, 330,631 breast augmentations were performed in the United States, a 227% increase since 1997. Of those performed, only 28% used saline implants and 72% used silicone.[2]

Information is widely available on the risks and possible adverse outcomes associated with breast augmentation surgery; nonetheless, there is widespread concern about its possible long-term health effects. Epidemiologic studies have shown no increased risk for breast cancer in women with breast implants compared with those without them, but studies on survival after breast cancer diagnosis in women with implants have produced uncertain results.

To address whether consolidated data could show a difference between women with and without breast implants in terms of stage distribution at diagnosis of breast cancer and postdiagnosis survival, Canadian researchers led by Dr. Brisson and Eric Lavigne, PhD, at Laval University, Quebec, carried out a systemic review and quantitative meta-analysis of studies published up to September 2012.[3] Their investigation was supported by funding from the Unité de recherche en santé des populations, Cancer Care Ontario, and the Public Health Agency of Canada.

Through a literature search of Medline, Embase, Global health, CINAHL, IPAB, and PsycINFO, the researchers identified 13 studies in women who had had cosmetic breast augmentation and in whom breast cancer was diagnosed that were eligible for inclusion in the meta-analyses. Most of the studies were done in the United States, and the rest in Canada or Northern Europe.

The first meta-analysis, based on 12 studies, identified a relative risk of 1.26 (95% confidence interval [CI], 0.99-1.60; P=.058) for a nonlocalized stage of breast cancer at diagnosis in women with implants vs women without implants.

This suggested that at diagnosis, women with cosmetic breast implants who are diagnosed with breast cancer tend to have later-stage tumors compared to cases diagnosed among women without implants.

The second meta-analysis, based on 5 of the studies, showed reduced survival after breast cancer among women who had implants compared with those who did not; the overall hazard ratio for breast cancer-specific mortality was 1.38 (95% CI, 1.08 to 1.75).

In the report of their study,[3] Dr. Brisson and his colleagues pointed out limitations specific to their analyses overall, including the possibility of selection bias, misclassification bias, confounding bias that affected individual studies, and the small number of studies used in the second meta-analysis. As a result, “considering the gaps and limitations in the available literature,” their results should be interpreted with caution, they said. However, their findings support other accumulating evidence, and consequently, they believe that “further investigations are warranted into the long-term effects of cosmetic breast implants on the detection and prognosis of breast cancer, adjusting for potential confounders.”

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