3rd March 22:31
Risk of connective tissue disorders among breast implant patients (scleroderma lupus arthritis)
Thanks to Gina for sending us this abstract...Myrl
Am J Epidemiol. 2004 Oct 1;160(7):619-27.
Risk of connective tissue disorders among breast implant patients.
Brinton LA, Buckley LM, Dvorkina O, Lubin JH, Colton T, Murray MC,
Epidemiology and Biostatistics Program, Division of Cancer Epidemiology
and Genetics, National Cancer Institute, Rockville, MD, USA.
In a US retrospective cohort study (1960-1996), 351 (4.8%) of 7,234
patients with breast implants and 62 (2.9%) of 2,138 patients who had
undergone other types of plastic surgery reported subsequent rheumatoid
arthritis (RA), scleroderma, systemic lupus erythematosus, or Sjogren's
syndrome (relative risk = 2.0, 95% confidence interval (CI): 1.5, 2.8).
Risks of RA, scleroderma, and Sjogren's syndrome were elevated both
before and after 1992, when the Food and Drug Administration changed
the status of breast implants to investigational. When records for
these diseases were retrieved (35-40% retrieval rate) and blindly
reviewed, two expert rheumatologists assessed only a minority of the
cases as being "likely" (e.g., regarding RA, 16.5% for implant patients
and 23.5% for comparison patients). Recalculation of incidence rates
using "likely" diagnoses found relative risks of 2.5 (95% CI: 0.8, 7.8)
for RA, scleroderma, and Sjogren's syndrome combined and 1.9 (95% CI:
0.6, 6.2) for RA only. When the proportions deemed "likely" were
applied to all self-reports, the estimated relative risks were 2.0 (95%
CI: 0.7, 5.4) for the three disorders combined and 1.3 (95% CI: 0.5,
3.8) for RA. These results indicate that self-reports of connective
tissue disorders are influenced by reporting and surveillance biases.
Given the diagnostic complexities of these diseases, excess risks, if
they exist, may be beyond detection even in a study of this size.