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Breast Implants and Connective Tissue Diseases, Revisited

Several previous meta-analyses have examined whether silicone breast implants cause connective tissue diseases. This new meta-analysis is probably the most comprehensive assessment to date.

Researchers identified 9 cohort studies, 9 case-control studies, and 2 cross-sectional studies. One study (see JW Apr 1 1996, p. 53, accession number 960319002, and JAMA 1996; 275:616) exerted disproportionate influence because of its size (nearly 400,000 women), but it was considered methodologically suspect because it used self-reported diagnoses not verified by medical record review. After excluding this study, researchers found no evidence that breast implants were associated with all connective tissue diseases combined (adjusted relative risk, 0.80) or with specific diseases such as rheumatoid arthritis, systemic lupus, or scleroderma. Inclusion of the JAMA study raised the RR to 1.14 for all connective tissue diseases, a result that just reached statistical significance. In a separate analysis of studies limited to silicone gel implants, there was no increased risk for connective tissue diseases.

Comment: Allegations of an association between silicone breast implants and connective tissue diseases have spawned general debates about the role of scientific evidence in settling legal disputes. In fact, this meta-analysis was prepared by a panel appointed to advise the federal judiciary. The authors conclude that currently available evidence does not support an association between implants and connective tissue diseases.

— AS Brett

Published in Journal Watch General Medicine March 24, 2000

Citation(s):

Janowsky EC et al. Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med 2000 Mar 16 342 781-790.

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Hulka BS et al. Experience of a scientific panel formed to advise the federal judiciary on silicone breast implants. N Engl J Med 2000 Mar 16 342 812-815.

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