title: Self-reported breast implants and connective-tissue diseases in female health professionals. A retrospective cohort study.
abstract: OBJECTIVE
  To evaluate the association of breast implants with connective-tissue diseases.
  
  
  METHODS
  Retrospective cohort study of 395,543 female health professionals who completed mailed questionnaires for potential participation in the Women's Health Study. A total of 10,830 women reported breast implants and 11,805 reported connective-tissue diseases between 1962 and 1991. Cox proportional hazards regression models were used in analyses.
  
  
  METHODS
  Self-reported connective-tissue diseases.
  
  
  RESULTS
  Compared with women who did not report breast implants, the relative risk (RR) of the combined end point of any connective-tissue disease among those who reported breast implants was 1.24 (95% confidence interval, 1.08 to 1.41, P = .0015). With respect to the individual diseases, the finding for other connective-tissue diseases (including mixed) was statistically significant (P = .017), the findings for rheumatoid arthritis, Sjogren's syndrome, dermatomyositis or polymyositis, or scleroderma were of borderline statistical significance (.05 < P < .10), and the finding for systemic lupus erythematosus was not statistically significant (P = .44). There were no clear trends in RR with increasing duration of breast implants.
  
  
  CONCLUSIONS
  These self-reported data from female health professionals are compatible with prior reports from other cohort studies that exclude a large hazard, but do suggest small increased risks of connective-tissue diseases among women with breast implants. The very large sample size makes chance an unlikely explanation for the results, but bias due to differential overreporting of connective-tissue diseases or selective participation by affected women with breast implants remains a plausible alternative explanation. The major contribution of this and other observational analytic studies has been to exclude large risks of connective-tissue diseases following breast implants.
authors.affiliation: Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA 02215-1204, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Hennekens
authors.forename: I M
authors.initials: IM
authors.lastname: Lee
authors.forename: N R
authors.initials: NR
authors.lastname: Cook
authors.forename: P R
authors.initials: PR
authors.lastname: Hebert
authors.forename: E W
authors.initials: EW
authors.lastname: Karlson
authors.forename: F
authors.initials: F
authors.lastname: LaMotte
authors.forename: J E
authors.initials: JE
authors.lastname: Manson
authors.forename: J E
authors.initials: JE
authors.lastname: Buring
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018427:Breast Implants / Q000009:adverse effects; D015331:Cohort Studies; D003240:Connective Tissue Diseases / Q000209:etiology*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology; D016387:Women's Health