Do silicone breast implants cause rheumatologic disorders? A systematic review for a court-appointed national science panel.
OBJECTIVE
To assist in evaluating expert testimony and scientific evidence presented in law suits brought against silicone breast implant manufacturers, a US District Court Order established a National Science Panel to assess whether existing studies provide scientific evidence of an association between silicone breast implants and systemic classic/accepted connective disease, atypical connective disease, and certain signs and symptoms identified by plaintiffs in the law suits. Local disorders potentially associated with these implants were not addressed in this review. Therefore, we performed a systematic review of published studies on the association between silicone breast implants and systemic connective tissue disorders.


METHODS
Data from relevant studies (human cohort, case-control, or cross-sectional studies with > or = 10 participants and appropriate controls) were identified through literature searches of Medline, Current Contents, HealthStar, Biological Abstracts, EMBase, Toxline, and Dissertation Abstracts. Two independent reviewers, using standard collection forms, extracted data from the included studies. Adjusted relative risks (RRs) in cohort studies and odds ratios (ORs) in case-control and cross-sectional studies were reported if provided; otherwise, unadjusted RRs and ORs were calculated.


RESULTS
Twenty-four studies meeting inclusion criteria were identified. No association was evident between breast implants and any established or atypical connective tissue disorder. There was discordance among studies in reports of arthralgias, lymphadenopathy, myalgias, sicca symptoms, skin changes, and stiffness.


CONCLUSIONS
The panel found no evidence to support expert testimony suggesting an association between silicone breast implants and connective diseases. Discordance for symptoms may reflect differences in symptoms included in various categories, the small number of cases, and the effect of having single subjects with > 1 symptom represented in analyses of each symptom reported. The process presented here is an early example of the use of independent scientific panels to help courts clarify scientific evidence in legal proceedings.
Tugwell
P
P
Centre for Global Health, University of Ottawa, Institute of Population Health, Ontario, Canada.
Wells
G
G
Peterson
J
J
Welch
V
V
Page
J
J
Davison
C
C
McGowan
J
J
Ramroth
D
D
Shea
B
B
D018427:Breast Implants / Q000009:adverse effects* / Q000706:statistics & numerical data; D016206:Databases, Bibliographic; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D015201:Meta-Analysis as Topic; D012216:Rheumatic Diseases / Q000453:epidemiology / Q000209:etiology*; D012828:Silicones / Q000009:adverse effects*
D012828:Silicones