Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival.
BACKGROUND
Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects.


METHODS
We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco-Oakland, in Seattle-Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics.


RESULTS
Twenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43-0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41-0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival.


CONCLUSIONS
In a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old.
Le
Gem M
GM
Northern California Cancer Center, Fremont, California, USA. gle@nccc.org
O'Malley
Cynthia D
CD
Glaser
Sally L
SL
Lynch
Charles F
CF
Stanford
Janet L
JL
Keegan
Theresa Hm
TH
West
Dee W
DW
D000328:Adult; D018427:Breast Implants; D001943:Breast Neoplasms / Q000401:mortality* / Q000523:psychology / Q000601:surgery*; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data*; D013405:Suicide; D016019:Survival Analysis
Plast Reconstr Surg. 2000 Feb;105(2):535-40
10697158
Plast Reconstr Surg. 1998 Jun;101(7):1810-8
9623821
N Engl J Med. 2000 Mar 16;342(11):781-90
10717013
Plast Reconstr Surg. 2000 Sep;106(4):769-76
11007387
Cancer Causes Control. 2000 Oct;11(9):819-27
11075871
J Am Coll Surg. 2001 Jan;192(1):1-8
11192909
Plast Reconstr Surg. 2001 May;107(6):1393-407
11335807
Plast Reconstr Surg. 2001 May;107(6):1409-12
11335808
Epidemiology. 2001 May;12(3):321-6
11337605
Plast Reconstr Surg. 2001 Jul;108(1):73-7
11420507
Ann Surg Oncol. 2001 Aug;8(7):586-91
11508620
Epidemiology. 2002 May;13 Suppl 3:S34-9
12071482
Cancer. 2003 Mar 1;97(5):1303-11
12599239
Plast Reconstr Surg. 2003 Mar;111(3):1060-8
12621175
BMJ. 2003 Mar 8;326(7388):527-8
12623911
Plast Reconstr Surg. 2003 Jul;112(1):83-90
12832880
Plast Reconstr Surg. 2003 Aug;112(2):467-76
12900604
BMJ. 2003 Oct 25;327(7421):947
14576229
Lancet. 2003 Oct 25;362(9393):1384
14594002
J Chronic Dis. 1982;35(8):675-83
7096531
Plast Reconstr Surg. 1985 Sep;76(3):415-20
4034759
Plast Reconstr Surg. 1991 Jan;87(1):1-7; discussion 8-9
1984252
Am J Epidemiol. 1992 Mar 15;135(6):609-18
1580237
Plast Reconstr Surg. 1993 Oct;92(5):795-800
8415960
Plast Reconstr Surg. 1994 Jul;94(1):115-9
8016223
Plast Reconstr Surg. 1995 Sep;96(3):513-8; discussion 519-20
7638276
Plast Reconstr Surg. 1996 Feb;97(2):269-75
8559808
Ann Plast Surg. 1995 Nov;35(5):458-68
8579262
Ann Intern Med. 1996 Apr 15;124(8):744-56
8633836
N Engl J Med. 1997 Mar 6;336(10):677-82
9041097
Am Surg. 1998 Dec;64(12):1195-9
9843345
Plast Reconstr Surg. 1997 Apr;99(5):1346-53
9105362