title: A nationwide study of connective tissue disease and other rheumatic conditions among Danish women with long-term cosmetic breast implantation.
abstract: OBJECTIVE
  Numerous epidemiologic studies have demonstrated that breast implants are not associated with connective tissue diseases (CTDs). However, many CTDs are rare, and continued follow-up of women with breast implants is warranted.
  
  
  METHODS
  We extended by 5 years the follow-up of our earlier population-based cohort study of Danish women with cosmetic breast implants (n = 2761) and comparison groups of women with other types of cosmetic surgery (n = 8807). All women were followed from January 1977 through December 2001. Hospitalization and outpatient data for CTD and ill-defined and other rheumatic conditions in the implant and comparison groups were compared with those in the general Danish population. Additionally, CTDs and fibromyalgia were confirmed through medical chart review, and direct comparisons of the breast implant cohort with the comparison cohort were performed.
  
  
  RESULTS
  When compared with general population rates, CTDs were not statistically significantly elevated in either the implant or the comparison cohorts. However, unspecified rheumatism was similarly increased in the implant (standardized rate ratio = 1.9; 95% confidence interval = 1.6 to 2.2) and comparison (standardized rate ratio = 1.5; 95% confidence interval = 1.4 to 1.7) cohorts. In analyses of diagnoses validated by chart review, women with cosmetic breast implants compared with those having other types of plastic surgery or consultation for plastic surgery had no statistically significant excess for any specific confirmed CTD or combined CTDs (hazard ratio = 1.3; 95% CI = 0.9 to 1.9). In addition, there was no relation between breast implants and confirmed fibromyalgia (hazard ratio = 1.2; 95% CI = 0.6 to 2.1).
  
  
  CONCLUSIONS
  This extension of our earlier cohort study further supports the consensus of epidemiologic research that breast implants are unrelated to the development of CTD.
authors.affiliation: International Epidemiology Institute, Rockville, MD 20850, USA.
authors.forename: Jon P
authors.initials: JP
authors.lastname: Fryzek
authors.forename: Lisbet
authors.initials: L
authors.lastname: Holmich
authors.forename: Joseph K
authors.initials: JK
authors.lastname: McLaughlin
authors.forename: Loren
authors.initials: L
authors.lastname: Lipworth
authors.forename: Robert E
authors.initials: RE
authors.lastname: Tarone
authors.forename: Trine
authors.initials: T
authors.lastname: Henriksen
authors.forename: Kim
authors.initials: K
authors.lastname: Kjøller
authors.forename: Søren
authors.initials: S
authors.lastname: Friis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects / Q000706:statistics & numerical data*; D003240:Connective Tissue Diseases / Q000453:epidemiology* / Q000209:etiology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012216:Rheumatic Diseases / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment; D012449:Safety