Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studiesBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2399 (Published 30 April 2013) Cite this as: BMJ 2013;346:f2399
- Eric Lavigne, epidemiologist12,
- Eric J Holowaty, adjunct professor3,
- Sai Yi Pan, epidemiologist2,
- Paul J Villeneuve, senior research scientist34,
- Kenneth C Johnson, adjunct professor5,
- Dean A Fergusson, senior scientist and director6,
- Howard Morrison, director2,
- Jacques Brisson, full professor1
- 1Centre de recherche du CHU de Québec, Faculté de médecine, Université Laval, Quebec, QC, Canada
- 2Public Health Agency of Canada, Ottawa, ON, Canada
- 3Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- 4Population Studies Division, Health Canada, Ottawa, ON, Canada
- 5Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
- 6Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Correspondence to: E Lavigne, Unité de recherche en santé des populations (URESP), Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Quebec, QC, Canada G1S 4L8
- Accepted 5 April 2013
Objectives To evaluate whether the stage distribution among women diagnosed as having breast cancer differs between those who have received breast implants for cosmetic purposes and those with no implants and to evaluate whether cosmetic breast augmentation before the detection of breast cancer is a predictor of post-diagnosis survival.
Design Systematic review of observational studies with two meta-analyses.
Data sources Systematic search of the literature published before September 2012 conducted in Medline, Embase, Global health, CINAHL, IPAB, and PsycINFO.
Study selection Eligible publications were those that included women diagnosed as having breast cancer and who had had augmentation mammaplasty for cosmetic purposes.
Results The overall odds ratio of the first meta-analysis based on 12 studies was 1.26 (95% confidence interval 0.99 to 1.60; P=0.058; I2=35.6%) for a non-localized stage of breast cancer at diagnosis comparing women with implants who had breast cancer and women without implants who had breast cancer. The second meta-analysis, based on five studies, evaluated the relation between cosmetic breast implantation and survival. This meta-analysis showed reduced survival after breast cancer among women who had implants compared with those who did not (overall hazard ratio for breast cancer specific mortality 1.38, 95% confidence interval 1.08 to 1.75).
Conclusions The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.
We thank Melanie Weger, reference librarian at Health Canada, for doing the search of the scientific literature and Anne Rosenberg for sharing data on a previous publication.
Contributors: EL, JB, and EJH were responsible for study concept and design and supervised the study. EL and SYP acquired the data, which was analyzed and interpreted by EL, JB, EJH, SYP, PJV, KCJ, DAF, and HM. EL drafted the manuscript, which was critically revised for important intellectual content by EL, JB, EJH, SYP, PJV, KCJ, DAF, and HM. EL did the statistical analysis with supervision from JB, EJH, and DAF. EL is the guarantor.
Funding: This work was supported through scholarship grants by the Unité de Recherche en Santé des Populations, Cancer Care Ontario, and the Public Health Agency of Canada.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organization that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: No additional data available.
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