As a group, women who receive breast implants for cosmetic purposes have numerous demographic, lifestyle, and reproductive differences from women in general, according to a study in today's issue of The Journal of the American Medical Association (JAMA). These average differences, ranging from increased alcohol use and higher sexual activity to a greater use of hair dyes, could confound studies trying to link breast implants to illnesses, say the researchers. But critics of the study argue that the differences are overblown and have been ruled out as confounding factors before.
In their study, researchers led by epidemiologist Linda Cook at the Fred Hutchinson Cancer Research Center in Seattle interviewed 3570 women, including 80 who had augmented their breasts for cosmetic--not reconstructive--purposes, asking them a host of questions about past alcohol and oral contraceptive use, smoking, sexual activity, and abortions. The researchers did not examine the women to determine whether they had had problems with their implants or currently suffered from illnesses.
The researchers found that the 80 women who received breast enlargements were, on average, nearly three times as likely as other women in the survey to consume seven or more alcoholic drinks each week; nine times more likely to have had at least 14 sexual partners; and more than twice as likely to have used birth control pills or to have had an abortion. On the physical side, they were much less likely to be overweight. Failure to consider such differences could cause researchers to over- or underestimate the health risks from implants, say the researchers. Implants have been widely blamed for connective tissue disease: a syndrome of aches, pains, fatigue, and dryness of the eyes and mouth that fails to meet existing criteria for classic rheumatoid diseases such as lupus.
In a commentary accompanying the JAMA study, Deborah J. del Junco, a health scientist at the Veterans Affairs Medical Center in Houston, says the study "brings us back full circle to the original question of long-term health risks associated with breast-implant surgery." But other researchers, such as Gary Solomon, associate director of the Department of Rheumatoid Diseases at the Hospital for Joint Diseases Orthopedic Institute in New York City, believe that confounding factors have been ruled out before. For example, in a 1995 clinical study of 680 women with cosmetic and reconstructive breast implants, Solomon found that both groups of women had "very similar complaints and very similar laboratory findings." Those data "argue against these other [characteristics] as being significant," he says. Nevertheless, Cook says she hopes the new work will prompt researchers to consider other factors when evaluating the health risks of breast implants.