Association of silicone breast implants with immunologic abnormalities: a prospective study

Abstract

Purpose: To study the possible association of silicone-breast-implant exposure and immunologic abnormalities within the Nurses’ Health Study, an ongoing prospective cohort study of women. Subjects and Methods: From this cohort, we randomly selected 200 women who had been exposed to silicone breast implants and who had never reported connective tissue diseases during 14 years of follow-up, and 500 age-matched, nonexposed women, including 100 with definite connective tissue diseases validated by medical record review, 100 with at least one symptom of a connective tissue disease, 100 with diabetes, and 200 healthy controls. Assays for antinuclear antibodies (ANA), including anti-dsDNA, anti-ssDNA, anti-Sm/RNP/Ro/La, and anti-Scl-70, rheumatoid factor, immunoglobulins, serum complement, and C-reactive protein level, and anticardiolipin, antithyroglobulin, antithyroid microsomal, and antisilicone antibodies were performed by standard techniques in blood samples collected in 1989 or 1990 before collection of silicone-breast-implant exposure data in 1992. Results: ANA was positive (≥1:40) in 14% of women with silicone breast implants compared with 20% of healthy women ( P = 0.11). Rheumatoid factor was positive (≥1:40) in 5% of women with silicone breast implants and 2% of healthy women ( P = 0.16). Women with silicone breast implants had a significantly higher frequency of anti-ssDNA antibodies than healthy women (41% and 29%, P = 0.012). Duration of implant was associated with a higher frequency of anti-ssDNA antibodies ( P = 0.03) but not with ANA or rheumatoid factor. No other significant differences in the frequencies of autoantibodies were observed in silicone breast implant–exposed women. Antisilicone antibodies were not found in any sample. Conclusion: We found no increased frequency of any immunologic abnormalities in women exposed to silicone breast implants, except for anti-ssDNA, which has unknown clinical relevance.