Breast Implant Illness: Are Social Media and the Internet Worrying Patients Sick?

Abstract

Sir: Physicians are seeing an increase in breast implant illness, a phrase describing ill-defined symptoms attributed to breast implants.1,2 Because of extensive media attention on breast implant-related issues, it is understandable why patients may confuse breast implant illness with other breast implant-related diagnoses, including breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of non-Hodgkin lymphoma.3,4 Given the increasing role of online media in disseminating medical information, understanding information regarding breast implant illness on such platforms and how it impacts patients’ understanding of breast implant illness may inform physicians how to more effectively communicate with their patients.3 In this study, we assessed Google Trends and Twitter content to identify catalysts to the increased incidence of breast implant illness. We queried Google Trends for relative search volumes of “breast implant illness” from February of 2018 to 2019. Results demonstrate an exponential increase in search popularity (Fig. 1). Searches peaked during the weeks of January 6 through 13 and February 3 through 10, 2019, correlating with a YouTube influencer’s (a user with power to persuade others through extensive follower networks) interview regarding her personal breast implant illness experience and issuance of the U.S. Food and Drug Administration’s letter raising awareness of BIA-ALCL, respectively.Fig. 1.: Comparison of Google Trends search popularity in the United States for breast implant illness with number of Twitter tweets containing #breastimplantillness in February of 2018 to 2019, by week. There is a positive correlation between Google Trends searches and Twitter tweets (r = 0.689; p < 0.001). Google Trends results demonstrate an exponentially increasing correlation between search popularity and time over the past year (February of 2018 to 2019; r = 0.807, p < 0.001). Google Trends searches peaked during the weeks of January 6, 2019, and February 3, 2019 (popularity, 82 and 100, respectively), an approximately eightfold increase since early 2018. Twitter results show an average of 11 tweets per week, which jumped to a high of 50 tweets the week of February 3, 2019.Twitter data demonstrate a positive correlation between tweets per week involving #breastimplantillness and Google Trends search popularity for breast implant illness (Fig. 1). From February of 2018 to 2019, there were an average of 11 tweets per week hashtagged #breastimplantillness, which jumped to 50 tweets the week of February 3, 2019. A thematic analysis found many tweets concomitantly referenced cancer, breast cancer, BIA-ALCL, and/or lymphoma, and of those, all but one cited non–evidence-based sources (e.g., influencers). Thirty-two percent of tweets the week of February 3, 2019, contained cancer- related terms. Given concomitant use of cancer-related terms with #breastimplantillness on Twitter, breast cancer-related terms were searched on Google Trends to determine correlation with breast implant illness. No correlation was found between breast cancer-related search terms and breast implant illness before the February of 2019 U.S. Food and Drug Administration BIA-ALCL letter; however, after the announcement, all search terms used were positively correlated with breast implant illness (Fig. 2).Fig. 2.: Comparison of Google Trends search popularity in the United States for breast implant illness with breast implant cancer, breast lymphoma, and BIA-ALCL in February of 2019. All search terms were positively correlated with breast implant illness (r = 0.626, r = 0.632, and r = 0.638 respectively; p < 0.001).Breast implant illness has largely been used to describe a spectrum of conditions ranging from vague symptoms (e.g., fatigue) to systemic illnesses (e.g., autoimmune diseases), despite the paucity of data linking these issues to breast implants.1,5 Our data suggest that the online community is also associating breast implant illness with cancer-related terms, particularly after issuance of the U.S. Food and Drug Administration’s BIA-ALCL letter. Several explanations can account for this finding. Individuals using the term breast implant illness may include cancer under the breast implant illness umbrella of symptoms and illnesses, or may be referring to different diagnoses altogether (e.g., BIA-ALCL), perhaps confusing medical terminology. Unfortunately, our sources prevent us from ascertaining users’ definitions of breast implant illness. Furthermore, sampling bias may result from deidentified Google data, tweets with similar topics from the same user, and use of trending hashtags to increase a tweet’s popularity. Nevertheless, our results do show increasing public interest in breast implant illness. It also suggests that influencers and social media are popularizing breast implant illness and perhaps inadvertently perpetuating misconceptions about breast implant illness and breast cancer. Physicians should be aware of these potential misunderstandings to better address patient concerns while delivering appropriate patient-centered care. DISCLOSURE The authors have no financial interest to disclose in relation to the content of this article. Widya Adidharma, M.D.Section of Plastic Surgery>Department of Surgery>University of Michigan>Ann Arbor, Mich. Kyle R. Latack, B.A.>Keck School of Medicine at University of>Southern California>Los Angeles, Calif. Shannon M. Colohan, M.D., M.Sc.>Shane D. Morrison, M.D., M.S.Division of Plastic SurgeryDepartment of SurgeryUniversity of WashingtonSeattle, Wash. Paul S. Cederna, M.D.Section of Plastic SurgeryDepartment of SurgeryUniversity of MichiganAnn Arbor, Mich.