Abstract
BackgroundFew studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects.MethodsWe analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco–Oakland, in Seattle–Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics.ResultsTwenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43–0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41–0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival.ConclusionsIn a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old.
Highlights
Over the past 30 years, an estimated 1.5–2 million women have received breast implants in the United States [1]
Postmastectomy breast implants were used by one-fifth of patients who were slightly younger at diagnosis and were more likely to be of white race/ethnicity and to have in situ disease than women without implants
Because of the relatively small percentage of patients lost to follow-up, we know that bias due to loss to follow-up has little impact on our survival findings since we found no substantial change in hazards ratios when we assumed the worst-case scenario that all patients lost to follow-up had all died or assumed that all patients lost to follow-up all lived until the end of the study period
Summary
Over the past 30 years, an estimated 1.5–2 million women have received breast implants in the United States [1]. Little research has addressed long-term survival, the few studies conducted suggest that use of implants for breast reconstruction does not impact patient survival [6,7,8,9]. These studies were limited by comprising clinic-based samples not necessarily representative of all patients, by small sample sizes, by lack of information on type of implant, and by short durations of follow-up. Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects
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