Le GM, O'Malley CD, Glaser S, et al. Breast implants following mastectomy in women with early-stage breast cancer: Prevalence and impact on survival

University of Iowa, Iowa City, Iowa, United States
Breast cancer research: BCR (Impact Factor: 5.49). 02/2005; 7(2):R184-93. DOI: 10.1186/bcr974
Source: PubMed


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.
We 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.
Twenty 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.
In 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.

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Available from: Gem Le, Dec 08, 2014
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    • "Breast cancer is almost always treated with surgery, chemotherapy, radiotherapy, and hormone therapy. Surgical procedures, called mastectomy or lumpectomy, have a role in treating most patients with breast cancer (68). During these procedures, the cancerous lesions are removed from the breast along with some of the surrounding tissue. "
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    • "This finding is not surprising, given that immediate breast reconstruction can interfere with post-mastectomy radiation therapy and that post-mastectomy radiation can adversely affect the aesthetic outcome of an immediate breast reconstruction [13]. Given the myriad of other subtle differences that can affect the treatment course for patients, it might be impossible to completely control for treatment effects within the context of an observational study, as has been reported by Le and colleagues [1]. Thus, a more desirable approach to assessing the long-term effects of reconstructive surgery might be within the context of a clinical trial, where treatment effects can be more fully taken into account. "
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    ABSTRACT: In a large study, published in this issue of Breast Cancer Research, Le and colleagues report that women receiving implants after mastectomies for early-stage breast cancer experience lower breast cancer mortality than women not receiving implants. Assessment of survival patterns among women receiving reconstructive implants is complex given unique patient characteristics, disease attributes, and treatment patterns. The interpretation of reduced mortality from breast cancer must be assessed in light of significantly reduced risks of death from most other causes. In contrast, patients receiving post-mastectomy implants had elevated rates of suicide, consistent with findings among women with cosmetic implants. Additional well-designed investigations are needed to clarify survival patterns among women receiving reconstructive implants.
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