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Excess Mortality From Suicide and Other External Causes of Death Among Women With Cosmetic Breast Implants

Lipworth, Loren ScD*‡; Nyren, Olof MD†§; Ye, Weimin PhD§; Fryzek, Jon P. PhD*†; Tarone, Robert E. PhD*†; McLaughlin, Joseph K. PhD*†

doi: 10.1097/SAP.0b013e318052ac50
Original Article

An increased rate of suicide among women with cosmetic breast implants has been consistently reported in the epidemiologic literature. We extended by 8 years the follow-up of our earlier mortality study of a nationwide cohort of 3527 Swedish women with cosmetic breast implants to examine in greater detail suicide and other causes of death. The number of deaths observed among these women was compared with the number expected among the age- and calendar-period-matched general female population of Sweden. Women with breast implants were followed for over 65,000 person-years, with a mean follow-up of 18.7 years (range, 0.1–37.8 years). Overall, 175 deaths occurred among women with breast implants versus 133.4 expected (standardized mortality ratio (SMR) = 1.3; 95% confidence interval [CI], 1.1–1.5). Among women with implants, we observed statistically significant 3-fold excesses of suicide (SMR, 3.0; 95% CI, 1.9–4.5) and deaths from alcohol or drug dependence (SMR, 3.1; 95% CI, 1.0–7.3), as well as an excess of deaths from accidents and injuries consistent with substance abuse or dependence. The increased risk of suicide was not apparent until 10 years after implantation. Deaths from cancer overall were close to expectation (SMR, 1.1; 95% CI, 0.8–1.4). Women with cosmetic implants had elevated SMRs for lung cancer and chronic respiratory disease. There was no excess of breast cancer mortality. The excess of deaths from suicides, drug and alcohol abuse and dependence, and other related causes suggests significant underlying psychiatric morbidity among these women. Thus, screening for preimplant psychiatric morbidity and postimplant monitoring among women seeking cosmetic breast implants may be warranted.

In a cohort study 3527 Swedish women with cosmetic breast implants were compared with age- and calendar period-matched controls for a mean follow-up of 18.7 years. Among implant patients a three-fold excess of suicides was noted (not apparent until 10 years postoperative) as well as an excess of deaths due to drug and alcohol dependence and to accidents and injuries contingent upon such dependence, suggesting a component of underlying psychiatric morbidity within this cohort.

From the *International Epidemiology Institute, Rockville, MD; †Departments of Medicine and ‡Preventive Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN; and the §Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.

Received January 21, 2007, and accepted for publication, after revision, February 25, 2007.

This study was funded by the International Epidemiology Institute, which in turn received funds from the Dow Corning Corporation. The Dow Corning Corporation was not involved in any aspect of the study design, data collection, data analysis, data interpretation, or writing of this manuscript. Dr. McLaughlin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Reprints: Joseph K. McLaughlin, PhD, International Epidemiology Institute, 1455 Research Blvd, Suite 550, Rockville, MD 20850. E-mail: jkm@iei.ws.

© 2007 Lippincott Williams & Wilkins, Inc.