Fw: Letter to the editor of the British Medical Journal re the Swedish article on implants and suicide

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----- Original Message ----- From: Zuckerman

Undisclosed-Recipient:;@...

Sent: Saturday, March 08, 2003 9:02 PM

Subject: Letter to the editor of the British Medical Journal re the Swedish article on implants and suicide

Dear Friends,

I wrote a letter in response to the Swedish study of implants and suicide in the British Medical Journal. It is below. I hope it will at least be published on their website. The original article is at http://bmj.com/cgi/content/full/326/7388/527?eaf. It was not very well designed, analyzed or intepreted. The last author, Nyren, has previously published articles on breast implants that are also flawed.

Best wishes,

Zuckerman

To the Editor of the British Medical Journal:

The findings provide an interesting comparison and are for the most part consistent with a study by the National Cancer Institute in the U.S. conducted by Dr. Louise Brinton et al. However, the Brinton et al study found an increase in suicides and some cancers compared to other plastic surgery patients. If women who undergo plastic surgery have more psychological problems than the general population, that would not explain the difference between suicide rates of breast augmentation patients compared to other women who underwent liposuction, rhinoplasty, and other plastic surgery at a similar age.

The Brinton results suggest that the increased vulnerability of plastic surgery patients is not the only explanation for the increased risk of suicide. Compared to most other plastic surgery patients, implant patients suffer from complications that tend to increase over time. Implant manufacturers report that many implant patients need additional surgery within the first three years, and that ruptures and other complications continue to increase over time. Our Center receives letters every week from women whose implants are broken and who are unable to afford to have them removed. Many of these women are quite desperate, especially in cases where silicone is migrating to other organs. Other women describe deformities and pain caused by their implants. Although Swedish women apparently have better access to medical care if complications arise, some of these complications are extremely difficult to fix. It is certainly possible that such problems may cause an increase in suicides.

It is also important to note that the Brinton study found that augmentation patients were three times as likely to die from lung cancer and other respiratory diseases compared to other plastic surgery patients, even though augmentation patients were no more likely to smoke than other plastic surgery patients. Although the augmentation patients who died of lung cancer were all smokers, augmentation patients who smoked were more likely to die than other plastic surgery patients who smoked. Since silica exposure is linked to lung cancer, it is possible that leakage from silicone implants increases the risk of lung cancer among smokers by irritating or damaging the lungs. It is unfortunate that the Koot et al study apparently did not statistically control for smoking, because it is possible that they too would have found an increased risk of lung cancer linked to breast implants, even among smokers.

A flaw of the Koot et al study is that it included women who had breast implants for less than one year. This certainly weakens the power of the statistical analysis, since one would not expect implants to cause mortality in such a short time. In contrast, the Brinton et al study included women who had breast implants for at least 8 years. Even that is not ideal; it would be more appropriate for a study of implants and cancer to only include women who had breast implants for at least 10-15 years.

Zuckerman, Ph.D.PresidentNational Center for Policy Research (CPR) for Women & Families1901 Pennsylvania Avenue, NWSuite 901Washington, DC 20006202 223-4000www.center4policy.org