Breast Implants and Connective-Tissue Disease

To the Editor. —The article by Dr Hennekens and colleagues¹ lends further support to recent epidemiologic studies finding that breast implants are associated with no or only a small increased risk of connective-tissue diseases² and breast cancer.³ Despite these studies, the public is being led to believe that implants are associated with or cause various diseases, as has been implied by the Dow Corning class action suit and more than a dozen articles in popular women's magazines.⁴ For many reasons, including the divergence of medical and public perceptions and the potential for loss of precious public trust, the medical field should closely scrutinize these studies for errors in design and analysis that result in missed associations.

One possible error is inattention to a potential confounder, estrogen serum level and tissue sensitivity. Estrogen is important in the pathogenesis of breast cancer, may play a predisposing role in connective-tissue diseases, and