3 mei 2013: Bron: BMJ. Published online April 30, 2013

Cosmetische borstimplantaten geplaatst in de jaren vooraf aan de eerste diagnose borstkanker, verhogen het risico op overlijden aan borstkanker met 28 tot 38 procent in vergelijking met vrouwen met borstkanker die geen implantaten hadden bij de eerste diagnose van hun borstkanker. Dit blijkt uit een meta analyse van 12 garandomiseerde studies waarin een vergelijking werd gemaakt tussen wel of geen borstimplantaten en kans op overlijden aan borstkanker en een systemische review studie van 5 gerandomiseerde studies naar de relatie tussen borstimplantaten en overlevingskansen. De resultaten zijn gepubliceerd in het British Journal of Medicin. Waarbij de redactie van BMJ opmerkt dat de studie enkele beperkingen kent die enige voorzichtigheid gebiedt bij het interpreteren van de resultaten.

"In de Verenigde Staten was een cosmetische borstvergroting een van de meest uitgevoerde cosmetische chirurgische ingrepen in 2011; 307 000 operaties werden uitgevoerd, een stijging van ongeveer 800% ten opzichte van de vroege jaren 1990," schrijft prof. dr. Eric Lavigne, van Centre de recherche du CHU de Quebec, Faculte de medecine, Universite Laval in Quebec City, Canada, "Hoewel borstvergroting populair is blijven er controverses over de lange termijn gevolgen voor de gezondheid van vrouwen die borstimplantaten hebben. Uit epidemiologische studies blijkt dat cosmetische borstimplantaten meestal niet worden geassocieerd met een verhoogd risico op borstkanker. Echter de zogeheten radio-opaciteit - ondoorzichtigheid - van cosmetische borstimplantaten belemmert een goede mammografische visualisatie van borstweefsel en belemmeert daarmee mogelijk
een vroege ontdekking van borstkanker", aldus prof. dr. Eric Lavigne

De resultaten:

De onderzoekers voerden een systematisch onderzoek uit in de databases van Medline, Embase, Global Health, CINAHL, IPAB en PsycINFO onder studies gepubliceerd vóór september 2012 en waarbij onder de deelnemers vrouwen waren opgenomen gediagnosticeerd met borstkanker die een cosmetische borstvergroting via een borstimplantaat hadden gehad.

De eerste meta-analyse omvatte 12 onderzoeken naar een niet gelokaliseerd stadium van borstkanker bij de eerste diagnose van vrouwen met implantaten die borstkanker hadden in vergelijking met vrouwen zonder implantaten die een eerste diagnose van borstkanker kregen. De totale odds ratio was 1,26 (95% betrouwbaarheidsinterval , 0,99-1,60; P = 0,058; 2 = 35,6%), wat wijst op een verhoogd risico van 26% aan borstkanker te overlijden.

De tweede meta analyse omvatte 5 studies waarin de relatie tussen cosmetische borst implantatie en overleving werd onderzocht. In vergelijking met vrouwen die geen implantaten hadden, bleek de overlevingskans voor vrouwen die wel een implantaat hadden de overlevingskansen voor die groep vrouwen beduidend lager te liggen. Algemeen hazard ratio voor borstkanker specifieke mortaliteit was 1,38, wat wijst op een verhoogd risico van 38% (95% BI, 1,08-1,75).

Beperkingen van deze studie zijn een mogelijke tendens naar "nondifferentiale misclassificatie" omdat bepaalde studies in beide meta analyses gevallen van borstkanker in situ hadden opgenomen. Elkaar tegensprekende resultaten in de individuele studies kunnen ook invloed hebben op de meta analyses. En daarnaast zouden gebruikte methoden om de hazard ratio's van beschikbare gegevens in elke individuele studie bij elkaar te voegen de variatie van de schattingen kunnen hebben beïnvloed.

Conclusie blijft echter dat tot nu toe verschenen onderzoek aantoont dat een cosmetische borstvergroting een negatief effect heeft op de overleving van vrouwen die later in hun leven worden gediagnosticeerd met borstkanker," aldus schrijven de auteurs. 

Het volledige studierapport: Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies is gratis in te zien.

Hier het abstract van deze studie met onderaan referentielijst van studies opgenomen in deze meta analyse en reviewstudie:

Cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2399 (Published 30 April 2013) Cite this as: BMJ 2013;346:f2399

  1. Eric Lavigne, epidemiologist12,
  2. Eric J Holowaty, adjunct professor3,
  3. Sai Yi Pan, epidemiologist2,
  4. Paul J Villeneuve, senior research scientist34,
  5. Kenneth C Johnson, adjunct professor5,
  6. Dean A Fergusson, senior scientist and director6,
  7. Howard Morrison, director2,
  8. Jacques Brisson, full professor1

Abstract

Objectives To evaluate whether the stage distribution among women diagnosed as having breast cancer differs between those who have received breast implants for cosmetic purposes and those with no implants and to evaluate whether cosmetic breast augmentation before the detection of breast cancer is a predictor of post-diagnosis survival.

Design Systematic review of observational studies with two meta-analyses.

Data sources Systematic search of the literature published before September 2012 conducted in Medline, Embase, Global health, CINAHL, IPAB, and PsycINFO.

Study selection Eligible publications were those that included women diagnosed as having breast cancer and who had had augmentation mammaplasty for cosmetic purposes.

Results The overall odds ratio of the first meta-analysis based on 12 studies was 1.26 (95% confidence interval 0.99 to 1.60; P=0.058; I2=35.6%) for a non-localized stage of breast cancer at diagnosis comparing women with implants who had breast cancer and women without implants who had breast cancer. The second meta-analysis, based on five studies, evaluated the relation between cosmetic breast implantation and survival. This meta-analysis showed reduced survival after breast cancer among women who had implants compared with those who did not (overall hazard ratio for breast cancer specific mortality 1.38, 95% confidence interval 1.08 to 1.75).

Conclusions The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.

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