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Monoclonal Gammopathy of Undetermined Significance and Exposure to Breast Implants
Elizabeth W. Karlson, MD;
Milenko Tanasijevic, MD;
Susan E. Hankinson, ScD;
Matthew H. Liang, MD, MPH;
Graham A. Colditz, MD, DrPH;
Frank E. Speizer, MD;
Peter H. Schur, MD
Arch Intern Med. 2001;161:864-867.
Background Animal studies and uncontrolled case series in humans have suggested
a possible association between breast implant exposure and monoclonal gammopathy.
Objective To assess whether there is an increased risk of monoclonal gammopathy
in women with silicone breast implants, we conducted a retrospective study
of women exposed to breast implants and matched nonexposed women nested within
a prospective cohort study (the Nurses' Health Study).
Methods We used serum protein electrophoresis and immunoglobulin subtype by
immunofixation to test 288 women exposed to breast implants and 288 age-matched,
nonexposed women who previously had provided a blood sample (1989-1990) for
monoclonal proteins.
Results Among the women exposed to breast implants, 5 had monoclonal gammopathy
of undetermined significance (MGUS) compared with 4 women among those not
exposed (odds ratio, 1.25; 95% confidence interval, 0.27-6.39). The distribution
of isotypes was similar across exposure groups. The exposed women with MGUS
tended to be older than the nonexposed women (mean age, 60.4 years vs 52.5
years, respectively; P = .03). None of the 9 women
with MGUS had reported multiple myeloma or other hematologic malignancies
up through 1996.
Conclusions We find little evidence to support a substantial increased risk of MGUS
in women exposed to breast implants. Larger studies are needed to determine
if a more modest relationship exists.
From the Department of Medicine, Division of Rheumatology, Immunology,
and Allergy (Dr Schur), Robert B. Brigham Multipurpose Arthritis and Musculoskeletal
Diseases Center (Drs Karlson and Liang), Channing Laboratory (Drs Hankinson,
Colditz, and Speizer), and the Department of Pathology (Dr Tanasijevic), Brigham
and Women's Hospital, and Harvard Medical School (Drs Karlson, Tanasijevic,
Hankinson, Liang, Colditz, Speizer, and Schur), Boston, Mass.
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