Breast Implants and Connective-Tissue Diseases

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Abstract
In a large cohort study, Sánchez-Guerrero et al. (June 22 issue)1 found no association between silicone breast implants and connective-tissue diseases, defined according to a variety of standardized criteria, or signs and symptoms of these diseases. The study provides further strong evidence that the case definition for silicone-related disorders does not include systemic lupus erythematosus or rheumatoid arthritis. It has been recognized since 1992, however, that most symptomatic women with breast implants have a chronic fatigue and fibromyalgia-like syndrome.2-4 It is unclear why the authors excluded the very syndrome in which they should have been the most interested — namely, fibromyalgia. Case definition is essential to useful epidemiology.

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