Breast Implant Prevalence in the Dutch Female Population Assessed by Chest Radiographs

Abstract

Background: Breast implant-related health problems are a subject of fierce debate. Reliable population-based estimates of implant prevalence rates are not available, however, due to a lack of historical registries and incomplete sales data, precluding absolute risk assessments.

Objectives: This study aimed to describe the methodology of a novel procedure to determine Dutch breast implant prevalence based on the evaluation of routine chest radiographs.

Methods: The validity of the new method was first examined in a separate study. Eight reviewers examined a series of 180 chest radiographs with (n = 60) or without (n = 120) a breast implant confirmed by a computed tomography or magnetic resonance imaging scan. After a consensus meeting with best-performing expert reviewers, we reviewed 3000 chest radiographs of women aged 20 to 70 years in 2 large regional hospitals in the Netherlands in 2015. To calculate the national breast implant prevalence, regional prevalence variations were corrected utilizing the National Breast Cancer Screening Program.

Results: Eight reviewers scored with a median sensitivity of 71.7% (range, 41.7%-85.0%) and a median specificity of 94.6% (range, 73.4%-97.5%). After a consensus meeting and a reevaluation by best-performing expert reviewers, sensitivity was 79.9% and specificity was 99.2%. The estimated national prevalence of breast implants among women between 20 and 70 years was 3.0%, ranging from 1.7% at 21 to 30 years to 3.9% between 51 and 60 years.

Conclusions: The novel method in this study was validated with a high sensitivity and specificity, resulting in accurate prevalence estimates and providing the opportunity to conduct absolute risk assessment studies on the health consequences of breast implants.

Figure 1.

Standard chest radiograph taken in (A) posterior-anterior and (B) lateral view in this 62-year-old woman due to suspicion of bilateral pneumonia. The implant can be seen as asymmetrical densities in the basal lung fields with a focal opacified aspect (arrows).

Figure 2.

Standard chest radiograph taken in (A) posterior-anterior and (B) lateral view in this 70-year-old woman due to suspicion of exacerbated lung emphysema. The implant can be seen by the evident calcifications in the periprosthetic capsule (arrows).

Figure 3.

Standard chest radiograph taken in (A) posterior-anterior and (B) lateral view in this 32-year-old woman due to suspicion of bilateral pneumonia. The implant can be seen by the metal magnetized valve/port of the tissue expander (arrows).

Figure 4.

Regional breast implant prevalence in the Netherlands per age group. This figure shows the region-specific breast implant prevalence (P) in women between 20 and 70 years. The eastern and southern regional prevalences were derived from the prevalence study, and both age-specific prevalences were multiplied by the region-specific coefficients of the Breast Cancer Screening Program and the regional population size to calculate a mean for the northern, western, and central regions.

Figure 5.

Estimated national breast implant prevalence in the Netherlands in 2015 among women between 20 and 70 years of age. The national breast implant prevalence (P) in Dutch women in the Netherlands between 20 and 70 years is shown, derived by combining differences in region-specific breast implant prevalence from the Breast Cancer Screening Program and regional prevalence from the prevalence study.