M “Silicone Wristbands as Personal Passive Response to Comment on ”

Response to Comment on “Silicone Wristbands as Personal Passive
with the results presented by O’Connell et al.,1 give support to
the possibility that silicone implants may act to reduce health
risks through sequestration of organic toxicants from
surrounding breast tissue.
azzuco and Zuckerman’s comment to the paper,
“Silicone Wristbands as Personal Passive Samplers”1
raises several interesting points, the foremost being that human
silicone explants (implants that have been removed from the
body) may be a novel way to examine chemical toxicants in a
manner similar to silicone wristbands deployed as personal
monitors. While they cite previous research showing the
potential of in vivo absorption of organic toxicants by silicone
from surrounding tissue,2 the authors make several points that
require further clarification concerning both the retention of
chemicals by silicone in the body and potential health issues
from silicone implants.
Several questions in the comment concern chemical
absorption into silicone within the body and possible
implications. Namely, that implant rupture could release
sequestered compounds back into the surrounding tissue as a
single concentrated dose and pose an unknown health risk.
However, this scenario is not realistic given the chemical
principles of the uptake process. Absorbed chemicals in silicone
implants (shell or gel) are either in equilibrium with the body
tissue, or in nonequilibrium while the implant is passively
sequestering chemicals from the surrounding tissue. Passive
uptake of any individual compound is the result of both
inherent compound properties in addition to physical
characteristics of the surrounding environment. Therefore,
some compounds may be more or less likely to be absorbed
into silicone within living tissue. This diffusion process will
move affected compounds from the tissue into the silicone over
time, and slow down as equilibrium is reached. The overall
likelihood of movement (i.e., fugacity) will not reverse and
suddenly release the bulk of compounds back into the
surrounding body tissue from which the compounds were
originally sequestered. Recently we have analyzed breast
explants and tested silicone in vivo sequestration in murine
models, and our results further substantiate these points (to be
In addition to chemical uptake into silicone, the comment
also mentions numerous health problems with breast implants
and gives the example of a very rare form of cancer for which
there is limited evidence of an association.3 It would be more
accurate to note that there have been anecdotal claims of
adverse health outcomes focused primarily on connective tissue
diseases. More than two dozen epidemiological studies have
been conducted to evaluate the possible association of silicone
implants with disease incidence and mortality (as opposed to
implant complications), but no consistent or conclusive
associations with specific diseases have been found including
connective tissue diseases.4 This is reflected in the latest FDA
safety report regarding risks associated with use of these
medical devices.5 Interestingly, and contrary to expectations of
increased incidence, epidemiological studies specifically evaluating breast cancer in this population report a 30−50% reduction
in risk seen when compared to women with no implant history
or to the general female population.6−10 These studies, coupled
© 2014 American Chemical Society
Steven G. O’Connell†
Susan E. Carozza‡
Nancy I. Kerkvliet†
Kim A. Anderson*,†
Department of Environmental and Molecular Toxicology,
College of Public Health and Human Sciences, Oregon
State University, Corvallis, Oregon 97331 United States
Corresponding Author
*Phone: 541-737-8501; fax: 541-737-0497; e-mail: kim.
[email protected]
The authors declare no competing financial interest.
(1) O’Connell, S. G.; Kincl, L. D.; Anderson, K. A. Silicone
wristbands as personal passive samplers. Environ. Sci. Technol. 2014, 48
(6), 3327−3335.
(2) Allan, I. J.; Baek, K.; Kringstad, A.; Roald, H. E.; Thomas, K. V.
Should silicone prostheses be considered for specimen banking? A
pilot study into their use for human biomonitoring. Environ. Int. 2013,
59, 462−468.
(3) Jewell, M.; Spear, S. L.; Largent, J.; Oefelein, M. G.; Adams, W. P.
Anaplastic large T-cell lymphoma and breast implants: A review of the
literature. Plast. Reconstr. Surg. 2011, 128 (3), 651−661.
(4) Lipworth, L.; Holmich, L.; McLaughlin, J. Silicone breast
implants and connective tissue disease: No association. Semin.
Immunopathol. 2011, 33 (3), 287−294.
(5) FDA. FDA Update on the Safety of Silicone Gel-Filled Breast
Implants; Center for Devices and Radiological Health. U.S. Food and
Drug Administration, 2011; pp 1−63.
(6) Brisson, J.; Holowaty, E. J.; Villeneuve, P. J.; Xie, L.; Ugnat, A. M.;
Latulippe, L.; Mao, Y. Cancer incidence in a cohort of Ontario and
Quebec women having bilateral breast augmentation. Int. J. Cancer
2006, 118 (11), 2854−2862.
(7) Lipworth, L.; Tarone, R. E.; Friis, S.; Ye, W. M.; Olsen, J. H.;
Nyren, O.; McLaughlin, J. K. Cancer among Scandinavian women with
cosmetic breast implants: A pooled long-term follow-up study. Int. J.
Cancer 2009, 124 (2), 490−493.
(8) McLaughlin, J. K.; Fryzek, J. P.; Ye, W. M.; Tarone, R. E.; Nyren,
O. Long-term cancer risk among Swedish women with cosmetic breast
implants: An update of a nationwide study. J. Natl. Cancer Inst. 2006,
98 (8), 557−560.
(9) Friis, S.; Holmich, L. R.; McLaughlin, J. K.; Kjoller, K.; Fryzek, J.
P.; Henriksen, T. F.; Olsen, J. H. Cancer risk among Danish women
with cosmetic breast implants. Int. J. Cancer 2006, 118 (4), 998−1003.
(10) Deapen, D. M.; Hirsch, E. M.; Brody, G. S. Cancer risk among
Los Angeles women with cosmetic breast implants. Plast. Reconstr.
Surg. 2007, 119 (7), 1987−1992.
Published: July 10, 2014
dx.doi.org/10.1021/es503177x | Environ. Sci. Technol. 2014, 48, 8927−8927