Correspondence/Rebuttal pubs.acs.org/est
Comment on “Silicone Wristbands as Personal Passive Samplers”
T
he excellent article by O’Connell et al.1 describes the remarkable utility of silicone bracelets as “chemical exposure monitors,” which can act as a personal data-gathering device to document an individual’s chemical exposures. The authors demonstrate the absorptive capacity of silicone for a diverse array of chemical entities, including pesticides, phthalates, polycyclic aromatic hydrocarbons (PAHs), and numerous other industrial and consumer product chemicals. An interesting implication of O’Connell et al. is that millions of women and men worldwide already have silicone biomonitoring devices in their bodies,2 since silicone is often used for implanted medical devices. Silicone breast implants, like silicone bracelets, have been shown to absorb chemicals from the surrounding tissue milieu that can be analyzed after explantation.3 Similar to the findings described in O’Connell et al., the authors of the implant study detected chemicals in silicone breast implants in amounts similar to those found in human tissues, suggesting that silicone equilibrates with surrounding tissue and can represent steady-state body burden of such substances. The authors found pesticides, phthalates, flame retardants, and other chemicals. The results were so striking that the authors suggested using removed silicone implants as biomonitoring devices to gain valuable epidemiological information about chemical exposures among these women. While silicone is used in many implants because it is considered relatively biocompatible and chemically inert, silicone interacts with human tissue and actively absorbs chemicals from the body. In fact, O’Connell et al. notes that silicone absorbs chemicals similar to the way human cells do. An important question is what are the potential implications of silicone retention of these chemicals within the implant? Could the implant act as an additional reservoir for lipophilic chemicals comparable to the function of adipose tissue of the breast?4 While these studies suggest that silicone behaves similarly to human tissue for the chemical entities examined, it is not known if silicone may have a greater or lesser affinity for some compounds based on their properties. Numerous health problems have been linked to silicone breast implants, including anaplastic large cell lymphomas (ALCL), a rare and potentially fatal cancer that can develop within the scar capsule around the implant.5 Several hypotheses have been suggested for implant-related ALCL, implicating an immunological mechanism likely attributable to tissue response to silicone.6,7 The significance of long-term accumulation of toxins within silicone implants and their potential contribution to these pathologies is unknown, but with approximately 5 million women with breast implants worldwide, this question deserves further study. The accumulation may be especially relevant when the implant leaks, which has been documented as inevitable as the implant ages, but is often not immediately detected.2,8 Although less attention has been paid to the health implications of other silicone implants, such as testicular implants, gastric lap bands, pectoral implants, cheek implants, and calf implants, the same health questions arise. However, silicone gel, which is primarily used in breast implants, may represent a unique © 2014 American Chemical Society
situation when the gel leaks and possibly migrates to secondary sites. We do not yet fully understand the complexity of the interactions between silicone implants and human tissue, but new evidence regarding implant-related ALCL and the results of O’Connell’s study raises questions about the implications for autoimmune and connective tissue diseases among women and men with silicone implants. Given the potential risks of leaking silicone gel suffused with chemicals, clinicians and patients should also be reminded that the FDA recommends that women with silicone gel breast implants undergo breast coil MRI monitoring of their implants three years after implantation every two years subsequently to check for rupture and leakage.2
Anna E. Mazzucco† Diana M. Zuckerman†,* †
■
National Center for Health Research, Washington, D.C. 20036, United States
AUTHOR INFORMATION
Corresponding Author
*Phone: (202) 223-4000; e-mail:
[email protected]. Notes
The authors declare no competing financial interest.
■
REFERENCES
(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) U.S. Food and Drug Administration. FDA Update on the Safety of Silicone Gel-Filled Breast Implants. 2011. http://www.fda.gov/ downloads/medicaldevices/productsandmedicalprocedures/ implantsandprosthetics/breastimplants/UCM260090.pdf (accessed May 22, 2014). (3) 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. (4) Petreas, M.; Smith, D.; Hurley, S.; Jeffrey, S. S.; Gilliss, D.; Reynolds, P. Distribution of persistent, lipid-soluble chemicals in breast and abdominal adipose tissues: lessons learned from a breast cancer study. Cancer Epidemiol., Biomarkers Prev. 2004, 13, 416−24. (5) Miranda, R. N.; Aladily, T. N.; Prince, H. M.; Kanagal-Shamanna, R.; de Jong, D.; Fayad, L. E.; et al. Breast implant−Associated anaplastic large-cell lymphoma: Long-term follow-up of 60 patients. J. Clin. Oncol. 2013, 32 (2), 114−120. (6) Ojo-Amaize, E. A.; Conte, V.; Lin, H. C.; Brucker, R. F.; Agopian, M. S.; Peter, J. B. Silicone-specific blood lymphocyte response in women with silicone breast implants. Clin. Diagn. Lab. Immunol. 1994, 1 (6), 689−695. (7) van Diest, P. J.; Beekman, W. H.; Hage, J. J. Pathology of silicone leakage from breast implants. J. Clin. Pathol. 1998, 51, 493−497. (8) Brown, S. L.; Silverman, B. G.; Berg, W. A. Rupture of silicone-gel breast implants: Causes, sequelae, and diagnosis. Lancet 1997, 350, 1531−37.
Published: July 10, 2014 8926
dx.doi.org/10.1021/es502594c | Environ. Sci. Technol. 2014, 48, 8926−8926
