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Mon, 9 Oct 2006 12:39:55 EDT

MONTREAL (CP) - Women with breast implants and those who've had plastic surgeries have lower rates of cancer than the general population but higher rates of suicide, suggests a recent Canadian study.

Although the researchers offered no definitive explanation for the increased suicide rates, they suggest greater attention be paid to the psychiatric state of potential cosmetic surgery patients.

"Serious consideration should be given to providing consultation for patients who are considered by the plastic surgeon to be at high risk of psychiatric disorder or suicide," says an article on the study, published recently in the American Journal of Epidemiology.

Previous international studies have reported similar results but small sample sizes have limited their impact.

The study, funded by Health Canada and carried out jointly by the Public Health Agency of Canada, the University of Toronto, Cancer Care Ontario and the University of Laval, is the largest such study to date, according to the researchers.

They combed vital statistics and death certificates of 24,558 women in Ontario and Quebec who underwent breast implant surgery from 1974 to 1989. They also tracked nearly 16,000 women who underwent other plastic surgeries during the same period and compared both with the general female population.

What they found is that, overall, women who underwent breast implantation had lower rates of mortality than the general population, at comparable ages over the same period.

They also had lower rates of cancer, contrary to popular belief, with 229 cancer deaths among the nearly 25,000 women. About 303 would be expected in the general female population.

But when it came to suicide, researchers identified 58 suicides among the 480 breast-implant recipients who died. In a comparable general female population without implants, they would have expected 33 suicide deaths.

"That's not a very large number," said Dr. Jacques Brisson of the department of social and preventive medicine at Laval University in Quebec.

"It's an increase in the number of deaths related to suicide but the number itself is not (large). So the risk of suicide among women with breast implants is not great. It's actually small, relatively speaking, but it still is larger than the general population."

Thirty-three of 383 deaths among women who had other plastic surgery were suicide. The researchers said they would have expected 22 suicide deaths for a comparable group in the general population.

It reinforces the need to be pay attention to patients' motivations and underlying psychological states, Brisson said.

The study comes as Health Canada is considering putting silicone implants back on the market for general use.

They've been available only under a compassionate release program since 1992, the height of fears over the health effects of silicone.

The program is largely symbolic, requiring some extra paperwork by physicians and patients to obtain the implants.

"The vast majority of them are done for cosmetic purposes on thin young women," said Dr. Donna Stewart, a professor of psychiatry at the University of Toronto and chairwoman of the university's women's health program.

Stewart said putting them back on the market for general use is still a concern.

The study raises important questions about the psychiatric state of some of the women who seek implants and plastic surgery.

"There have been studies showing that many of these women have low self-esteem," Stewart said. "They tend to be anxious, they tend to be depressed. . .

"There should be screening of these women very carefully before they're given implants."