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—We appreciate the interest of Drs Stewart and Elliott in our recently published article comparing characteristics of women with and without breast augmentation. It is true that our study included a relatively small number of women with breast augmentation (n=80), but they were randomly identified from the general population in 3 defined geographic areas stratified by 5-year age groups. While the age distribution of the sample is different from that of the general population, women in each 5-year age group are representative of all women of similar age in the defined geographic areas. These women were not identified on the basis of the presence of any disease or the utilization of any health care facility.We agree that confounding can never be entirely ruled out as an explanation for associations that are observed in epidemiologic studies such as ours. For example, the positive association we observed between oral contraceptive use
Cook LS, Daling JR, Voigt LF, deHart MP, Malone KE, Weiss NS, Stanford JS, Brinton LA, Gammon MD, Brogan D. Characteristics of Women With and Without Breast Implants-Reply. JAMA. 1997;278(10):818-819. doi:10.1001/jama.1997.03550100044025