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As the first generation of women who received cosmetic breast implants ages, questions remain about cancer risk. This study is an update of the Los Angeles Augmentation Mammaplasty Study and examines cancer risk among women with long-term exposure to breast implants.The authors conducted a record linkage cohort study of patients with cosmetic breast implants by abstracting from records of the private practices of 35 board-certified plastic surgeons in Los Angeles County, California. They included 3139 Caucasian women who received cosmetic breast implants between 1953 and 1980. Spanish-surnamed women, nonresidents of Los Angeles County, and patients with prior subcutaneous mastectomy or breast cancer were excluded. Cancer outcomes through 1994 were ascertained through record linkage with the Los Angeles County Cancer Surveillance Program.With a mean follow-up period of 15.5 years, 43 cases of breast cancer were observed, compared with 62.6 expected, based on Los Angeles County population-based incidence rates (standardized incidence ratio, 0.69; 95% CI, 0.50 to 0.93). Significant increases were observed for cancer of the lung and bronchus (standardized incidence ratio, 2.14; 95% CI, 1.42 to 3.09) and vulvar cancer (standardized incidence ratio, 3.47; 95% CI, 1.39 to 7.16).The breast cancer results of this study are consistent with the previous reports of the Los Angeles study as well as with several other long-term cohort studies. Lung cancer has previously been found to be increased in this cohort and also in some, but not most, other studies. The increased risk of vulva cancer has previously been observed in this cohort and just one other.