ABSTRACT
Evidence suggests that women with schizophrenia are less likely to be screened for breast cancer, more likely to suffer from breast cancer, and more likely to die of breast cancer than women without schizophrenia or general population controls. Antipsychotic drugs, and especially prolactin-raising antipsychotic drugs, have been suggested to increase the breast cancer risk, but the evidence has so far been inconclusive. Against this background, a recent, large, nationwide, case-control study in Finland examined the odds of previous prolonged exposure to prolactin-raising and prolactin-sparing antipsychotic drugs in women with schizophrenia who were (cases) versus were not (controls) diagnosed with breast cancer. The study found that, relative to < 1 year of antipsychotic exposure, breast cancer was associated with significantly increased odds of previous, prolonged (> 5 years) exposure to prolactin-raising antipsychotics. The associations were not statistically significant for prolactin-sparing antipsychotics. The study is critically examined from the perspective of interpretation of the odds ratio and its limitations in order to help readers understand how to better evaluate and generalize findings in case-control studies. This is necessary because results in case-control studies are often incorrectly interpreted, and the limitations of the odds ratios derived in such studies are often not recognized. It is concluded that the design and findings of the reviewed study could not allow readers to judge whether or not prolactin-sparing antipsychotics are associated with lower breast cancer risk than prolactin-raising antipsychotics. In contexts other than breast cancer risk, adverse consequences associated with prolactin elevation are well known, and avoidance or management of hyperprolactinemia is therefore desirable.
Continue Reading...
Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.
References (15)
- Fitzmaurice C, Abate D, Abbasi N, et al; Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol. 2019;5(12):1749–1768. PubMed CrossRef
- Solmi M, Firth J, Miola A, et al. Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people. Lancet Psychiatry. 2020;7(1):52–63. PubMed CrossRef
- Hwong A, Wang K, Bent S, et al. Breast cancer screening in women with schizophrenia: a systematic review and meta-analysis. Psychiatr Serv. 2020;71(3):263–268. PubMed CrossRef
- Zhuo C, Triplett PT. Association of schizophrenia with the risk of breast cancer incidence: a meta-analysis. JAMA Psychiatry. 2018;75(4):363–369. PubMed CrossRef
- Zhuo C, Tao R, Jiang R, et al. Cancer mortality in patients with schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2017;211(1):7–13. PubMed CrossRef
- Ni L, Wu J, Long Y, et al. Mortality of site-specific cancer in patients with schizophrenia: a systematic review and meta-analysis. BMC Psychiatry. 2019;19(1):323. PubMed CrossRef
- Johnston AN, Bu W, Hein S, et al. Hyperprolactinemia-inducing antipsychotics increase breast cancer risk by activating JAK-STAT5 in precancerous lesions. Breast Cancer Res. 2018;20(1):42. PubMed CrossRef
- Wang M, Wu X, Chai F, et al. Plasma prolactin and breast cancer risk: a meta- analysis. Sci Rep. 2016;6(1):25998. PubMed CrossRef
- De Hert M, Peuskens J, Sabbe T, et al. Relationship between prolactin, breast cancer risk, and antipsychotics in patients with schizophrenia: a critical review. Acta Psychiatr Scand. 2016;133(1):5–22. PubMed CrossRef
- Taipale H, Solmi M, Lähteenvuo M, et al. Antipsychotic use and risk of breast cancer in women with schizophrenia: a nationwide nested case-control study in Finland. Lancet Psychiatry. 2021;8(10):883–891. PubMed CrossRef
- Norton EC, Dowd BE, Maciejewski ML. Odds ratios-current best practice and use. JAMA. 2018;320(1):84–85. PubMed CrossRef
- Andrade C. Odd odds. J Clin Psychiatry. 2011;72(11):1558–1559, author reply 1559. PubMed CrossRef
- Andrade C. Understanding relative risk, odds ratio, and related terms: as simple as it can get. J Clin Psychiatry. 2015;76(7):e857–e861. PubMed CrossRef
- Henderson DC. Managing weight gain and metabolic issues in patients treated with atypical antipsychotics. J Clin Psychiatry. 2008;69(suppl 1):e04. PubMed CrossRef
- Peuskens J, Pani L, Detraux J, et al. The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review. CNS Drugs. 2014;28(5):421–453. PubMed CrossRef
Advertisement
GAM ID: sidebar-top