Antipsychotic Use and Risk of Breast Cancer in Women With Severe Mental Illness: Replication of a Nationwide Nested Case-Control Database Study.
Schizophr Bull
; 2024 Apr 30.
Article
in En
| MEDLINE
| ID: mdl-38687213
ABSTRACT
BACKGROUND AND HYPOTHESIS:
Breast cancer is more prevalent in women with severe mental illness than in the general population, and use of prolactin-increasing antipsychotics may be a contributing factor. STUDYDESIGN:
A nested case-control study was conducted using the Swedish nationwide registers (inpatient/outpatient care, sickness absence, disability pension, prescribed drugs, cancers). All women aged 18-85 years with schizophrenia/schizoaffective/other nonaffective psychotic disorder/bipolar disorder and breast cancer (cases) were matched for age, primary psychiatric diagnosis, and disease duration with five women without cancer (controls). The association between cumulative exposure to prolactin-increasing/prolactin-sparing antipsychotics and breast cancer was analyzed using conditional logistic regression, adjusted for comorbidities and co-medications. STUDYRESULTS:
Among 132 061 women, 1642 (1.24%) developed breast cancer between 2010 and 2021, at a mean age of 63.3â ±â 11.8 years. Compared with 8173 matched controls, the odds of breast cancer increased in women with prior exposure to prolactin-increasing antipsychotics for 1-4 years (adjusted odds ratio [aOR]â =â 1.20, 95% confidence interval [CI]â =â 1.03-1.41), and forâ ≥â 5 years (aORâ =â 1.47, 95%CIâ =â 1.26-1.71). There were no increased or decreased odds of breast cancer with exposure to prolactin-sparing antipsychotics of either 1-4 years (aORâ =â 1.17, 95%CIâ =â 0.98-1.40) or ≥5 years (aORâ =â 0.99, 95%CIâ =â 0.78-1.26). The results were consistent across all sensitivity analyses (ie, according to different age groups, cancer types, and primary psychiatric diagnosis).CONCLUSIONS:
Although causality remains uncertain, exposure to prolactin-elevating antipsychotics forâ ≥â 1 year was associated with increased odds of breast cancer in women with severe mental illness. When prescribing antipsychotics, a shared decision-making process should consider individual risk factors for breast cancer.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
Schizophr Bull
Year:
2024
Document type:
Article