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. Study design 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. Study results Among 132 061 women, 1642 (1.24%) developed breast cancer between 2010 and 2021, at a mean age of 63.3 ± 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] = 1.20, 95% confidence interval [CI] = 1.03–1.41), and for ≥ 5 years (aOR = 1.47, 95%CI = 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 (aOR = 1.17, 95%CI = 0.98–1.40) or ≥5 years (aOR = 0.99, 95%CI = 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 for ≥ 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.

中文翻译：

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患有严重精神疾病的女性抗精神病药物的使用和患乳腺癌的风险：全国嵌套病例对照数据库研究的复制


背景和假设 乳腺癌在患有严重精神疾病的女性中比在一般人群中更普遍，使用增加催乳素的抗精神病药可能是一个促成因素。研究设计 使用瑞典全国登记册（住院/门诊护理、病假、残疾抚恤金、处方药、癌症）进行了一项嵌套病例对照研究。所有 18-85 岁患有精神分裂症/分裂情感/其他非情感性精神病/双相情感障碍和乳腺癌的女性（病例）在年龄、主要精神病学诊断和病程方面与 5 名无癌症女性（对照组）相匹配。使用条件 logistic 回归分析累积暴露于催乳素增加/催乳素保留的抗精神病药物与乳腺癌之间的关联，并针对合并症和联合用药进行调整。研究结果在 132 061 名女性中，1642 名 （1.24%） 在 2010 年至 2021 年期间患乳腺癌，平均年龄为 63.3 ± 11.8 岁。与 8173 名匹配的对照相比，既往暴露于增加催乳素的抗精神病药物 1-4 年（校正比值比 [aOR] = 1.20,95% 置信区间 [CI] = 1.03-1.41）和 ≥ 5 年（aOR = 1.47,95%CI = 1.26-1.71）的女性患乳腺癌的几率增加。暴露于减少催乳素的抗精神病药物 1-4 年 （aOR = 1.17， 95%CI = 0.98-1.40） 或 ≥5 年 （aOR = 0.99， 95%CI = 0.78-1.26） 患乳腺癌的几率没有增加或降低。结果在所有敏感性分析中都是一致的 （即，根据不同的年龄组、癌症类型和原发性精神病学诊断）。 结论 尽管因果关系仍不确定，但暴露于催乳素升高的抗精神病药物 ≥ 1 年与患有严重精神疾病的女性患乳腺癌的几率增加有关。在开具抗精神病药时，共同决策过程应考虑乳腺癌的个体危险因素。