Suicide After Breast Cancer: an International Population-Based Study of 723 810 Women

University of Helsinki, Helsinki, Uusimaa, Finland
Journal of the National Cancer Institute (Impact Factor: 12.58). 11/2006; 98(19):1416-9. DOI: 10.1093/jnci/djj377
Source: PubMed


Few studies have examined long-term suicide risk among breast cancer survivors, and there are no data for women in the United States. We quantified suicide risk through 2002 among 723,810 1-year breast cancer survivors diagnosed between January 1, 1953, and December 31, 2001, and reported to 16 population-based cancer registries in the United States and Scandinavia. Among breast cancer survivors, we calculated standardized mortality ratios (SMRs) and excess absolute risks (EARs) compared with the general population, and the probability of suicide. We used Poisson regression likelihood ratio tests to assess heterogeneity in SMRs; all statistical tests were two-sided, with a .05 cutoff for statistical significance. In total 836 breast cancer patients committed suicide (SMR = 1.37, 95% confidence interval [CI] = 1.28 to 1.47; EAR = 4.1 per 100,000 person-years). Although SMRs ranged from 1.25 to 1.53 among registries, with 245 deaths among the sample of US women (SMR = 1.49, 95% CI = 1.32 to 1.70), differences among registries were not statistically significant (P for heterogeneity = .19). Risk was elevated throughout follow-up, including for 25 or more years after diagnosis (SMR = 1.35, 95% CI = 0.82 to 2.12), and was highest among black women (SMR = 2.88, 95% CI = 1.44 to 5.17) (P for heterogeneity = .06). Risk increased with increasing stage of breast cancer (P for heterogeneity = .08) and remained elevated among women diagnosed between 1990 and 2001 (SMR = 1.36, 95% CI = 1.18 to 1.57). The cumulative probability of suicide was 0.20% 30 years after breast cancer diagnosis.

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    • "Depression and suicidal ideation is not uncommon in cancer sufferers. Schairer et al [11] showed, from the SEER database, that the risk of suicide amongst breast cancer patients was 37% higher than expected when compared to the general population. A national study in Scotland showed the relative risk of suicide to be 1.5 in cancer sufferers [12]. "
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    ABSTRACT: Penile cancer is an uncommon malignancy with an incidence of 1 per 100,000. Conservative and radical treatments can be disfiguring and may have an impact on sexual function, quality of life (QOL), social interactions, self-image and self-esteem. Knowledge of how this disease affects patients is paramount to developing a global, multi-disciplinary approach to treatment. A Medline/PubMed literature search was conducted using the terms "sexual function penis cancer"; "quality of life penis cancer" and "psychological effects penis cancer" from 1985 to 2008. Articles containing quantitative data on QOL, sexual function or psychological well-being were included. 128 patients from 6 studies were included. 5 studies contained retrospective data whilst 1 study collected prospective data on erectile function. In the 6 studies 13 different quantitative tools were used to assess psychological well-being, QOL and sexual function. The General Health Questionnaire (GHQ) showed impaired well-being in up to 40% in 2 studies. Patients undergoing more mutilating treatments were more likely to have impaired well-being. The Hospital Anxiety and Depression Score (HADS) demonstrated pathological anxiety up to 31% in 2 studies. 1 study used the Diagnostic and Statistical Manual of Mental Disorders of psychiatric illness (DSM III-R) with 53% exhibiting mental illness, 25% avoidance behaviour and 40% impaired well-being. 12/30 suffered from post-traumatic stress disorder. The IIEF-15 was the commonest tool used to assess sexual function. The results varied from 36% in 1 study with no sexual function to 67% in another reporting reduced sexual satisfaction to 78% in another reporting high confidence with erections. The treatment of penile cancer results in negative effects on well-being in up to 40% with psychiatric symptoms in approximately 50%. Up to two-thirds of patients report a reduction in sexual function. This study demonstrates that penile cancer sufferers can exhibit significant psychological dysfunction, yet no standardised tools or interventional pathways are available. Therefore, there is a need to identify and assess adequate tools to measure psychological and sexual dysfunction in this group of patients.
    BMC Urology 09/2009; 9(1):8. DOI:10.1186/1471-2490-9-8 · 1.41 Impact Factor
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    • "On the other hand, a proportion of people who have no history of psychiatric disorder can have suicide ideation. As found by Schairer and colleagues [28], patients with physical illness are also at greater risk for suicide, therefore, having a screening instrument which can be used in diverse settings, with a cut-off point determining suicide ideation for different populations, is vital. "
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    ABSTRACT: An efficient screening instrument which can be used in diverse settings to predict suicide in different populations is vital. The aim of this study was to use the five-item Brief Symptom Rating Scale (BSRS-5) as a screening instrument for the prediction of suicide ideation in psychiatric, community and general medical settings. Five hundred and one psychiatric, 1,040 community and 969 general medical participants were recruited. The community participants completed a structured telephone interview, and the other two groups completed the self-report BSRS-5 questionnaire. The logistic regression analysis showed that the predictors of suicide ideation for the psychiatric group were depression, hostility and inferiority (p < 0.001, p = 0.016, p = 0.011), for the community group, inferiority, hostility and insomnia (p < 0.001, p < 0.001, p = 0.003), and for the general medical group, inferiority, hostility, depression and insomnia (p < 0.001, p = 0.001, p = 0.020, p = 0.008). The structural equation model showed the same symptom domains that predicted suicide ideation for all three groups. The receiver operating characteristic curve using the significant symptom domains from logistic regression showed that for the psychiatric group, the optimal cut-off point was 4/5 for the total of the significant dimensions (positive predictive value [PPV] = 78.01%, negative predictive value [NPV] = 79.05%), for the community group, 7/8 (PPV = 68.75%, NPV = 96.09%), and for the general medical group, 12/13 (PPV = 92.86%, NPV = 88.48%). The BSRS-5 is an efficient tool for the screening of suicide ideation-prone psychiatric inpatients, general medical patients, and community residents. Understanding the discriminative symptom domains for different groups and the relationship between them can help health care professionals in their preventative programs and clinical treatment.
    BMC Psychiatry 07/2008; 8(1):53. DOI:10.1186/1471-244X-8-53 · 2.21 Impact Factor
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    • "Suicide after breast cancer is also more common than suicide in the general population. In the large study by Schairer et al., the risk was elevated throughout follow-up and dependent on stage of disease [8]. The standardized mortality ratio was 1.37 and the excess absolute risk 4.1 per 100,000 person years. "
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    ABSTRACT: Case presentation This is an unusual case where a 49-year old female patient with known schizophrenia, paranoid type and a history of early-stage breast cancer, which was treated more than 6 years earlier, attempted suicide. Computed tomography and magnetic resonance imaging after this incident revealed the presence of multiple brain metastases as the first symptomatic site of recurrent cancer. Further staging lead to the diagnosis of lung, hilar and mediastinal lymph node metastases and histology confirmed estrogen receptor-positive metastatic cancer. Treatment consisted of whole-brain radiotherapy and letrozole. Twenty-one months later, the patient is in continued partial remission.
    Cases Journal 02/2008; 1(1):195. DOI:10.1186/1757-1626-1-195
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