Schizophrenia and cancer: An epidemiological study

Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK.
The British Journal of Psychiatry (Impact Factor: 7.99). 11/2005; 187(4):334-8. DOI: 10.1192/bjp.187.4.334
Source: PubMed


For decades there has been interest in the possibility that people with schizophrenia might have some protection against cancer, and that, if this were so, it might hold clues about aetiological mechanisms in schizophrenia.
To study cancer incidence in schizophrenia.
Cohort analysis of linked hospital and death records was used to compare cancer rates in people with schizophrenia with a reference cohort.
We did not find a reduced risk for cancer overall (rate ratio 0.99,95% CI 0.90-1.08) or for most individual cancers. There was, however, a significantly low rate ratio for skin cancer (0.56,95% CI 0.36-0.83).
We found no evidence that schizophrenia confers protection against cancer in general. Low rates of cancer are consistent with the hypothesis that sun exposure may influence the development of schizophrenia, although other explanations are also possible.

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Available from: Clare Wotton, Jul 08, 2014
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    • "This suggests a discrepancy between cancer risk exposure (e.g., smoking) and cancer incidence in schizophrenia (Goldacre et al. 2005), an association that has been described paradoxical (Hodgson et al, 2010). Nevertheless, these two conditions co-occur (Goldacre et al. 2005). It can create difficulties in management when the patient is clinically stable on clozapine and require chemotherapeutic agents that can frequently cause myelosuppression and neutropenia as it can pose several dilemmas for the clinicians. "

    Full-text · Article · Dec 2013 · Psychiatria Danubina
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    • "c o m / l o c a t e / s c h r e s these findings, the Disability Rights Commission suggested that the UK Government should consider enhanced bowel and breast cancer screening for people with schizophrenia. These results are striking and worthy of further exploration because of their clinical implications and because they differ from those of some other UK and international research studies (Goldacre et al., 2005). In a recent study using data from the UK General Practice Research Database up to 2002, Osborn et al. (2007) found that mortality rates for the most common seven UK cancers were not significantly raised in people with SMI. "
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    ABSTRACT: BACKGROUND: A recent United Kingdom (UK) report found that breast and colorectal cancers were more common in people with severe mental illness (SMI) and recommended targeted screening. Epidemiological evidence is however inconsistent. OBJECTIVES: To estimate relative incidence rates for colorectal, breast and lung cancer, and the overall incidence of the commonest other UK cancers, in people with SMI compared with people without SMI. METHOD: Cohort study in the UK using The Health Improvement Network (THIN) primary care database between 1990 and June 2008. Poisson regression was used to obtain adjusted incidence rate ratios (IRRs) for cancer, comparing two cohorts of people over 18; with and without a diagnosis of SMI. RESULTS: We identified 20,632 people with SMI and 116,152 people without, with median follow up of over 6years. No significant associations were observed between SMI and cancers of the breast (adjusted IRR 1.17; 95% confidence interval 0.95-1.45), colon (0.70; 0.46-1.05), rectum (1.05; 0.65-1.69) or lung (0.84; 0.65-1.10). The adjusted IRR for an aggregate cancer outcome in SMI was 0.95; 0.85-1.06. Results were similar for schizophrenia and bipolar disorder. CONCLUSIONS: In a cohort analysis within a large UK primary care database, the incidence of colo-rectal, breast and lung cancer, and of all common cancers, did not differ significantly in people with SMI, including schizophrenia, compared with people without SMI. Our results do not support enhanced screening procedures for cancer in people with SMI.
    Full-text · Article · Dec 2012 · Schizophrenia Research
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    • "However there is less consensus on malignancy risks [44]. For example for breast cancer some studies have shown an increased risk [8] [14] [45] [46] while others have shown a decreased [4] or insignificant [5] [13] [19] [24] [26] risk among patients treated for schizophrenia (for review see [6] [15]). "
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    ABSTRACT: Important data was recently published on the potential genotoxic or carcinogenic effects of antipsychotics, as well as on their cytotoxic properties on cancer cells, that must be considered by psychiatrists in the benefit/risk ratio of their prescriptions. To answer whether or not antipsychotics, as a class or only some specific molecules, may influence cancer risk among treated patients. METHODS ELIGIBILITY CRITERIA: All studies (in vitro, animal studies and human studies) concerning effects of antipsychotic drugs on cancer development were included. The search paradigm [neoplasms AND (antipsychotic agents OR neuroleptic OR phenothiazine)] was applied to Medline (1966-present) and Web of Science (1975-present). Ninety-three studies were included in the qualitative synthesis. Results can be summarized as follows: (1) patients with schizophrenia may be less likely to develop cancer than the general population, (2) antipsychotics as a class cannot be considered at the moment as at risk for cancer, even if some antipsychotics have shown carcinogenic properties among rodents, (3) phenothiazines seem to have antiproliferative properties that may be useful in multidrug augmentation strategies in various cancer treatments, but their bad tolerance may decrease usage amongst non-psychotic patients, and (4) clozapine appears to have a separate status given that this molecule shows antiproliferative effects implied in agranulocytosis as well as a potential increased risk for leukemia. Benefit/risk ratio regarding cancer risk is in favor of treating patients with schizophrenia with antipsychotic drugs. The practicing clinician should be reassuring on the subject of cancer risk due to antipsychotic drugs.
    Full-text · Article · Apr 2012 · Medical Hypotheses
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