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Neuroleptic-induced Prolactin Level Elevation and Breast CancerAn Emerging Clinical Issue
Paul M. Schyve, MD;
Francine Smithline, MD;
Herbert Y. Meltzer, MD
Arch Gen Psychiatry. 1978;35(11):1291-1301.
Abstract
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• This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion. All available neuroleptics, including reserpine, raise serum prolactin levels. Elevated serum prolactin level increases the incidence of spontaneously occurring mammary tumors in mice, and increases the growth of established carcinogeninduced mammary tumors in rats. Caution is necessary in extrapolating this relationship to human mammary tumors because human and rodent tumors differ in some important characteristics, including hormone responsiveness. Serum prolactin levels in women with, or at risk for, breast cancer have generally been normal, and only a minority of human mammary tumors respond to changes in serum prolactin levels. Epidemiologic studies have failed to demonstrate an increased risk of breast cancer associated with the use of neuroleptics or reserpine. Thus, although some human mammary tumors are prolactin dependent, the available evidence does not demonstrate an increased risk of breast cancer in women receiving neuroleptics. We conclude that (1) additional epidemiologic studies of the incidence of mammary tumors in women treated with neuroleptics are desirable; (2) it is premature to mandate warning patients of an unknown and undemonstrated increase in the risk of developing breast cancer associated with neuroleptic treatment; (3) detection of existing mammary tumors by breast examination prior to administration of neuroleptics is desirable; and (4) development of antipsychotic drugs that do not increass serum prolactin level may be indicated.
Author Affiliations
From the Laboratory of Biological Psychiatry, Illinois State Psychiatric Institute, Chicago (Drs Schyve, Smithline, and Meltzer), and the Department of Psychiatry, University of Chicago, Pritzker School of Medicine (Drs Schyve and Meltzer).
Footnotes
Accepted for publication July 24, 1978.
Read in part before the Sixth World Congress of Psychiatry of the World Psychiatric Association, Honolulu, August 1977.
Reprint requests to Illinois State Psychiatric Institute, 1601 W Taylor St, Chicago, IL 60612 (Dr Schyve).
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