This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (40)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Oncology  • Breast Cancer  • Women's Health  • Women's Health, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Philip S. Wang, MD,DrPH; Alexander M. Walker, MD,DrPH; Ming T. Tsuang, MD,PhD,DSc; E. John Orav, PhD; Robert J. Glynn, PhD,ScD; Raisa Levin, MS; Jerry Avorn, MD

Arch Gen Psychiatry. 2002;59:1147-1154.

Background  Although animal studies have raised the possibility that prolactin-elevating dopamine antagonists used to treat psychotic disorders may initiate and promote breast cancers, epidemiologic studies in humans have been limited and inconsistent.

Methods  A retrospective cohort study was conducted of 52 819 women exposed and 55 289 not exposed to dopamine antagonists between January 1, 1989, and June 30, 1995. All participants were 20 years or older, initially free of breast cancer, and enrolled in the Medicaid or the Pharmaceutical Assistance to the Aged and Disabled programs of New Jersey. Incident breast cancer cases were identified through the New Jersey Cancer Registry and definitive breast cancer surgeries. Adjusted hazard ratios of breast cancer were calculated from multivariable proportional hazards models.

Results  Use of antipsychotic dopamine antagonists was associated with a 16% increase in the risk of breast cancer (adjusted hazard ratio, 1.16; 95% confidence interval, 1.07-1.26), with a dose-response relationship between larger cumulative dosages and greater risk. The increased risk was also seen in women who used prolactin-elevating antiemetic dopamine antagonists despite having different breast cancer risk profiles than antipsychotic dopamine antagonist users. Dopamine antagonist use was not associated with risk of colon cancer, a control condition not related to elevated prolactin levels. The increased risk of breast cancer among dopamine antagonist users was not explained by increased surveillance or protopathic bias.

Conclusions  Antipsychotic dopamine antagonist use may confer a small but significant risk of breast cancer. In light of the small hazards and the possibility of residual confounding, these findings should lead to follow-up investigations but not to changes in treatment strategies.

From the Division of Pharmacoepidemiology and Pharmacoeconomics (Drs Wang, Glynn, and Avorn and Ms Levin) and the Clinical Epidemiology Section (Dr Orav), Brigham and Women's Hospital, Harvard Medical School; the Department of Epidemiology, Harvard School of Public Health (Drs Wang, Walker, and Tsuang); and the Harvard Institute of Psychiatric Epidemiology and Genetics and the Massachusetts Mental Health Center, Harvard Medical School (Dr Tsuang), Boston.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Secondary Effects of Antipsychotics: Women at Greater Risk Than Men
Seeman
Schizophr Bull 2009;35:937-948.
ABSTRACT | FULL TEXT  

Hyperprolactinemia and possibly related development of prolactinoma during amisulpride treatment; three cases
Akkaya et al.
J Psychopharmacol 2009;23:723-726.
ABSTRACT  

Evidence for the Partial Dopamine-Receptor Agonist Aripiprazole as a First-Line Treatment of Psychosis in Patients With Iatrogenic or Tumorogenic Hyperprolactinemia
Hoffer et al.
Psychosomatics 2009;50:317-324.
ABSTRACT | FULL TEXT  

The emerging physical health challenges of antipsychotic associated hyperprolactinaemia in patients with serious mental illness
Dursun et al.
J Psychopharmacol 2008;22:3-5.
 

Adverse effects of prolactin in rodents and humans: breast and prostate cancer
Harvey et al.
J Psychopharmacol 2008;22:20-27.
ABSTRACT  

Medical causes and consequences of hyperprolactinaemia. A context for psychiatrists
Holt
J Psychopharmacol 2008;22:28-37.
ABSTRACT  

A review of the association between antipsychotic use and hyperprolactinaemia
Bushe et al.
J Psychopharmacol 2008;22:46-55.
ABSTRACT  

Categorical prevalence and severity of hyperprolactinaemia in two UK cohorts of patients with severe mental illness during treatment with antipsychotics
Bushe et al.
J Psychopharmacol 2008;22:56-62.
ABSTRACT  

Comparative genomics of susceptibility to mammary carcinogenesis among inbred rat strains: role of reduced prolactin signaling in resistance of the Copenhagen strain
Ren et al.
Carcinogenesis 2008;29:177-185.
ABSTRACT | FULL TEXT  

Prevalence of hyperprolactinaemia in a naturalistic cohort of schizophrenia and bipolar outpatients during treatment with typical and atypical antipsychotics
Bushe and Shaw
J Psychopharmacol 2007;21:768-773.
ABSTRACT  

Forty-five years of schizophrenia: personal reflections.
Seeman
History of Psychiatry 2006;17:363-373.
ABSTRACT  

Hyperprolactinaemia as an adverse effect in regulatory and clinical toxicology: role in breast and prostate cancer
Harvey et al.
Hum Exp Toxicol 2006;25:395-404.
ABSTRACT  

Aripiprazole in the treatment of acute manic or mixed episodes in patients with bipolar I disorder: a 3-week placebo-controlled study
Sachs et al.
J Psychopharmacol 2006;20:536-546.
ABSTRACT  

Reversal of Symptomatic Hyperprolactinemia by Aripiprazole
WAHL and OSTROFF
Am. J. Psychiatry 2005;162:1542-1543.
FULL TEXT  

Pharmacological Treatments for First-Episode Schizophrenia
Robinson et al.
Schizophr Bull 2005;31:705-722.
ABSTRACT | FULL TEXT  

Gender Differences in the Prescribing of Antipsychotic Drugs
Seeman
Am. J. Psychiatry 2004;161:1324-1333.
ABSTRACT | FULL TEXT  

Physical Health Monitoring of Patients With Schizophrenia
Marder et al.
Am. J. Psychiatry 2004;161:1334-1349.
ABSTRACT | FULL TEXT  

More Bad News About Antipsychotic Drugs
JWatch Psychiatry 2003;2003:6-6.
FULL TEXT  

Rosack
Psychiatr. News 2003;38:18-18.
FULL TEXT